A new visual evoked potential system for vision screening in infants and young children.
BACKGROUND
With a prevalence of 3-5%, amblyopia represents a major public health problem. Effective treatment depends on early detection, and a broad consensus of professional opinion supports vision screening of infants and young children. No single method of screening has been demonstrated to be superior in detecting amblyopia and all methods have significant limitations.


METHODS
We assessed a new, "child-friendly" visual evoked potential (VEP) system (ENFANTtrade mark II, Diopsys Corp., Metuchen, NJ) for use in screening. We studied 122 children, aged 6 months to 5 years, comparing test results in a masked fashion to results of standard ophthalmologic examinations. A statistical program analyzed VEP differences between fellow eyes to determine a "pass" or "fail" for each child. For verbal patients, clinical amblyopia was defined as an interocular difference of two or more lines in best-corrected visual acuity. For preverbal patients, clinical amblyopia was defined by the clinician's decision to treat with occlusion or atropine penalization. Preverbal children with significant refractive errors or structural eye pathology were also considered clinically abnormal.


RESULTS
The test was completed by 94% of the study group, each child requiring an average of 10 minutes to complete testing of both eyes. The sensitivity was 0.973, the specificity 0.808, the positive predictive value 0.706, and the negative predictive value 0.984.


CONCLUSIONS
With its easy electrode placement and rapid, attractive stimulus, the new system overcomes technical difficulties which were associated with older VEP techniques. The test shows promise as a screening tool for detecting amblyopia and other visual deficits in young children.
Simon
John W
JW
Department of Ophthalmology/Lions Eye Institute, Albany Medical College, NY 12208, USA. SimonJ@mail.amc.edu
Siegfried
John B
JB
Mills
Monte D
MD
Calhoun
Joseph H
JH
Gurland
Judith E
JE
D000550:Amblyopia / Q000175:diagnosis*; D002675:Child, Preschool; D005074:Evoked Potentials, Visual; D005189:False Positive Reactions; D006801:Humans; D007223:Infant; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000379:methods*