The 130th Annual Meeting of APHA

Abstract #52328

Ann Marie Hulstein, OD¹, Kathleen Reuter, OD¹, and Paulette P Schmidt, OD, MS². (1) The Ohio State University, College of Optometry, 320 West 10th Avenue, P.O. Box 182342, Columbus, OH 43218-2342, 614-247-6919, hulstein.1@osu.edu, (2) Department of Pediatric Optometry, The Ohio State University, 338 West Tenth Avenue, Columbus, OH 43210

Purpose: The most frequent cause of amblyopia in early childhood is significant refractive error. The performance of noncycloplegic retinoscopy and three handheld autorefractors is evaluated in screening for detecting hyperopia, astigmatism, and anisometropia. Methods: Forty-two preschoolers were screened using noncycloplegic retinoscopy and three autorefractors: Nikon Retinomax K-plus and Welch Allyn (WA) instruments: Prototype and Sure Sight (SS) 1.22. Cycloplegic retinoscopy was performed as the gold standard. Receiver operating characteristic (ROC) curves were generated for refracting methods for the refractive error categories. Cut points for each refracting method were picked to simultaneously maximize sensitivity and specificity for each category. Results: Using area under the ROC curve, noncycloplegic retinoscopy (.96) shows the best overall performance as a screening test for hyperopia followed by the Retinomax (.87), WA SS 1.22 (.85), and WA Prototype (.81). For astigmatism, all the refracting methods perform very well (>.97). All refracting methods performed poorly for anisometropia: retinoscopy (.54), Retinomax (.54), WA Prototype (.70), and WA SS 1.22 (.66). The cut points for hyperopia were as follows: retinoscopy +1.50 D, Retinomax +1.00 D, WA Prototype +3.00 D, WA SS 1.22 +3.75 D. The cut points for astigmatism were as follows: retinoscopy –1.50 DC, Retinomax –2.00 DC, and WA SS 1.22 -2.25 DC. Conclusions: For hyperopia and astigmatism, sensitivity and specificity are maximized for each instrument depending on the cut points selected. ROC curves show that all refractive methods are weak for detecting anisometropia.

Learning Objectives:

• • 1)Identify frequent causes of amblyopia in childhood.
  • 2)Describe four methods used to detect significant refractive error.
  • 3)Identify the effectiveness of four methods used to detect amblyogenic refractive error.

Keywords: Screening Instruments,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.