Validation of a vision screening service according to AFSOP recommendations
Reviewed by Fiona Rowe

This study evaluated the accuracy of the diagnostic parameters used in the French Association for Paediatric Ophthalmology and Strabismus (AFSOP) screening protocol performed by an orthoptist in relation to the reference standard ophthalmology examination. The study also evaluated parent satisfaction with the screening protocol along with analysis of direct medical costs. This was a prospective single-centre study. AFSOP recommendations target two age groups: aged 12 months for children with amblyopia risk factors and 3-year-olds for mass screening (visual acuity, photoscreen and cover test). All screening was undertaken by orthoptists who determined pass/fail based on the referral criteria. All were then seen by ophthalmology on the same day – the ophthalmologist was blinded to screening and referral data. The study included 300 patients: 149 female, 151 male. Median age was 42.3 months. Orthoptic examination was unreliable or incomplete in 21 patients. Abnormal visual acuity (<5/10 right/left eye or >1 line interocular difference) was found in 29%. Mean visual acuity was 0.6logMAR. The photoscreen mean sphere was +1.5D, mean cylinder of 0.6D and mean anisometropia of 0.3D. Abnormal refraction was found in 27%. Abnormal cover test results were found in 12%. Overall, 42% had at least one abnormality – positive referrals. On ophthalmology examination, 2 could not have a reliable refraction. For the remainder, cycloplegia refractive abnormality was found for 35% and 1% had ocular abnormalities. Overall, 41% were deemed to require treatment by the ophthalmologist. In comparing the photoscreen vs. cycloplegic refraction, the inter class correlation coefficient was strong for cylinder power (0.867), axis (0.868) and anisometropia (0.879) but not for sphere (0.572). Overall sensitivity and specificity were 78% and 98%. For orthoptic vs ophthalmology examinations, sensitivity and specificity for visual acuity, photoscreen and cover test were 61% and 88%, 63% and 98%, and 27% and 97% respectively. For overall test combination, sensitivity and specificity were 90% and 89% with 85% positive predictive value, 88% negative predictive value and 96% overall test efficiency. Twenty patients were referred without any abnormality confirmed by ophthalmology. Twelve were not referred but had a real abnormality (all with refractive error but none were amblyopic). More than 90% of parents reported satisfaction or very satisfied with the service. The authors conclude these results validate the AFSOP recommendations for vision screening in 3-year-olds.

Evaluation of the diagnostic parameters of the amblyopia and risk factors for amblyopia screening protocol in 3-year-olds according to recommendations from the French Association for Pediatric Ophthalmology and Strabismus (AFSOP) compared with reference ophthalmological examination: the ORTHOPHTHALMO study.
Lequeuex L, Bonifas C, Alby A, et al.
STRABISMUS
2025;33(2):93–103.