title: Screening for amblyopia in preverbal children with photoscreening photographs. III. improved grading criteria for hyperopia.
abstract: OBJECTIVE
  To examine the ability of the Medical Technology and Innovations (MTI), Inc., Photoscreener (Cedar Falls, IA) to detect hyperopia and to improve the photograph grading criteria to screen for amblyopiogenic levels of hyperopia.
  
  
  METHODS
  Cross-sectional study and reanalysis. PARTICIPANTS AND TESTING: In previous work, 392 participants received a complete ophthalmologic examination and were photographed using the MTI Photoscreener. For this study, all 209 participants with normal examination findings (65 children) or hyperopia without anisometropia (144 children) were selected. The data were reanalyzed using modified photograph grading and ophthalmologic examination failure criteria. Potential reasons for why many children with hyperopia passed photoscreening were explored.
  
  
  METHODS
  We determined whether a study participant would pass or fail screening with a given photograph grading and ophthalmologic examination failure criteria.
  
  
  RESULTS
  Most children with hyperopia of +2.00 to +3.50 diopters (D) passed screening with the MTI instrument, in most cases because their photographs lacked bright crescents. When bright crescents in at least two of the four possible meridians were the grading guideline for screening failure and the pediatric ophthalmologists' consensus hyperopia failure criteria (> +3.50 D) were adopted, the sensitivity for hyperopia detection was 100% and the specificity was 88%. Identical results were obtained using the American Academy of Ophthalmology Preferred Practice Pattern hyperopia failure criteria (>/= +4.50 D).
  
  
  CONCLUSIONS
  The MTI photograph grading guidelines can be simplified, and the ophthalmologic examination failure criteria for hyperopia can be improved. The presence of a bright crescent in the lower or the left pupillary margin indicate hyperopia in an amblyopiogenic range (> +3.50 D).
authors.affiliation: Wilmer Ophthalmologic Institute, Johns Hopkins University, Baltimore, Maryland, USA. ptong@jhmi.edu
authors.forename: P Y
authors.initials: PY
authors.lastname: Tong
authors.forename: J P
authors.initials: JP
authors.lastname: Macke
authors.forename: R E
authors.initials: RE
authors.lastname: Bassin
authors.forename: M
authors.initials: M
authors.lastname: Everett
authors.forename: E
authors.initials: E
authors.lastname: Enke-Miyazaki
authors.forename: J M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: D R
authors.initials: DR
authors.lastname: Stager
authors.forename: M M
authors.initials: MM
authors.lastname: Parks
authors.forename: G R
authors.initials: GR
authors.lastname: Beauchamp
mesh_terms: D000550:Amblyopia / Q000175:diagnosis*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000145:classification / Q000175:diagnosis*; D007223:Infant; D008297:Male; D010781:Photography / Q000145:classification / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000379:methods*