This study examined the agreement between the spot vision screener and cycloplegic retinoscopy (gold-standard assessment), particularly focused on astigmatism. Children aged 12–35 months were recruited following failure of routine photoscreening over a 3-year period. The spot vision screener and cycloplegic retinoscopy were carried out by different examiners and the optometrist/ophthalmologist conducting the retinoscopy was masked to the spot vision screening results. A total of 410 children were recruited and completed the examinations. The spot vision screener was reported to underestimate hyperopia and overestimate astigmatism when compared with cycloplegic retinoscopy. Cycloplegic retinoscopy detected clinically significant additional hyperopia in 60% of children, while higher astigmatism measurements were found in 24% on the spot vision screener. Based on the more recent astigmatism screening criteria (>3.00D) the spot vision screener had a sensitivity of 75% and specificity of 89%. The study highlights an important limitation of the spot vision screener: it may under-refer children with significant hyperopia while potentially over-referring children with astigmatism. Limitations acknowledged by the authors are that the study population was children who had already failed screening and was heavily weighted towards Hispanic, which may limit generalisability and there was only a small proportion with astigmatism. This study demonstrates the spot vision screener to be an effective screening tool; however, its results should be interpreted with caution and not considered a substitute for a cycloplegic refraction when significant refractive error is suspected.
Comparison of vision screener and cycloplegic refraction for detection of astigmatism
Reviewed by Lauren Hepworth
Agreement between the spot vision screener and cycloplegic retinoscopy for toddlers with astigmatism.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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