The Spot Vision Screener underestimates hyperopia in children

Nevertheless, in children 12-36 months of age, this autorefraction screening tool is valuable for identifying risk factors for amblyopia.

child with amblyopia and corrective eye patch

Children with uncorrected hyperopia have difficulties learning in school.

Methods to assess the vision in children <3 years of age have not been widely studied. The American Academy of Ophthalmology (AAO) and the American Academy of Pediatrics (AAP) have recommended, for this age group, instrument-based vision screening. Here, autorefraction or photorefraction is used too determine the refractive status of the eyes. The results are then compared to a normative database.

The Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) is a handheld photorefractor that can be used to measure refractive errors, ocular alignment, and pupil sizes simultaneously from both eyes. Its sensitivity and specificity has been reported to range from 81.8-89.8% and 70.4-88%, respectively. However, a previous small-scale study concluded that the Spot was only marginally useful in screening for high hyperopia.

This clinical study was therefore done to assess the value of the Spot in children <3 years of age. Standard comprehensive clinical examinations were done, and patient demographics were recorded.

The ROC curve for the Spot in detecting targeted vision disorders showed an area under the curve (AUC) of 0.790, which corresponds to a ‘good’ performance level. The sensitivity and specificity of the Spot in detecting risk factors for amblyopia (ARFs) in children 12-36 months old were 78.3% and 84.5%, respectively.

However, there was note of an underestimation of hyperopia, especially for spherical errors ≥ 5.4 diopters (D), when compared with cycloplegic retinoscopy. This may be important because a previous study showed that an uncorrected hyperopia of ≥4.0 D in preschoolers is associated with difficulties in learning and literacy.

The study recommends that given the difficulties the child may face due to undiagnosed refractive errors, a comprehensive examination be performed in conjunction with screening devices.

Srinivasan, G., Russo, D., Taylor, C., Guarino, A., DipPharm, P., & Moore, B. (2019). Validity of the Spot Vision Screener in detecting vision disorders in children 6 months to 36 months of age. Journal of American Association for Pediatric Ophthalmology and Strabismus. doi: 10.1016/j.jaapos.2019.06.008

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