Traditional and Instrument-Based Vision Screening in Third-Grade Students
Evan Silverstein; Elaine R. McElhinny
Virginia Commonwealth University
Introduction: AAPOS recommends optotype-based vision screening for children>5 years old. Instrument-based screening for 3-4 year olds are more time-efficient and have higher positive predictive value(PPV) than traditional optotype screening. This study evaluates instrument-based vision screening and traditional screening for third-grade students.
Methods: Third-graders from 16 schools in a single county in Virginia were screened by traditional methods(optotypes and stereoacuity) and Plusoptix S12. Children referred from either method received a comprehensive eye examination with cycloplegic refraction in the schools. Time to screen was recorded.
Results: 1593 children were screened by both methods. 516(32.4%) children were referred–287(18.0%) by traditional and 398(25.0%) by Plusoptix. 247(47.9%) children received cycloplegic examinations. There was no statistical difference(p>0.05) of PPV between the methods for identifying children with acuity<20/30(75.2% and 70.1%) or who were prescribed glasses(73.8% and 82.2%). Time to screen was significantly less(p<0.01) for the Plusoptix(2.0 vs 0.5 minutes). Eight children referred only by the traditional screen(passing the Plusoptix screen) had visual acuity <20/40 without any explainable refractive error or amblyopia risk factors.
Discussion: The Plusoptix has similar PPV to traditional vision screening and detects children with acceptable visual acuity but may have a need for glasses. Children with non-refractive decreased visual acuity may be missed by instrument-based screens.
Conclusion: Instrument-based vision screening is more time efficient than traditional screening and has a similar PPV in third-grade students. Input from teachers to identify struggling students may be helpful if students are screened solely with autorefractors or photoscreeners.
References: 1 Sean P. Donahue, Brian Arthur, Daniel E. Neely, Robert W. Arnold, David Silbert, James B. Ruben, Guidelines for automated preschool vision screening: A 10-year, evidence-based update. JAAPOS 2013;17:4-8.
2 April A. Salcido, Joel Bradley, Sean P. Donahue. Predictive Value of Photoscreening and Traditional Screening of Preschool Children. JAAPOS;9:114-120.