ABSTRACT

Background

Children’s vision screening children commonly uses optotype-based visual acuity or instrument-based methods measuring amblyogenic risk factors (ARFs).

Objective

To compare the performance of the Spot Vision Screener (SVS) (PediaVision, Welch Allyn, NY) and a nurse-administered visual acuity screen (NVAS) in identifying ARFs and decreased visual acuity.

Methods

A prospective, cross-sectional population-based study of preschool children in South-East Queensland, Australia. Eligible participants had both forms of screening by trained community nurses. All children with an abnormal result by either method as well as a cohort of randomly selected children who passed both assessments were assessed at a tertiary paediatric ophthalmology clinic.

Results

Over a 10 month period, 2237 children (mean age; 64.4 ± 4.0 months) were screened from 38 schools. 6.4% of children failed SVS and 8.3% failed NVAS (with 3.8% overlap, failing both). The positive predictive value (PPV) in identifying either ARFs and/or reduced VA for the SVS and NVAS was 70.4% (95% Confidence Interval (CI): 61.6%–78.2%) and 60.5% (95% CI: 52.6%–67.9%) respectively. Highest PPV to detect either ARFs and/or reduced VA was achieved by a ‘hybrid’ method by combining failed NVAS and failed SVS: 91.0% (95% CI: 82.4 to 96.3) but this would risk children with sight impairment being missed in the community.

Conclusion

To our knowledge, this is the first population-based study providing detailed comparative measures of diagnostic accuracy for NVAS and SVS in preschool children. One in ten preschool children failed one or both screens. A number of children who required ophthalmic intervention were missed if only one screening method was utilized.

中文翻译：

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基于社区的学龄前儿童视力筛查；Spot 视力筛查仪和验光仪测试的性能

摘要

背景

儿童视力筛查儿童通常使用基于视标的视力或基于仪器的方法来测量弱基因风险因素 (ARF)。

客观的

比较 Spot Vision Screener (SVS) (PediaVision, Welch Allyn, NY) 和护士管理的视力筛查 (NVAS) 在识别 ARF 和视力下降方面的性能。

方法

一项针对澳大利亚昆士兰东南部学龄前儿童的前瞻性、横断面人群研究。符合条件的参与者接受了训练有素的社区护士的两种形式的筛查。在三级儿科眼科诊所对任何一种方法结果异常的所有儿童以及通过两项评估的随机选择的一组儿童进行评估。

结果

在 10 个月期间，对 38 所学校的 2237 名儿童（平均年龄；64.4 ± 4.0 个月）进行了筛查。6.4% 的儿童 SVS 失败，8.3% 的 NVAS 失败（重叠率为 3.8%，两者均失败）。识别 SVS 和 NVAS 的 ARF 和/或降低的 VA 的阳性预测值 (PPV) 为 70.4%（95% 置信区间 (CI)：61.6%–78.2%）和 60.5%（95% CI：52.6%– 67.9%）。通过结合失败的 NVAS 和失败的 SVS 的“混合”方法实现了检测 ARF 和/或 VA 降低的最高 PPV：91.0%（95% CI：82.4 至 96.3），但这可能会导致视力障碍儿童被遗漏。社区。

结论

据我们所知，这是第一个以人群为基础的研究，提供了对学龄前儿童 NVAS 和 SVS 诊断准确性的详细比较测量。十分之一的学龄前儿童未能通过一个或两个屏幕。如果只使用一种筛查方法，许多需要眼科干预的儿童就会被遗漏。