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      Performance of the Plusoptix A09 Photoscreener in Detecting Amblyopia Risk Factors in Chinese Children Attending an Eye Clinic

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          Abstract

          Purpose

          To assess the accuracy of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in children and determine referral criteria when using Plusoptix A09 for a large-scale vision screening.

          Methods

          Pediatric patients attending our eye clinic underwent a comprehensive ophthalmic examination that included photorefraction, orthoptic examination, anterior segment assessment, fundus examination and cycloplegic retinoscopy. The measurements were collected for statistical analyses.

          Results

          One hundred and seventy-eight children (mean age ± SD: 6.2±2.4 years, range: 2.2 to 14.1 years) were included in the study. The mean spherical equivalent (SE) obtained using Plusoptix A09 (P SE) was 0.57 D lower than that obtained from cycloplegic retinoscopy (CR SE) ( P = 0.00). However, there was no statistically significant difference of Jackson cross cylinder J 0 and J 45 between Plusoptix A09 (P J) and cycloplegic retinoscopy (CR J) ( P = 0.14, P = 0.26). The relationship of SE obtained from Plusoptix A09 and SE obtained from cycloplegic retinoscopy was presented as the equation: CR SE = 0.358 + 0.776 P SE + 0.064 P SE 2 + 0.011 P SE 3. Based on the Receiver Operating Characteristic (ROC) curve, the Plusoptix A09 had an overall sensitivity of 94.9% and specificity of 67.5% for detecting refractive amblyopia risk factors. The sensitivity and specificity of the Plusoptix A09 for detection of strabismus were 40.7% and 98.3%, respectively; detection of amblyopia and/or strabismus was 84.7% and 63.2%, respectively.

          Conclusions

          The Plusoptix A09 photoscreener underestimated hyperopia and overestimated myopia according to SE when compared with cycloplegic retinoscopy. The accuracy of the Plusoptix A09 in detecting amblyopia risk factors in children could be improved by the regression equation and optimized criteria for refractive amblyopia risk factors developed in the present study. Moreover, the Plusoptix A09 photoscreener is not suitable for a large-scale strabismus screening when it is applied solely.

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          Most cited references33

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          Power vectors: an application of Fourier analysis to the description and statistical analysis of refractive error.

          L N Thibos, W. Wheeler, D. Horner (1997)
          The description of sphero-cylinder lenses is approached from the viewpoint of Fourier analysis of the power profile. It is shown that the familiar sine-squared law leads naturally to a Fourier series representation with exactly three Fourier coefficients, representing the natural parameters of a thin lens. The constant term corresponds to the mean spherical equivalent (MSE) power, whereas the amplitude and phase of the harmonic correspond to the power and axis of a Jackson cross-cylinder (JCC) lens, respectively. Expressing the Fourier series in rectangular form leads to the representation of an arbitrary sphero-cylinder lens as the sum of a spherical lens and two cross-cylinders, one at axis 0 degree and the other at axis 45 degrees. The power of these three component lenses may be interpreted as (x,y,z) coordinates of a vector representation of the power profile. Advantages of this power vector representation of a sphero-cylinder lens for numerical and graphical analysis of optometric data are described for problems involving lens combinations, comparison of different lenses, and the statistical distribution of refractive errors.
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            Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study.

            Paulette Schmidt, Maureen Maguire, Velma Dobson … (2004)
            To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). Multicenter, cross-sectional study. A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems. 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). Sensitivity for detecting children with > or =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. 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 or =1 targeted conditions and for detecting the most important conditions. Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having > or =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.
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              Early screening for amblyogenic risk factors lowers the prevalence and severity of amblyopia.

              M Eibschitz-Tsimhoni, T Friedman, Z Friedman … (2000)
              To evaluate the efficacy of a mass screening program for amblyopia and amblyogenic risk factors in infants. Since 1968, children between the ages of 1 and 2(1/2) years in the city of Haifa, Israel, have been systematically screened for amblyopia and amblyogenic risk factors. The screening is performed by the Ophthalmology Department of Bnai-Zion Medical Center (formerly known as Rothchild Hospital). In 1995, we compared the prevalence and severity of amblyopia in two populations of 8-year-old children in elementary school: one group was a cohort of 808 children from the city of Haifa and its vicinity, who had been screened in infancy (between 1988 and 1990); and the second group, the control group, was a cohort of 782 children from Hadera and its vicinity, where this early screening program is not conducted. Amblyopia was defined as corrected visual acuity of 1 line difference in corrected visual acuity between the two eyes. Referral rate, treatment rate, sensitivity, specificity, and positive predictive value and negative predictive value of the screening test in detecting factors that later resulted in the development of amblyopia were examined. The prevalence of amblyopia in the 8-year-old population screened in infancy was found to be 1.0% compared with 2.6% in the 8-year-old population that had not been screened in infancy (P =.0098). The prevalence of amblyopia with visual acuity of < or =5/15 (20/60) in the amblyopic eye was 0.1% in the screened population compared with 1.7% in the non-screened population (P =.00026). In the screened infant population, 3.6% were referred from the screening examination to a confirmatory examination and 2.2% were treated. The screening examination had a sensitivity of 85.7% and a specificity of 98.6% for amblyopia. The positive predictive value of the screening examination was 62.1% and the negative predictive value was 99.6%. The screening program for amblyopia and amblyogenic risk factors in infants, followed by appropriate treatment, is effective in significantly reducing the prevalence and severity of amblyopia in children.
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                Author and article information

                Contributors
                Zhong-Lin Lu: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 1 June 2015
                Publication date Collection: 2015
                Volume: 10
                Issue: 6
                Electronic Location Identifier: e0126052
                Affiliations
                [001]Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
                The Ohio State University, Center for Cognitive and Brain Sciences, Center for Cognitive and Behavioral Brain Imaging, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: XRY WZJ ZWL LHW. Performed the experiments: XRY WZJ ZWL WWX FJL. Analyzed the data: XRY WZJ ZWL LHW. Contributed reagents/materials/analysis tools: XRY WZJ ZWL WWX FJL. Wrote the paper: XRY WZJ ZWL.

                ‡ Xiao-Ran Yan, Wan-Zhen Jiao and Zhi-Wei Li are co-first authors on this work.

                Article
                Publisher ID: PONE-D-14-45514
                DOI: 10.1371/journal.pone.0126052
                PMC ID: 4452218
                PubMed ID: 26030210
                SO-VID: 7a064671-ff38-4b43-adcf-97ede6a9d3eb
                Copyright statement: Copyright @ 2015
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                Date received : 27 October 2014
                Date accepted : 28 March 2015
                Page count
                Figures: 6, Tables: 5, Pages: 13
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Custom metadata
                Data Availability All relevant data are within the paper.

                ScienceOpen disciplines: Uncategorized
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