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Introduction
In 2016, the American Academy of Pediatrics and the National Center for Children's Vision and Eye Health recommended instrument-based vision screening for children up to 6 years old and as an alternative when visual acuity cannot be obtained.1–3 The devices provide quick screening results, with minimal effort on the part of the tester or the child. Multiple studies have reported good efficacy of screening devices in detecting amblyopia risk factors in children.4–8 The National Center for Children's Vision and Eye Health notes that “this age range may expand as high quality, peer reviewed, published research emerges.”9
The Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) is marketed for use in patients aged 6 months and older.10 In school-aged children, the focus of primary screening shifts from preventing amblyopia to detecting visual disturbances, including refractive errors that may interfere with academic performance. We sought to determine the accuracy of the Spot Vision Screener in children 6 years and older in our population of pediatric ophthalmology patients. Results of the Spot Vision Screener were compared with three gold standard conditions of increasingly narrow refractive error criteria, as found by comprehensive examination.
Patients and Methods
The protocol was approved by the institutional review board at the Medical University of South Carolina for Human Research and informed consent was obtained from the patients' parents and/or guardians prior to enrollment. The protocol for this continuing prospective study has been previously reported.6,8,11,12 Patients between 6 and 16 years old who presented for a complete pediatric ophthalmological examination when study personnel were available between June 2012 and March 2017 were included in the study. Children were screened with the Spot Vision Screener by lay personnel prior to the ophthalmic examination. The Spot Vision Screener software v.2.1.4 with installed manufacturer “out-of-the-box” cutoffs was used.13
The Spot Vision Screener provides a report of pupillary diameter, ocular alignment, estimated binocular refraction, and referral recommendation: “all measurements within range” or “complete eye exam[ination] recommended.” Several attempts were made to obtain a successful reading. Patients for whom the screening was not able to be completed (ie, no refraction estimate or recommendation) were included in the study as automatic referrals. A comprehensive ophthalmic examination was performed by a pediatric ophthalmologist masked to the screener results. All patients...