Results of a community vision-screening program using the Spot photoscreener.

PURPOSE: To describe the results of vision screenings performed with the Spot photoscreener in the community setting.
METHODS: Low-income, predominantly Hispanic children in day care and preschool settings were screened by lay operators using the Spot photoscreener. Inclusion criteria were age 6-72 months and availability of a complete photoscreening record. Referral criteria were based on Vision Screening Committee of American Association for Pediatric Ophthalmology and Strabismus guidelines. Data were stratified by age group and analyzed for percentage of children referred for hyperopia, myopia, astigmatism, anisometropia, anisocoria, and ocular misalignment. Vision screening records were compared with comprehensive eye examination records from an optometrist or ophthalmologist to determine positive predictive value.
RESULTS: Vision screening examinations were performed on 8,317 subjects from September 2011 through May 2012. The mean age of the 7,814 subjects (3953 males) meeting inclusion criteria was 44.4 months. The Spot referred 2,393 (30.6%). Of the screened population, the suspected reason for referral was astigmatism in 1,863 (23.8%), ocular misalignment in 879 (11.3%), anisometropia in 90 (1.2%), myopia in 82 (1.1%), hyperopia in 63 (0.8%), and anisocoria in 16 (0.2%). Comprehensive examination reports, including a cycloplegic refraction, were available for 300 referred children (12.5%). The reason for referral was confirmed in 55.7%, with an overall positive predictive value of 65.7%.
CONCLUSIONS: The Spot photoscreener yielded a high overall referral rate. Although a high prevalence of astigmatism may be expected in this population, a high referral rate for suspected ocular misalignment led to a very high proportion of false positive referrals, suggesting that the software for this algorithm is in need of refinement.