title: Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study.
abstract: OBJECTIVE
  To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists).
  
  
  METHODS
  Multicenter, cross-sectional study.
  
  
  METHODS
  A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems.
  
  
  METHODS
  Certified LEPs administered 11 commonly used or commercially available screening tests. Results from a standardized comprehensive eye examination were used to classify children with respect to 4 targeted conditions: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA).
  
  
  METHODS
  Sensitivity for detecting children with > or =1 targeted conditions at selected levels of specificity was the primary outcome measure. Sensitivity also was calculated for detecting conditions grouped into 3 levels of importance.
  
  
  RESULTS
  At 90% specificity, sensitivities of noncycloplegic retinoscopy (NCR) (64%), the Retinomax Autorefractor (63%), SureSight Vision Screener (63%), and Lea Symbols test (61%) were similar. Sensitivities of the Power Refractor II (54%) and HOTV VA test (54%) were similar to each other. Sensitivities of the Random Dot E stereoacuity (42%) and Stereo Smile II (44%) tests were similar to each other and lower (P<0.0001) than the sensitivities of NCR, the 2 autorefractors, and the Lea Symbols test. The cover-uncover test had very low sensitivity (16%) but very high specificity (98%). Sensitivity for conditions considered the most important to detect was 80% to 90% for the 2 autorefractors and NCR. Central interpretations for the MTI and iScreen photoscreeners each yielded 94% specificity and 37% sensitivity. At 94% specificity, the sensitivities were significantly better for NCR, the 2 autorefractors, and the Lea Symbols VA test than for the 2 photoscreeners for detecting > or =1 targeted conditions and for detecting the most important conditions.
  
  
  CONCLUSIONS
  Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having > or =1 targeted conditions, but nearly 90% of children with the most important conditions. The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive error in other ways. These results have important implications for screening preschool-aged children.
authors.affiliation: College of Optometry, The Ohio State University, 320 West Tenth Avenue, PO Box 182342, Columbus, OH 43218-2342, USA.
authors.forename: Paulette
authors.initials: P
authors.lastname: Schmidt
authors.forename: Maureen
authors.initials: M
authors.lastname: Maguire
authors.forename: Velma
authors.initials: V
authors.lastname: Dobson
authors.forename: Graham
authors.initials: G
authors.lastname: Quinn
authors.forename: Elise
authors.initials: E
authors.lastname: Ciner
authors.forename: Lynn
authors.initials: L
authors.lastname: Cyert
authors.forename: Marjean Taylor
authors.initials: MT
authors.lastname: Kulp
authors.forename: Bruce
authors.initials: B
authors.lastname: Moore
authors.forename: Deborah
authors.initials: D
authors.lastname: Orel-Bixler
authors.forename: Maryann
authors.initials: M
authors.lastname: Redford
authors.forename: Gui-shuang
authors.initials: GS
authors.lastname: Ying
mesh_terms: D000550:Amblyopia / Q000175:diagnosis*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008007:Licensure, Medical; D008297:Male; D009885:Ophthalmology; D009907:Optometry; D012030:Refractive Errors / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013285:Strabismus / Q000175:diagnosis*; D014786:Vision Disorders / Q000175:diagnosis*; D015351:Vision Screening; D014787:Vision Tests / Q000295:instrumentation*; D014792:Visual Acuity