Detecting High Hyperopia: The Plus Lens Test and the Spot Vision Screener

Feldman, Samuel; Peterseim, Mae Millicent W.; Trivedi, Rupal H.; Wilson, M. Edward; Cheeseman, Edward W.; Papa, Carrie

doi:10.3928/01913913-20161013-05

Cited by 14 publications

(20 citation statements)

References 18 publications

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“…Feldman et al . evaluated the plus lens test (+2.50D) in 109 children aged 2–12 years, reported a sensitivity and specificity of 38.1% and 89.7% for detecting hyperopia of >+2.50D, when the majority of letters could be read on the 6/9 line . Their results support the current findings of poor performance of the plus lens test for detecting hyperopia, in this case with a different plus lens power and a different definition of hyperopia, but with both studies demonstrating low test sensitivity.…”

Section: Discussionsupporting

confidence: 71%

“…A limitation of Feldman et al . 's study, was that participants were recruited from a paediatric ophthalmology clinic, and may be existing spectacle wearers; furthermore, it was not clear whether the plus lens test was undertaken over the spectacle correction. Children with corrected hyperopia may elicit a different response to the plus lens test when unaided (specifically, they will be more able to relax their accommodation to see through the plus lens) compared with uncorrected hyperopic children (who may be constantly over‐accommodating).…”

Section: Discussionmentioning

confidence: 99%

“…Other screening tests, such as the plus lens test are also often used, which requires children to read a distance visual acuity chart through a positive power (convex) lens. Children able to read the distance acuity chart (6/9 or better) or children who have a reduction of less than two lines through a plus lens are presumed to be hyperopic . The underlying principle of the plus lens test is that children with hyperopia will relax their accommodation and see clearly through the plus power lens (positive screening result), whereas children without hyperopia will be blurred and visual acuity reduced dependent on the power of the plus lens.…”

Section: Introductionmentioning

confidence: 99%

“…The sensitivity and specificity of the plus lens test has recently been compared to the spot vision screener, (an automated vision screener that uses photorefraction), in terms of their ability to detect hyperopia in children aged 2–12 years . The study demonstrated that both screening tests had low sensitivity with good specificity (plus lens test: sensitivity = 38.1%, specificity = 89.8% [6/9 cut‐off]; spot vision screener: sensitivity = 23.8%, specificity = 100%) in detecting moderate hyperopia (>+2.50D).…”

Section: Introductionmentioning

confidence: 99%

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Validity of the +1.50 plus lens screening test as a predictor of uncorrected moderate hyperopia

Hopkins

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et al. 2019

Ophthalmic Physiologic Optic

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Purpose Screening for uncorrected hyperopia in school children is important given its association with poorer visual function and academic performance. However, standard distance visual acuity screening may not detect low to moderate hyperopia. The plus lens test is used to screen for hyperopia in many school screening protocols, but has not been well validated. The current study investigated the effectiveness of the plus lens test to identify hyperopia in school children. Methods Participants included Grade 2 school children. Monocular distance visual acuity (logMAR letter chart) was measured unaided, and then through a +1.50D lens, known as the plus lens test. Cycloplegic refraction was undertaken to classify moderate hyperopia (≥+2.00D). Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated for commonly used cut‐offs for the plus lens test: 6/6, 6/9 and less than two lines difference between unaided acuity and acuity through the plus lens test. Results The sample included 59 children (mean age 7.2 ± 0.4 years). Fourteen (24%) children were classified as having uncorrected hyperopia. The sensitivity and specificity of the +1.50 plus lens test for identifying hyperopia were 0% and 98% respectively for a 6/6 cut‐off, 29% and 91% for 6/9 cut‐off, and 50% and 76% for a <2 line reduction between unaided acuity and acuity through the plus lens test. Receiver Operating Curve (ROC) analysis revealed area under curves of 0.69 based on acuity through the plus lens test, and 0.65 for a reduction in acuity through the plus lens test. Conclusions The plus lens test has low sensitivity for detecting uncorrected hyperopia using traditional cut‐offs of 6/9 or better. This raises questions about the role of the plus lens test in school screening batteries.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validity of the +1.50 plus lens screening test as a predictor of uncorrected moderate hyperopia

Hopkins

Black

White

et al. 2019

Ophthalmic Physiologic Optic

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“…Ersetzt durch die heute übliche CyclopentolatSkiaskopie und in ausgesuchten Fällen den Photoscreener [1,2] hat die Skiaskopie viel an Schrecken verloren. Klare Richtlinien zur Brillenverordnung [1], eine empfohlene Brillenadaptationszeit und Okklusionsstrategie sowie Möglichkeiten zur Verbesserung der Compliance erleichtern die Behandlung der Amblyopie.…”

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