title: Plusoptix photoscreening may replace cycloplegic examination in select pediatric ophthalmology patients.
abstract: OBJECTIVE
  To determine whether children presenting to a pediatric ophthalmologist and found to have a normal Plusoptix photoscreener (PlusoptiX GmbH, Nuremberg, Germany) result, normal visual acuity (children age 3+), and normal alignment/motility receive additional benefit from a dilated fundus examination.
  
  
  METHODS
  The medical records of all children seen at one pediatric ophthalmology practice between 2007 and 2010 who were coded as having had a photoscreening were retrospectively reviewed. Of the total number of records identified, one-half were selected randomly for review. Patients who underwent plusoptiX screening on the first visit were included. Patients with abnormal alignment and/or abnormal vision as well as those referred for examination as determined by a medical or ophthalmic condition that required a dilated fundus examination were excluded.
  
  
  RESULTS
  Of 1,377 patients identified, 697 were selected randomly for record review. Of these, 451 had had an initial plusoptiX screening. A total of 222 had a normal result. Of the 190 patients analyzed, cycloplegic examination provided additional diagnostic information for only 4 children: 1 with nonvisually significant congenital cataract, 1 with refractive amblyopia from moderate astigmatism, 1 with moderate hyperopia who later was found to have accommodative esotropia, and 1 with increased cupping but normal IOP.
  
  
  CONCLUSIONS
  A normal plusoptiX result, combined with normal alignment/motility evaluation and visual acuity was found to have a 98% negative predictive value for ophthalmic pathology, including significant refractive error. The plusoptiX and an abbreviated eye examination may obviate the need for dilation in select children.
authors.affiliation: Family Eye Group, Lancaster, Pennsylvania 17601, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Silbert
authors.forename: Noelle S
authors.initials: NS
authors.lastname: Matta
authors.forename: Kristen
authors.initials: K
authors.lastname: Andersen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis; D012030:Refractive Errors / Q000175:diagnosis*; D012189:Retrospective Studies; D015351:Vision Screening / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology*