Elsevier

Ophthalmology

Volume 111, Issue 4, April 2004, Pages 637-650
Ophthalmology

Original article
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.
https://doi.org/10.1016/j.ophtha.2004.01.022Get rights and content

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.

Section snippets

Participants

Subjects were children who were enrolled in Head Start programs25 in the vicinity of the 5 VIP clinical centers (Berkeley, California; Boston, Massachusetts; Columbus, Ohio; Philadelphia, Pennsylvania; Tahlequah, Oklahoma). Head Start is a national, comprehensive child development program that serves preschool children and their families. The goal of Head Start is to increase the school readiness of children from low income families. Vision in Preschoolers Study subjects were ≥3 and <5 years on

Study population

In years 1 and 2, 2211 children who had failed the Head Start vision screening and 1772 children who had not failed the screening were selected for enrollment. Consent was obtained and eligibility criteria fulfilled for 3121 of the 3983 children (78.3%). Screening was completed for 2780 (89.1%) of the children enrolled. Gold standard examinations were performed on 2666 (95.6%) of screened children, of whom 2588 (97.1%) completed VA testing, cover testing, and cycloplegic refraction. All

Discussion

Phase I of the VIP Study is the first comprehensive investigation of an array of currently relevant preschool vision screening tests. The research design allows valid comparisons of the accuracy of the tests in detecting a defined set of significant and prevalent vision disorders. The vision screening tests were administered by LEPs (optometrists and pediatric ophthalmologists) under controlled, standardized conditions. The tests evaluated included recently developed photorefractive devices and

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    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.

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