Screening for amblyopia in preverbal children with photoscreening photographs 1: Iii. improved grading criteria for hyperopia☆
Received 8 October 1999; accepted 8 May 2000.
Abstract
Objective
To examine the ability of the Medical Technology and Innovations (MTI), Inc., Photoscreener (Cedar Falls, IA) to detect hyperopia and to improve the photograph grading criteria to screen for amblyopiogenic levels of hyperopia.
Design
Cross-sectional study and reanalysis.
Participants and testing
In previous work, 392 participants received a complete ophthalmologic examination and were photographed using the MTI Photoscreener. For this study, all 209 participants with normal examination findings (65 children) or hyperopia without anisometropia (144 children) were selected. The data were reanalyzed using modified photograph grading and ophthalmologic examination failure criteria. Potential reasons for why many children with hyperopia passed photoscreening were explored.
Main outcome measures
We determined whether a study participant would pass or fail screening with a given photograph grading and ophthalmologic examination failure criteria.
Results
Most children with hyperopia of +2.00 to +3.50 diopters (D) passed screening with the MTI instrument, in most cases because their photographs lacked bright crescents. When bright crescents in at least two of the four possible meridians were the grading guideline for screening failure and the pediatric ophthalmologists’ consensus hyperopia failure criteria (> +3.50 D) were adopted, the sensitivity for hyperopia detection was 100% and the specificity was 88%. Identical results were obtained using the American Academy of Ophthalmology Preferred Practice Pattern hyperopia failure criteria (≥ +4.50 D).
Conclusions
The MTI photograph grading guidelines can be simplified, and the ophthalmologic examination failure criteria for hyperopia can be improved. The presence of a bright crescent in the lower or the left pupillary margin indicate hyperopia in an amblyopiogenic range (> +3.50 D).
Manuscript no. 99693.
aWilmer Ophthalmologic Institute, Johns Hopkins University, Baltimore, Maryland, USA
bDepartment of Molecular Biology and Genetics, Johns Hopkins University, Baltimore, Maryland, USA
cDepartment of Ophthalmology, Mount Sinai Medical Center, New York, New York, USA
dPediatric Ophthalmology and the Center for Adult Strabismus, Dallas, Texas, USA
fDepartment of International Health and the Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland, USA
gDepartment of Ophthalmology, Children’s National Medical Center, Washington, DC, USA
Reprint requests to Patrick Y. Tong, MD, PhD, Wilmer Ophthalmological Institute, Room 3-109A, Oncology Building, Johns Hopkins Hospital, Baltimore, MD 21287
☆ Supported by the National Children’s Eye Care Foundation, Dallas, Texas; the National Institutes of Health (grant no.: 1 K08EY00362-01); an unrestricted departmental grant from Research to Prevent Blindness, Inc., New York, New York; the Roy and Niuta Titus Foundation, New York, New York; and the Clinician Scientist Award, Johns Hopkins University, Baltimore, Maryland.
1 The authors have no proprietary interest in the instrument described in this paper nor in any other vision screening device.
2 Dr. Tong was a Fellow of the National Children’s Eye Care Foundation, 1994–1995.
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