Comparison of preschool vision screening tests as administered by licensed eye care professionals in the vision in preschoolers study☆
The results and conclusions presented in this article represent the opinions of the authors and not necessarily those of the administrators, supervisory boards, governmental agencies, or any other entity operating a Head Start school that participated in the Vision in Preschoolers Study.
Received 4 December 2003; accepted 20 January 2004.
Abstract
Purpose
To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists).
Design
Multicenter, cross-sectional study.
Participants
A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems.
Methods
Certified LEPs administered 11 commonly used or commercially available screening tests. Results from a standardized comprehensive eye examination were used to classify children with respect to 4 targeted conditions: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA).
Main outcome measures
Sensitivity for detecting children with ≥1 targeted conditions at selected levels of specificity was the primary outcome measure. Sensitivity also was calculated for detecting conditions grouped into 3 levels of importance.
Results
At 90% specificity, sensitivities of noncycloplegic retinoscopy (NCR) (64%), the Retinomax Autorefractor (63%), SureSight Vision Screener (63%), and Lea Symbols test (61%) were similar. Sensitivities of the Power Refractor II (54%) and HOTV VA test (54%) were similar to each other. Sensitivities of the Random Dot E stereoacuity (42%) and Stereo Smile II (44%) tests were similar to each other and lower (P<0.0001) than the sensitivities of NCR, the 2 autorefractors, and the Lea Symbols test. The cover–uncover test had very low sensitivity (16%) but very high specificity (98%). Sensitivity for conditions considered the most important to detect was 80% to 90% for the 2 autorefractors and NCR. Central interpretations for the MTI and iScreen photoscreeners each yielded 94% specificity and 37% sensitivity. At 94% specificity, the sensitivities were significantly better for NCR, the 2 autorefractors, and the Lea Symbols VA test than for the 2 photoscreeners for detecting ≥1 targeted conditions and for detecting the most important conditions.
Conclusions
Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having ≥1 targeted conditions, but nearly 90% of children with the most important conditions. The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive error in other ways. These results have important implications for screening preschool-aged children.
Reprint requests to The Vision in Preschoolers Study Center, The Ohio State University, College of Optometry, 320 West Tenth Avenue, PO Box 182342, Columbus, OH 43218-2342, USA
☆ Supported by grants from the National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland: U10EY12534, U10EY12545, U10EY12547, U10EY12550, U10EY12644, U10EY12647, and U10EY12648.
* The members of the Vision in Preschoolers Study Group are listed in the Appendix. Disclosures of financial interests of writing committee members are noted in the Appendix.
ABSTRACT