title: The Receiver-Operator Curve for Flip-Card Surround HOTV in Younger School Children: Validation of a Simple Flip Card for School Acuity Testing.
abstract: BACKGROUND
  The AAP vision screening guidelines are not uniformly delivered. Moderate amblyopia can be successfully treated in children 7 years of age and older. The ideal method and threshold of vision and/or acuity testing in school is not known.
  
  
  METHODS
  1700 students from first grade, kindergarten, and pre-kindergarten were screened with a flip-card, surround HOTV protocol with other eye patched combined with photoscreening; 234 students had "Gold Standard" confirmatory exams from which AAPOS standards were validated.
  
  
  RESULTS
  Receiver Operator Curves were constructed by adjusting referral criteria by grade. A cutoff of 20/25 yielded fairly good (50%) sensitivity and 90% specificity for first grade and kindergarten, but many of the pre-kindergarten were unable to complete the testing.
  
  
  CONCLUSIONS
  Patched surround HOTV flip-card acuity is useful in starting school children and a cut-off of 20/25 passing acuity is suggested. Pre-kindergarten are not well acuity screened due to high inconclusive rate.
authors.forename: Rachel
authors.initials: R
authors.lastname: Leman
authors.forename: M Diane
authors.initials: MD
authors.lastname: Armitage
authors.forename: Robert W
authors.initials: RW
authors.lastname: Arnold