Community photoscreening of six to nine month old infants for amblyopiogenic risk factors.
Photorefraction (PR) is gaining acceptance as potentially the most effective objective screening technique for amblyopia risk factors in the preverbal child. This study determined the validity and feasibility of using the Auckland eccentric photorefractor in the detection of amblyopiogenic factors in six to nine month old infants in an established community-based vision screening program. Photographs were analysed and compared to results of clinical examination including cycloplegic refraction. Amblyopia risk factors were present in 7.2% of the infants clinically examined. Analysis only of readable photographs in children who were also clinically examined, gave sensitivities ranging from 71% to 79%, and specificities ranging from 81% to 86%. Inclusion in the analysis of photo-failures lowered sensitivity figures to 56% to 61%, and specificity to 63% to 70%. Photofailures were predominantly due to poor operator technique. Calculation of kappa scores indicated fair observer reliability. In conclusion, PR could provide a feasible and sufficiently reliable screening technique in the infant, but requires adequate training and auditing of screening personnel performance for optimum effectiveness.
Hope
C
C
Department of Surgery, University of Auckland Medical School, New Zealand.
Roulston
J
J
Hoey
C
C
Wong
A
A
Clover
G
G
D000550:Amblyopia / Q000175:diagnosis* / Q000453:epidemiology; D005006:Ethnicity; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D010781:Photography / Q000379:methods*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014786:Vision Disorders / Q000453:epidemiology; D015351:Vision Screening