Performance of Four New Photoscreeners on Pediatric Patients With High Risk Amblyopia

Purpose: A new study by the American Academy of Pediatrics touts the benefits of photoscreening, especially in preverbal children who cannot yet perform monocular acuity screening. Emerging devices have not been compared in young and developmentally challenged children. Methods: Consecutive patients in a pediatric eye practice had a comprehensive eye examination and four photoscreens: PlusoptiX (PlusoptiX, Nuremburg, Germany), SPOT (PediaVision, Lake Mary, FL), iScreen (iScreen, Memphis, TN), and the GoCheckKids application (Gobiquity, Aliso Viejo, CA) for the iPhone 4s (Apple, Cupertino, CA) with Delta Center Crescent interpretation. They were validated according to the 2003 American Association for Pediatric Ophthalmology and Strabismus uniform guidelines. Results: One hundred eight children aged 1 to 12 years participated, with 56% having amblyopia risk factors and 10% having autism. For the four devices, sensitivity, specificity, and inconclusive results were as follows: PlusoptiX (83%, 86%, 23%), SPOT (80%, 85%, 4%), iScreen (75%, 88%, 13%) and iScreen (with Delta Center Crescent) (92%, 88%, 0%), and GoCheckKids (with Delta Center Crescent) (81%, 91%, 3%). Conclusions: Even in high risk and young children, current instrument- based screeners can reliably screen for refractive and strabismic risk factors that lead to amblyopia. Some devices can reduce the proportion of inclusive results in challenging cases.