Limits on improving the positive predictive value of the Welch Allyn SureSight for preschool vision screening

Silverstein, Emanuel; Lorenz, Sylvia; Emmons, Kathy; Donahue, Sean P.

doi:10.1016/j.jaapos.2008.08.011

Cited by 12 publications

(13 citation statements)

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“…37-39 On the other hand, in multisite vision preschool screening studies, much higher SureSight Autorefractor success rates (>99%) have been described. 16,40 …”

Section: Discussionmentioning

confidence: 99%

Beyond Screening for Risk Factors

et al. 2014

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IMPORTANCE Commercially available automated vision screening devices assess refractive risk factors, not amblyopia or strabismus, underreferring affected children and overreferring healthy children. Nearly half of affected children are not identified until after age 5 years, when treatment is less effective.OBJECTIVES To determine the diagnostic accuracy of the Pediatric Vision Scanner (PVS), a binocular retinal birefringence scanner, to objectively identify strabismus and amblyopia, and to compare retinal birefringence screening with a widely used automated pediatric screening device.DESIGN, SETTING, AND PARTICIPANTS Three hundred consecutive preschool children (aged 2-6 years) were screened using the PVS and the SureSight Autorefractor at 2 pediatric ophthalmology private practices. A masked comprehensive pediatric ophthalmic examination provided the gold standard for determining sensitivity and specificity for each screening device. MAIN OUTCOMES AND MEASURESThe primary outcome was sensitivity and specificity of the PVS for detecting the targeted conditions, strabismus and amblyopia, in children aged 2 to 6 years. Secondary outcomes included the positive and negative likelihood ratios of the PVS for identifying the targeted conditions. In addition, sensitivity, specificity, and positive and negative likelihood ratios of the SureSight Autorefractor for the targeted conditions were assessed in the same cohort of children. RESULTSOf the 300 patients, 188 had strabismus only, amblyopia only, or both, and 112 had no strabismus or amblyopia. The sensitivity of the PVS to detect strabismus and amblyopia (0.97; 95% CI, 0.94-1.00) was significantly higher than that of the SureSight Autorefractor (0.74; 95% CI, 0.66-0.83). Specificity of the PVS for strabismus and amblyopia (0.87; 95% CI, 0.80-0.95) was significantly higher than that of the SureSight Autorefractor (0.62; 95% CI, 0.50-0.73). CONCLUSIONS AND RELEVANCEThe PVS identified children with strabismus and/or amblyopia with high sensitivity, outperforming the SureSight Autorefractor. Accurate, early detection of these conditions could improve long-term vision outcomes of affected preschool children.

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“…37-39 On the other hand, in multisite vision preschool screening studies, much higher SureSight Autorefractor success rates (>99%) have been described. 16,40 …”

Section: Discussionmentioning

confidence: 99%

Beyond Screening for Risk Factors

et al. 2014

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“…21,22 Handheld autorefractors use optical methods to estimate the refractive error of each eye, 1 eye at a time, and as such, are limited in their ability to detect strabismus in the absence of an abnormal refractive error. However, autorefractors remain useful in detecting anisometropia in the absence of strabismus, which is the most common cause of amblyopia undetected at an early age.…”

Section: Instrument-based Screening Techniquesmentioning

confidence: 99%

Procedures for the Evaluation of the Visual System by Pediatricians

Donahue¹,

Baker²

2016

Pediatrics

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117

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“…In our previous study of an enriched population of 300 children aged 2-6 years screened in a pediatric ophthalmology setting, 19 sensitivity of the Pediatric Vision Scanner was determined to be 97%, significantly higher than the SureSight sensitivity of 63% when using Silverstein-Vanderbilt criteria. 20 All children who screened with the Pediatric Vision Scanner and the SureSight were referred for the gold standard examination (GSE) by a pediatric ophthalmologist. However, only 1 in 3 patients tested ultimately appeared in the ophthalmology office for the GSE.…”

Section: Discussionmentioning

confidence: 99%

“…If 5 measurements with reliability scores ≥6 could not be obtained, an "unable to perform" result was reported. Both devices generated a "refer" (+) or "pass" (−) result per manufacturer recommendations (Silverstein-Vanderbilt criteria 20 to evaluate the SureSight data).…”

Section: Methodsmentioning

confidence: 99%

“…19 The sensitivity of the Pediatric Vision Scanner in that setting was 97% (95% CI, 94%-100%), significantly higher than the SureSight sensitivity of 63% (95% CI, 54%-72%) when using Silverstein-Vanderbilt criteria. 20 The Pediatric Vision Scanner also demonstrated better specificity than the SureSight (87% [95% CI, 80%-95%] vs 70% [95% CI, 59%-81%]]. Although positive and negative likelihood ratios were used to infer the expected accuracy of the Pediatric Vision Scanner in a pediatric primary care screening setting, there remains a question of whether specificity can be adequately estimated based on data obtained from an enriched cohort.…”

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confidence: 99%

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High specificity of the pediatric vision scanner in a private pediatric primary care setting

Jost¹,

Dao²,

Katz³

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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Purpose-To determine the specificity of the Pediatric Vision Scanner, a binocular retinal birefringence scanner, in its intended setting, a pediatric primary care office.Methods-A total of 102 preschool children (age 2-6 years) were screened during a well-child pediatric visit using the Pediatric Vision Scanner and the SureSight Autorefractor and completed a masked comprehensive pediatric ophthalmic examination (gold standard examination).Results-Based on the gold standard examination, one child had anisometropic amblyopia, and the remaining 101 had no amblyopia or strabismus. Specificity of the Pediatric Vision Scanner was 90% (95% CI, 82%-95%) while specificity of the SureSight was 87% (95%CI, 79-93%). Combining these results with the sensitivity of the devices determined in our previous study conducted in a pediatric ophthalmology office setting, the positive likelihood ratio for the Pediatric Vision Scanner was 10.2; for the SureSight, 5.0. The negative likelihood ratio for the Pediatric Vision Scanner was 0.03; for the SureSight, 0.42, a significant difference. Conclusions-ThePediatric Vision Scanner had high specificity (90%) in screening for amblyopia and strabismus as part of a pediatric well-child visit. Likelihood ratio analysis suggests that affected children have a high probability of being correctly identified by the Pediatric Vision Scanner. The high level of confidence conferred by Pediatric Vision Scanner screening may remove an important barrier to vision screening in pediatric primary care.Correspondence: Reed M. Jost, MS, Retina Foundation of the Southwest, 9600 North Central Expressway, Suite 200, Dallas, TX 75231 (reedjost@retinafoundation.org). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The authors have no financial interest in any screening device. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptAmblyopia is the most common cause of monocular visual impairment, affecting 2%-4% of children age 6 years and younger. 1,2 Delayed detection and treatment can lead to permanent vision loss. [3][4][5][6] Young children are unlikely to be aware of decreased vision in one eye; thus, the primary aim of preschool vision screening is the detection of amblyopia. Strabismus is the most common amblyogenic risk factor. 7,8 Even in the absence of amblyopia, strabismus can disrupt the development of normal binocular vision, detrimentally affect fine motor skills, and have psychosocial consequences. 9-13 Preschool vision screening could help identify children with the targeted conditions of amblyopia or strabismus wh...

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Limits on improving the positive predictive value of the Welch Allyn SureSight for preschool vision screening

Cited by 12 publications

References 11 publications

Beyond Screening for Risk Factors

Beyond Screening for Risk Factors

Procedures for the Evaluation of the Visual System by Pediatricians

High specificity of the pediatric vision scanner in a private pediatric primary care setting

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