title: Validation of a school-based amblyopia screening protocol in a kindergarten population.
abstract: OBJECTIVE
  To validate a school-based amblyopia screening program model by comparing its outcomes to those of a state-of-the-art conventional ophthalmic clinic examination in a kindergarten population of children between the ages of 4 and 5 years.
  
  
  METHODS
  An amblyopia screening protocol, which consisted of visual acuity measurement using Lea charts, ocular alignment test, ocular motility assessment, and stereoacuity with TNO random-dot test, was performed at school in a pediatric 4- to 5-year-old population by qualified healthcare professionals. The outcomes were validated in a selected group by a conventional ophthalmologic examination performed in a fully equipped ophthalmologic center. The ophthalmologic evaluation was used to confirm whether or not children were correctly classified by the screening protocol. The sensitivity and specificity of the test model to detect amblyopia were established.
  
  
  RESULTS
  A total of 18,587 4- to 5-year-old children were subjected to the amblyopia screening program during the 2010-2011 school year. A population of 100 children were selected for the ophthalmologic validation screening. A sensitivity of 89.3%, specificity of 93.1%, positive predictive value of 83.3%, negative predictive value of 95.7%, positive likelihood ratio of 12.86, and negative likelihood ratio of 0.12 was obtained for the amblyopia screening validation model.
  
  
  CONCLUSIONS
  The amblyopia screening protocol model tested in this investigation shows high sensitivity and specificity in detecting high-risk cases of amblyopia compared to the standard ophthalmologic examination. This screening program may be highly relevant for amblyopia screening at schools.
authors.affiliation: Pediatric Ophthalmology Department, Vissum Alicante, Alicante - Spain.|Fundación Jorge Alió, Alicante - Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Casas-Llera
authors.affiliation: Fundación Jorge Alió, Alicante - Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Ortega
authors.affiliation: Fundación Jorge Alió, Alicante - Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Rubio
authors.affiliation: Fundación Jorge Alió, Alicante - Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Santos
authors.affiliation: Universidad Miguel Hernández, Alicante - Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Prieto
authors.affiliation: Pediatric Ophthalmology Department, Vissum Alicante, Alicante - Spain.|Universidad Miguel Hernández, Alicante - Spain.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alio
mesh_terms: D000550:Amblyopia / Q000175:diagnosis*; D002675:Child, Preschool; D005133:Eye Movements; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000592:standards*; D014792:Visual Acuity / Q000502:physiology