title: The opportunistic screening of refractive errors in school-going children by pediatrician using enhanced Brückner test.
abstract: OBJECTIVE
  The aim of this study was to compare the results of enhanced Brückner test (EBT) performed by a pediatrician and an experienced pediatric ophthalmologist.
  
  
  METHODS
  In this prospective double-masked cohort study, a pediatrician and a pediatric ophthalmologist performed the EBT in a classroom of a school in semi-dark lighting condition using a direct ophthalmoscope. The results of the test were compared using 2 × 2 Bayesian table and kappa statistics. The findings of the pediatric ophthalmologists were considered gold standard.
  
  
  RESULTS
  Two hundred and thirty-six eyes of 118 subjects, mean age 6.8 ± 0.5 years (range, 5.4-7.8 years), were examined. The time taken to complete this test was <10 s per subject. The ophthalmologist identified 59 eyes as ametropic (12 hyperopic and 47 myopic eyes) and 177 as emmetropic compared to 61 eyes as ametropic and 175 emmetropic by pediatrician. The prevalence of the test positive was 25.9%. The sensitivity of the pediatrician was 90.2%, specificity was 97.7%, predictive value of the positive test was 93.2%, and predictive value of the negative test was 96.6%. The clinical agreement (kappa) between the pediatric ophthalmologist and the pediatrician was 0.9.
  
  
  CONCLUSIONS
  The results of the EBT performed by pediatrician were comparable to that of an experienced pediatric ophthalmologist. Opportunistic screening of refractive errors using EBT by a pediatrician can be an important approach in the detection of ametropia in children.
authors.affiliation: Department of Pediatric Community Ophthalmology, Pediatric Ophthalmology Brigade of , Jyotirmay Eye Clinic, Ocular Motility Lab and Pediatric Low Vision Center, Thane, Maharashtra, India.
authors.forename: Piyush
authors.initials: P
authors.lastname: Jain
authors.affiliation: Department of Pediatric Community Ophthalmology, Pediatric Ophthalmology Brigade of , Jyotirmay Eye Clinic, Ocular Motility Lab and Pediatric Low Vision Center, Thane; Department of Pediatric Ophthalmology, Mahatme Eye Hospital, Nagpur, Maharashtra, India.
authors.forename: Mihir T
authors.initials: MT
authors.lastname: Kothari
authors.affiliation: Department of Pediatrics, SVD Savarkar Municipal Hospital, Mumbai, Maharashtra, India.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Gode
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009887:Ophthalmoscopy / Q000379:methods*; D000072143:Pediatricians; D015995:Prevalence; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology*; D012030:Refractive Errors / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015203:Reproducibility of Results; D015351:Vision Screening / Q000379:methods*