Visual acuity screening versus noncycloplegic autorefraction screening for astigmatism in native American preschool children
Visual acuity screening versus noncycloplegic autorefraction screening for astigmatism in native American preschool children
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DOI：
10.1016/s1091-8531(99)70062-5
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发表时间：
1999-06-01
期刊：
影响因子：
1.6
通讯作者：
Dobson, V
中科院分区：
文献类型：
--
作者：
Miller, JM;Harvey, EM;Dobson, V
简介：作为检测严重屈光不正的手段，视力筛查（VAS）对于学龄前儿童的可靠性不如学龄儿童。我们希望将 VAS 的有效性与客观方法（非散瞳验光筛查 (NCARS)）的有效性进行比较，以检测是否存在需要矫正眼镜的显着散光。方法：我们调查了 245 名 3 至 5 岁的美国原住民 Head Start 注册者。我们尝试使用 Lea Symbols logMAR Chart（Precision Vision Inc，Villa Park，III）获得裸眼视力，使用 Nikon Retinomax K-plus（Nikon Corp，Melville，NY）获得非散瞳验光，以及每只眼睛的散瞳验光 (CR)。 VAS 失败标准是眼睛之间的视力差异为 2 线，或者两只眼睛的视力差于 20/40。根据对 AAPOS 会员的调查，NCARS 和 CR 失败标准是眼镜矫正阈值超过第 50 个百分位。结果：我们为 96% 的儿童完成了 VAS，为 100% 的儿童完成了 NCARS 和 CR。该样本中显着散光屈光不正的患病率很高（31%）。十名不允许进行双侧视力测量的受试者被评分为具有阳性测试结果。 VAS 的敏感性和特异性分别为 90% 和 44%。 NCARS 的敏感性和特异性分别为 91% 和 86%。假设自动验光仪的费用是转诊检查费用的 300 倍，在对 1044 名儿童进行筛查后，NCARS 变得具有成本效益。结论：VAS 具有较高的敏感性，但特异性较差。 NCARS 大大减少了不必要的转介数量。在这一人群中，NCARS 在对大约 1000 名儿童进行筛查后变得具有成本效益。
Introduction: Visual acuity screening (VAS) is less reliable in preschoolers than in school-aged children as a means of detecting significant refractive error. We wished to compare the effectiveness of VAS with the effectiveness of an objective method, noncycloplegic autorefraction screening (NCARS), in detecting the presence of significant astigmatism warranting spectacle correction. Methods:We examined 245 Native American Head Start registrants aged 3 to 5 years. We attempted to obtain uncorrected visual acuity using Lea Symbols logMAR Chart(Precision Vision Inc, Villa Park, III), noncycloplegic autorefraction using the Nikon Retinomax K-plus (Nikon Corp, Melville, NY), and cycloplegic refraction (CR) on each eye. The VAS failure criterion was either a 2-line acuity difference between eyes or acuity worse than 20/40 in either eye. The NCARS and CR failure criterion was the spectacle correction threshold exceeding the 50th percentile on the basis of a survey of AAPOS members. Results: We completed VAS in 96% of children and NCARS and CR in 100% of children. There was high prevalence (31%) of significant astigmatic refractive error in this sample. Ten subjects who did not permit bilateral visual acuity measurements were scored as having a positive test result. The sensitivity and specificity of VAS were 90% and 44%, respectively. NCARS had sensitivity and specificity of 91% and 86%, respectively. NCARS becomes cost-effective after 1044 children are screened, assuming that the cost of the autorefractor is 300 times the cost of the referral examination. Conclusion: VAS offers high sensitivity but suffers from poor specificity. NCARS greatly reduces the number of unnecessary referrals. In this population, NCARS becomes cost-effective after approximately 1000 children are screened.