Background Community photoscreening for amblyopia had successfully been adopted by many communities, however many clinics curtailed screening as a result of the COVID-19 pandemic. We modified three conventional devices and tested them for outdoor, drive-by socially distanced photoscreening and refraction. Methods External frames that provide luminance control and focus distance were fashioned for plusoptiX S12 (Nuremberg, Germany), Adaptica 2WIN in Kaleidos case (Padova, Italy) and the Rebion blinq (Boston, USA). Children were screened by each device and then Retinomax (Righton, Japan) before AAPOS guideline validation. Results Eighty-eight children average age 8±7 years had precise refraction and alignment from which 69% AAPOS 2003 risk factors were determined. The sensitivity/specificity/inconclusive rate for plusoptiX was 85%/96%/16%, for 2WIN 79%/89%/5% and for blinq 43%/74%/8%. Blinq improved to 54%/70% when screening for amblyopia ± strabismus. Bland Altman analysis of spherical equivalent showed plusoptiX and 2WIN with less over-minus than Retinomax and J0 and J45 vectors highly reliable for astigmatism determination. Conclusion The infrared photorefractors in modified cases reliably screened amblyopia risk factors and refraction. The birefringent scanner provided drive-by results but less reliably with wire-frame opaque case than without the case in a dimly lit room. Modified drive-by photoscreeners could help reduce amblyopia and provide socially distanced refraction during an extended pandemic.
plastic shielded sufficient ambient light so that blinq could get a reading outdoors, but the performance of blinq suffered compared to conventional indoor use. We surmised this may have been due to the lack of facial view for the aiming beams, but we agree with Dr. Hunter that disruption of infrared light could also have been the culprit.There remain some potential advantages to a hood, or tent between the patient and the screening device. 2 These can decrease luminance and stray light. But they also can help fixation. Young and developmentally delayed children often do not understand the need to look at a small fixation target on an instrument-based screener so they may glance at peripheral distractions including the screener's face. If the screener then tries to "hide" behind the screening device, certain devices show the patient's face in their monitor so focus and alignment can be accomplished. Such device aiming is inherently obvious with smart phone photoscreening by GoCheck Kids. Viewing the patient's image on a monitor was not possible with the former MTI photoscreener or the current iScreen photoscreener which also made use of aiming beams like the blinq. In the future, it might be possible to include a small camera that projects the patient's face to the blinq monitor under these circumstances.We remain amazed at the technology of the blinq and its potential to shed light on amblyopia, strabismus and perhaps many other entities. We hope the COVID-19 pandemic social distancing guidelines will soon be relaxed to allow even more widespread, valid early amblyopia detection worldwide. DisclosureDr. Arnold is a board member of Glacier Medical Software that markets ROP-Check could-based NICU software. Dr. Arnold is a board member of PDI Check that makes a vision screening game for autostereoscopic screens on Nintendo 3DS.
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