The Plusoptix Photoscreener to Detect Amblyopia in Children
The Plusoptix Photoscreener to Detect Amblyopia in Children
Aims To evaluate the accuracy and applicability of Plusoptix photoscreener in screening pre-verbal children at risk of amblyopia.
Methods In this cross-sectional population-based study 996 children aged 6–36 months were screened with the Plusoptix. The children underwent complete examinations that included a manual cycloplegic retinoscopy, slit lamp examination, cover test, the Hirschberg test and an assessment of fixation pattern. In addition, the prevalence of amblyogenic risk factors was estimated, the Plusopix measurements were compared with cycloplegic retinoscopy, and the referral criteria were modified to improve the accuracy of the device.
Results Amblyogenic hyperopia >+3.50 D, myopia >−3.00 D, astigmatism >1.50 D in the orthogonal meridian or >1.00 D in the oblique meridian, or anisometropia >1.50 D was detected in 4.7%, 0.0%, 12.3% and 0.5% of the samples, respectively. The average difference between retinoscopy and photorefraction for spherical equivalence was −0.16±1.0 D (p<0.05). Testability was 98.1% for the Plusoptix. The Plusoptix vision screener referred 47.8% of these children for sensitivity, specificity, positive predictive value and false-negative rates of 100%, 38.7%, 19% and 100%, respectively. These same measurements with the modified referral criteria (hyperopia ≥2.00 D in children under 12 months and astigmatism ≥1.25 D) were 93.6%, 51.2%, 21.7% and 98.2%.
Conclusion The Plusoptix is a useful objective screening instrument, but still has low specificity for detecting amblyopia risk factors in the paediatric population.
Amblyopia is the most common cause of decreased vision in children. The prevalence of amblyopia is estimated to be about 2%–5%. Early diagnosis through visual screening, referrals for complementary examinations and early interventions may lead to better visual outcomes and national screening programmes have decreased the burden of this disease in some countries.
Plusoptix is a digital photoscreener that takes a digital video of the patient using infrared beams that are immediately analysed by the software installed on a linked laptop. This instrument is remarkable because it is portable and easy to use in examining younger children. Previous studies have shown promising results of the Plusoptix in detecting amblyopia risk factors, but due to insufficient information about its applicability in children less than 3 years of age, in this study the Plusoptix was used to screen for amblyopia risk factors in children between 6 and 36 months of age.
Abstract and Introduction
Abstract
Aims To evaluate the accuracy and applicability of Plusoptix photoscreener in screening pre-verbal children at risk of amblyopia.
Methods In this cross-sectional population-based study 996 children aged 6–36 months were screened with the Plusoptix. The children underwent complete examinations that included a manual cycloplegic retinoscopy, slit lamp examination, cover test, the Hirschberg test and an assessment of fixation pattern. In addition, the prevalence of amblyogenic risk factors was estimated, the Plusopix measurements were compared with cycloplegic retinoscopy, and the referral criteria were modified to improve the accuracy of the device.
Results Amblyogenic hyperopia >+3.50 D, myopia >−3.00 D, astigmatism >1.50 D in the orthogonal meridian or >1.00 D in the oblique meridian, or anisometropia >1.50 D was detected in 4.7%, 0.0%, 12.3% and 0.5% of the samples, respectively. The average difference between retinoscopy and photorefraction for spherical equivalence was −0.16±1.0 D (p<0.05). Testability was 98.1% for the Plusoptix. The Plusoptix vision screener referred 47.8% of these children for sensitivity, specificity, positive predictive value and false-negative rates of 100%, 38.7%, 19% and 100%, respectively. These same measurements with the modified referral criteria (hyperopia ≥2.00 D in children under 12 months and astigmatism ≥1.25 D) were 93.6%, 51.2%, 21.7% and 98.2%.
Conclusion The Plusoptix is a useful objective screening instrument, but still has low specificity for detecting amblyopia risk factors in the paediatric population.
Introduction
Amblyopia is the most common cause of decreased vision in children. The prevalence of amblyopia is estimated to be about 2%–5%. Early diagnosis through visual screening, referrals for complementary examinations and early interventions may lead to better visual outcomes and national screening programmes have decreased the burden of this disease in some countries.
Plusoptix is a digital photoscreener that takes a digital video of the patient using infrared beams that are immediately analysed by the software installed on a linked laptop. This instrument is remarkable because it is portable and easy to use in examining younger children. Previous studies have shown promising results of the Plusoptix in detecting amblyopia risk factors, but due to insufficient information about its applicability in children less than 3 years of age, in this study the Plusoptix was used to screen for amblyopia risk factors in children between 6 and 36 months of age.
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