Community based vision screening in preschool children; performance of the Spot Vision Screener and optotype testing
Community based vision screening in preschool children; performance of the Spot Vision Screener and optotype testing
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DOI：
10.1080/09286586.2021.1962918
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发表时间：
2021-08-22
影响因子：
1.8
通讯作者：
Gole, Glen
中科院分区：
文献类型：
--
作者：
Kapoor, Vishal;Shah, Shaheen P.;Gole, Glen
背景儿童视力筛查儿童通常使用基于视力类型的视力或基于仪器的方法来测量弱视的危险因素(ARF)。目的比较Spot Vision Screener(SVS)(PediaVision，Welch Allyn，NY)和护士管理的视敏度筛查(NVAS)在识别急性呼吸窘迫综合征(ARF)和视力下降方面的性能。方法对澳大利亚昆士兰州东南部的学龄前儿童进行前瞻性、横断面人群研究。符合条件的参与者接受了训练有素的社区护士的两种形式的筛查。所有结果不正常的儿童以及一组随机选择的通过两种评估的儿童都在三级儿科眼科诊所进行评估。结果在10个月的时间里，对38所学校的2237名儿童进行了筛查，平均年龄为64.4+/-4.0个月。6.4%的儿童SVS不及格，8.3%的NVAS不及格(重叠3.8%，两者均不及格)。阳性预测值分别为70.4%(95%可信区间：61.6%~78.2%)和60.5%(95%可信区间：52.6%~67.9%)。通过将失败的NVAS和失败的SVS相结合，获得了检测ARF和/或VA减少的最高PPV：91.0%(95%CI：82.4%到96.3)，但这将有可能导致社区错过视力障碍儿童。结论据我们所知，这是第一项以人群为基础的研究，提供了学龄前儿童NVAS和SVS诊断准确性的详细比较措施。十分之一的学龄前儿童一个屏幕或两个屏幕都不及格。如果只使用一种筛查方法，许多需要眼科干预的儿童被遗漏。
Background Children's vision screening children commonly uses optotype-based visual acuity or instrument-based methods measuring amblyogenic risk factors (ARFs). Objective To compare the performance of the Spot Vision Screener (SVS) (PediaVision, Welch Allyn, NY) and a nurse-administered visual acuity screen (NVAS) in identifying ARFs and decreased visual acuity. Methods A prospective, cross-sectional population-based study of preschool children in South-East Queensland, Australia. Eligible participants had both forms of screening by trained community nurses. All children with an abnormal result by either method as well as a cohort of randomly selected children who passed both assessments were assessed at a tertiary paediatric ophthalmology clinic. Results Over a 10 month period, 2237 children (mean age; 64.4 +/- 4.0 months) were screened from 38 schools. 6.4% of children failed SVS and 8.3% failed NVAS (with 3.8% overlap, failing both). The positive predictive value (PPV) in identifying either ARFs and/or reduced VA for the SVS and NVAS was 70.4% (95% Confidence Interval (CI): 61.6%-78.2%) and 60.5% (95% CI: 52.6%-67.9%) respectively. Highest PPV to detect either ARFs and/or reduced VA was achieved by a 'hybrid' method by combining failed NVAS and failed SVS: 91.0% (95% CI: 82.4 to 96.3) but this would risk children with sight impairment being missed in the community. Conclusion To our knowledge, this is the first population-based study providing detailed comparative measures of diagnostic accuracy for NVAS and SVS in preschool children. One in ten preschool children failed one or both screens. A number of children who required ophthalmic intervention were missed if only one screening method was utilized.