PDF(Pubmed)
Abstract：
To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation.
As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination.
Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8.
In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination.
Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8.
In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
摘要：
目的：根据更新的2021年AAPOS视力筛查委员会关于基于仪器的儿科视力筛查验证的指南，评估Spot视力筛查。
方法：作为IRB批准的正在进行的前瞻性研究的一部分，儿童在进行全面检查前接受了Spot筛查.
结果：在1,090名儿童中的1,036名（95％）成功进行了斑点筛查。48%的参与者被推荐使用Spot制造商指南进行进一步筛查，通过金标准检查，发现所有儿童中有40％患有2021年弱视危险因素或视觉上明显的屈光不正。Spot建议与2021年的标准相比相当好，总体敏感性为0.88，特异性为0.78。将更新的指南应用于远视点，屈光参差,和散光产生中等至较差的敏感性（0.27-0.77），但具有出色的特异性（>0.9）。接收器工作特性分析曲线下的面积表明，对于每个诊断近视的斑点，总体上具有良好的预测性能。远视,散光,屈光参差(范围，0.87-0.97）。我们的研究结果表明，年龄较大的儿童将散光的仪器转诊标准从1.5D（本研究中使用的筛选器的制造商阈值）增加到2D。将屈光参差截止值从1D降低至0.75D将使灵敏度从0.59提高至>0.8。
结论：在我们的研究人群中，Spot的整体预测能力良好，灵敏度为0.88，特异性为0.78。我们推荐特定的设备屈光转诊标准，以使用更新的AAPOS指南最大限度地提高筛查效果。
方法：作为IRB批准的正在进行的前瞻性研究的一部分，儿童在进行全面检查前接受了Spot筛查.
结果：在1,090名儿童中的1,036名（95％）成功进行了斑点筛查。48%的参与者被推荐使用Spot制造商指南进行进一步筛查，通过金标准检查，发现所有儿童中有40％患有2021年弱视危险因素或视觉上明显的屈光不正。Spot建议与2021年的标准相比相当好，总体敏感性为0.88，特异性为0.78。将更新的指南应用于远视点，屈光参差,和散光产生中等至较差的敏感性（0.27-0.77），但具有出色的特异性（>0.9）。接收器工作特性分析曲线下的面积表明，对于每个诊断近视的斑点，总体上具有良好的预测性能。远视,散光,屈光参差(范围，0.87-0.97）。我们的研究结果表明，年龄较大的儿童将散光的仪器转诊标准从1.5D（本研究中使用的筛选器的制造商阈值）增加到2D。将屈光参差截止值从1D降低至0.75D将使灵敏度从0.59提高至>0.8。
结论：在我们的研究人群中，Spot的整体预测能力良好，灵敏度为0.88，特异性为0.78。我们推荐特定的设备屈光转诊标准，以使用更新的AAPOS指南最大限度地提高筛查效果。
