Sensitivity and Specificity of Preschool Vision Screening in Iran
AbstractBackground: To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the National Vision Screening Program for 7 yr old children in Iran.Methods: In this cross-sectional study, eight cities in Iran were selected through multistage cluster sampling. Selected cities were Sari, Birjand, Ardabil, Mashhad, Bandar Abbas, Dezful, Yazd, and Arak, in Iran in 2013. Totally, 4614 schoolchildren were selected, 4106 of which participated in the study. An optometrist at the school site conducted all vision tests. Results were compared against those recorded on each child’s health card. Those with an uncorrected visual acuity worse than 20/25 in at least one eye screened positive for a vision problem.Results: 8.49% [95% confidence interval, 7.65 to 9.39] of the examinees had a vision problem. The sensitivity rate of the school entry screening was 38.15% (95% CI, 33.01 to 43.50) and the specificity rate was 93.11 (95%CI 92.25 to 93.90). The positive and negative predictive values were 33.93 (29.24 to 38.88) and 94.19 (93.39 to 94.93), respectively. Sensitivity and specificity rates did not significantly differ between boys and girls. For the uncorrected visual acuity tested by public health care workers compared to optometrists, the area under the ROC surface was 0.741 (P<0.001). The best-associated criterion was an uncorrected visual acuity more than 0.05 LogMAR with 67.3% sensitivity and 74.7% specificity.Conclusion: The validity of the school entry vision screening by health workers is low. To reduce false negative rates, some supplementary examinations such as refraction and near visual acuity measurements as well as further training of screeners should be considered.
Anera RG, Soler M, de la Cruz Cardona J, Salas C, Ortiz C (2009). Prevalence of refractive errors in school-age children in Morocco. Clin Exp Ophthalmol, 37(2): 191-6.
Pascolini D, Mariotti SP (2012). Global estimates of visual impairment: 2010. Br J Ophthalmol, 96(5): 614-8.
Kumah BD, Ebri A, Abdul-Kabir M, Ahmed AS, Koomson NY, Aikins S, Aikins A, Amedo A, Lartey S, Naidoo K (2013). Refractive error and visual impairment in private school children in Ghana. Optom Vis Sci, 90(12): 1456-61.
Robaei D, Huynh SC, Kifley A, Mitchell P (2006). Correctable and non-correctable visual impairment in a population-based sample of 12-year-old Australian children. Am J Ophthalmol, 142(1): 112-8.
Pascual M, Huang J, Maguire MG, Kulp MT, Quinn GE, Ciner E, Cyert LA, Orel-Bixler D, Moore B, Ying GS, et al. (2014). Risk factors for amblyopia in the vision in preschoolers study. Ophthalmology, 121(3): 622-9.
Chaine G, Hullo A, Sahel J, Soubrane G, Espinasse-Berrod MA, Schutz D, Bourguignon C, Harpey C, Brault Y, Coste M, Moccatti D, Bourgeois H (1998). Case-control study of the risk factors for age related macular degeneration. France-DMLA Study Group. Br J Ophthalmol, 82(9): 996-1002.
OstadiMoghaddam H, Fotouhi A, Hashemi H, Yekta A, Heravian J, Ghalandarabadi M, Rezvan F, Jafarzadehpur E, Abdolahi-nia T, Khabazkhoob M (2012). Validity of vision screening tests by teachers among school children in Mashhad, Iran. Ophthalmic Epidemiol, 19(3): 166-71.
Ransbarger KM, Dunbar JA, Choi SE, Khazaeni LM (2013). Results of a community vision-screening program using the Spot photoscreener. J AAPOS, 17(5): 516-20.
Moghaddam AA, Kargozar A, Zarei-Ghanavati M, Najjaran M, Nozari V, Shakeri MT (2012). Screening for amblyopia risk factors in pre-verbal children using the Plusoptix photoscreener: a cross-sectional population-based study. Br J Ophthalmol, 96(1): 83-6.
Birch EE (2013). Amblyopia and binocular vision. Prog Retin Eye Res, 33: 67-84.
Williams C, Northstone K, Howard M, Harvey I, Harrad RA, Sparrow JM (2008). Prevalence and risk factors for common vision problems in children: data from the ALSPAC study. Br J Ophthalmol, 92(7): 959-64.
Khandekar R, Parast N, Arabi A (2009). Evaluation of 'vision screening' program for three to six-year-old children in the Republic of Iran. Indian J Ophthalmol, 57(6): 437-42.
Weinand F, Graf M, Demming K (1998). Sensitivity of the MTI photoscreener for amblyogenic factors in infancy and early childhood. Graefes Arch Clin Exp Ophthalmol, 236(11): 801-5.
Barry JC, Konig HH (2003). Test characteristics of orthoptic screening examination in 3 year old kindergarten children. Br J Ophthalmol, 87(7): 909-16.
Rasmussen F, Thoren K, Caines E, Andersson J, Tynelius P (2000). Suitability of the lang II random dot stereotest for detecting manifest strabismus in 3-year-old children at child health centres in Sweden. Acta Paediatr, 89(7): 824-9.
