title: Performance of Spot Photoscreener in Detecting Amblyopia Risk Factors in Chinese Pre-school and School Age Children Attending an Eye Clinic.
abstract: OBJECTIVE
  To evaluate the effectiveness of Spot photoscreener in detecting amblyopia risk factors meeting 2013 the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) criteria in Chinese preschool and school-age children.
  
  
  METHODS
  One hundred and fifty-five children (310 eyes), aged between 4 to 7 years (5.74 ± 1.2 years) underwent complete ophthalmologic examination, photoscreening, and cycloplegic retinoscopy refraction. The agreement of the results obtained with the photoscreening and retinoscopy was evaluated by linear regression and Bland-Altman plots. The sensitivity and specificity of detecting amblyopia risk factors were calculated based on the AAPOS 2013 guidelines. The overall effectiveness of detecting amblyopia risk factors was analyzed with Receiver Operating Characteristic (ROC) curves.
  
  
  RESULTS
  The mean refractive errors measured with the Spot were: spherical equivalent (SE) = 0.70 ± 1.99 D, J0 = 0.87 ± 1.01 D, J45 = 0.09 ± 0.60 D. The mean results from retinoscopy were: SE = 1.19 ± 2.22 D, J0 = 0.77 ± 1.00 D, J45 = -0.02 ± 0.45 D. There was a strong linear agreement between results obtained from those two methods (R2 = 0.88, P<0.01). Bland-Altman plot indicated a moderate agreement of cylinder values between the two methods. Based on the criteria specified by the AAPOS 2013 guidelines, the sensitivity and specificity (in respective order) for detecting hyperopia were 98.31% and 97.14%; for detecting myopia were 78.50% and 88.64%; for detecting astigmatism were 90.91% and 80.37%; for detecting anisometropia were 93.10% and 85.25%; and for detection of strabismus was 77.55% and 88.18%.
  
  
  CONCLUSIONS
  The refractive values measured from Spot photoscreener showed a moderate agreement with the results from cycloplegic retinoscopy refraction, however there was an overall myopic shift of -0.49D. The performance in detecting individual amblyopia risk factors was satisfactory, but could be further improved by optimizing criteria based on ROC curves.
authors.affiliation: Department of strabismus and pediatric ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China.
authors.forename: Yajun
authors.initials: Y
authors.lastname: Mu
authors.affiliation: College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida, United States of America.
authors.forename: Hua
authors.initials: H
authors.lastname: Bi
authors.affiliation: College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida, United States of America.
authors.forename: Edgar
authors.initials: E
authors.lastname: Ekure
authors.affiliation: Department of strabismus and pediatric ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Ding
authors.affiliation: Department of strabismus and pediatric ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Wei
authors.affiliation: Department of strabismus and pediatric ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Hua
authors.affiliation: Department of strabismus and pediatric ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China.
authors.forename: Xuehan
authors.initials: X
authors.lastname: Qian
authors.affiliation: Department of retina and vitreous, Tianjin Medical University Eye Hospital, Tianjin, China.
authors.forename: Xiaorong
authors.initials: X
authors.lastname: Li
mesh_terms: D000550:Amblyopia / Q000175:diagnosis*; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D006801:Humans; D009885:Ophthalmology; D012372:ROC Curve; D042262:Retinoscopy; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013285:Strabismus / Q000175:diagnosis