Pediatric Non-Refractive Vision Screening with EyeSwift, PDI Check and Blinq: Non-Refractive Vision Screening with Two Binocular Video Games and Birefringent Scanning

Abstract

Background The purpose of this paper is to validate three recent non-refractive devices that target sensory and/or strabismus risk factors for amblyopia. EyeSwift® with eye tracking and PDI Check on autostereoscopic Nintendo 3DS are video games that estimate acuity, binocularity and color. The Rebion blinq assesses foveation by birefringence. Methods Students were consented to be screened by each device as if by a school nurse before confirmatory examination with optimized, refined refraction. Results were compared with correlation and Bland Altman plots while screening ability was compared with 2021 AAPOS Guidelines and the strabismus-amblyopia rubric proposed by David Hunter. Results A total of 77 ethnically diverse students, aged 11±4 (4–19) years had a 77% prevalence of 2021 risk factors. Near visual acuity, inter-eye difference and stereopsis correlated significantly (p<0.01) for the EyeSwift® (r 2 0.14, 0.06 and 0.45) and PDI Check (r 2 0.23, 0.22 and 0.32). The sensitivity/specificity to target 2021-AAPOS: Hunter-rubric for EyeSwift® was 82%/56%: 74%/62%, for PDI Check was 75/64%: 69%/69% and for blinq 75/48%: 82%/39%. Sensitivity/specificity for the seven color-deficient students was 86%/84% for EyeSwift® and 100%/81% for PDI Check. Screening time was 96±19 s for PDI Check and 375±102 s for EyeSwift but less than 25 s for blinq. Conclusion Reliable near visual acuity, stereo and color testing were obtained from the two binocular and touch screen devices often with minimal coaching of the student. The blinq rapidly gives an estimate of whether both eyes are steadily fixing, and the ProVersion predicted 100% which eye is deviated or amblyopic. Non-refractive validation metrics were beneficial.

Acuity Comparison Methods via Timed Test-Retest Precision of Matching-Card e-ETDRS Compared to PDI Check in Treated Amblyopes and Superb Normals

“…Typically, conventional visual acuity utilizes fixed, determined sized optotypes viewed from a specified distance so they subtend a given angle from the eye, and then the subject conveys their impressions usually by talking, or pointing to a matching card with large, representative optotype figures. Eye tracking can enhance vision assessment in very young children performing forced preferential looking 12 as well as vision 13 and reading performance in older children. 13 Outside of the eye clinic, parents can now screen their children’s vision with printed charts, websites or smartphones 14 at home.…”

“…Eye tracking can enhance vision assessment in very young children performing forced preferential looking 12 as well as vision 13 and reading performance in older children. 13 Outside of the eye clinic, parents can now screen their children’s vision with printed charts, websites or smartphones 14 at home. 15 The PEDIG protocol utilizes the surround HOTV optotypes in a computer presentation (EVA; electronic vision assessment) for children under the age of 7 years 16 and the electronic ETDRS (Early Treatment of Diabetic Retinopathy Study) electronically presented Sloan optotypes for children aged 7 years and older.…”

Comparative Analysis of Strabismus Measurement Using a Video Oculagraphy System and Alternate Prism Cover Test

“…ET and VOG are currently used in various areas associated with visual functioning, including nystagmus, 6–8 oculomotricity, 9–14 contrast sensitivity, 15 visual acuity, 15 pupillography, 16 cyclotorsion, 17,18 and primarily for detecting and/or quantifying ocular misalignment, whether it be heterophoria 19–24 or heterotropia 25–52 …”