Robinson B, Bobier WR, Martin E, Bryant L (1999). Measurement of the validity of a preschool vision screening program. Am J Public Health, 89(2): 193-8.
Matta NS, Singman EL, Silbert DI (2008). Performance of the Plusoptix vision screener for the detection of amblyopia risk factors in children. J AAPOS, 12(5): 490-2.
Matta NS, Arnold RW, Singman EL, Silbert DI (2009). Comparison between the plusoptiX and MTI Photoscreeners. Arch Ophthalmol, 127(12): 1591-5.
Donahue SP, Johnson TM, Leonard-Martin TC (2000). Screening for amblyogenic factors using a volunteer lay network and the MTI photoscreener. Initial results from 15,000 preschool children in a statewide effort. Ophthalmology, 107(9): 1637-44; discussion 45-6.
Khandekar R, Al Harby S, Abdulmajeed T, Helmi SA, Shuaili IS (2004). Validity of vision screening by school nurses in seven regions of Oman. East Mediterr Health J, 10(4-5): 528-36.
Arnold RW, Tulip D, McArthur E, Shen J, Tappel J, Arnold LE, Winkle E, Armitage MD (2012). Predictive value from pediatrician plusoptix screening: impact of refraction and binocular alignment. Binocul Vis Strabolog Q Simms Romano, 27(4): 227-32.
Bhave A, Bhargava R, Rizvi A, Rizvi T, Kumar R (2011). Hospital and community validation of a screening instrument for detection of neurodisability in Indian children aged 6 months to 2 years. Neuroepidemiology, 37(3-4): 177-82.
Salcido AA, Bradley J, Donahue SP (2005). Predictive value of photoscreening and traditional screening of preschool children. J AAPOS, 9(2): 114-20.
Silverstein E, Lorenz S, Emmons K, Donahue SP (2009). Limits on improving the positive predictive value of the Welch Allyn SureSight for preschool vision screening. J AAPOS, 13(1): 45-50.
Schmidt P, Maguire M, Dobson V, Quinn G, Ciner E, Cyert L, Kulp MT, Moore B, Orel-Bixler D, Redford M, Ying GS (2004). Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study. Ophthalmology, 111(4): 637-50.
Sudhan A, Pandey A, Pandey S, Srivastava P, Pandey KP, Jain BK (2009). Effectiveness of using teachers to screen eyes of school-going children in Satna district of Madhya Pradesh, India. Indian J Ophthalmol, 57(6): 455-8.
Donahue SP, Johnson TM, Ottar W, Scott WE (2002). Sensitivity of photoscreening to detect high-magnitude amblyogenic factors. J AAPOS, 6(2): 86-91.
Berry BE, Simons BD, Siatkowski RM, Schiffman JC, Flynn JT, Duthie MJ (2001). Preschool vision screening using the MTI-Photoscreener. Pediatr Nurs, 27(1): 27-34.
Pott JW, Oosterveen DK, Van Hof-van Duin J (1998). Screening for suppression in young children: the polaroid suppression test. J Pediatr Ophthalmol Strabismus, 35(4): 216-22.
Birch E, Williams C, Hunter J, Lapa MC (1997). Random dot stereoacuity of preschool children. ALSPAC "Children in Focus" Study Team. J Pediatr Ophthalmol Strabismus, 34(4): 217-22; quiz 47-8.
Cordonnier M, Kallay O (2001). Non-cycloplegic screening for refractive errors in children with the hand-held autorefractor Retinomax: final results and comparison with non-cycloplegic photoscreening. Strabismus, 9(2): 59-70.
Barry JC, Konig HH (2001). Non-cycloplegic screening for amblyopia via refractive findings with the Nikon Retinomax hand held autorefractor in 3 year old kindergarten children. Br J Ophthalmol, 85(10): 1179-82.
Briscoe D, Lifshitz T, Grotman M, Kushelevsky A, Vardi H, Weizman S, Biedner B (1998). A new computer program for mass screening of visual defects in preschool children. Br J Ophthalmol, 82(4): 415-8.
Simon JW, Siegfried JB, Mills MD, Calhoun JH, Gurland JE (2004). A new visual evoked potential system for vision screening in infants and young children. J AAPOS, 8(6): 549-54.
Atilla H, Oral D, Coskun S, Erkam N (2001). Poor correlation between "fix-follow-maintain" monocular/binocular fixation pattern evaluation and presence of functional amblyopia. Binocul Vis Strabismus Q, 16(2): 85-90.
Kemper AR, Keating LM, Jackson JL, Levin EM (2005). Comparison of monocular autorefraction to comprehensive eye examinations in preschool-aged and younger children. Arch Pediatr Adolesc Med, 159(5): 435-9.
Buchner TF, Schnorbus U, Grenzebach UH, Busse H (2004). Examination of preschool children for ametropia: first experiences using a new hand-held autorefractor. Strabismus, 12(2): 111-7.
Fotouhi A, Khabazkhoob M, Hashemi H, Mohammad K (2007). Sensitivity and Specificity of Visual Screeni 39. choolchildren, 2004. Iran J Epidemiol, 3(1): 11-7.