Purpose: To evaluate averaged, repeat Spot Vision Screener (Welch Allyn) refractive screening with and without maximal atropine cycloplegia in preschool Chinese children.
Methods: Refractive errors of 450 preschool children aged 3 to 6 years were measured by cycloplegic retinoscopy as the gold standard. The Spot Vision Screener was used to examine the refractive errors of these children before and after cycloplegia. The differences between the two methods were assessed using the Wilcoxon test and Bland-Altman plot. The accuracy of the Spot Vision Screener in detecting refractive errors was evaluated by receiver operating characteristic curve analysis.
Results: Before cycloplegia, the Spot Vision Screener provided statistically significantly lower values of sphere (median difference: 1.50 diopters [D], 95% CI: 1.38 to 1.63 D) and spherical equivalent (median difference: 1.56 D, 95% CI: 1.50 to 1.69 D). For hyperopia of greater than 3.00 D spherical value (n = 118), the median difference between the Spot Vision Screener and cycloplegic retinoscopy was 2.63 D (95% CI: 2.50 to 2.88 D). The Bland-Altman plot showed that the difference between the results of the two examination methods was large. The sensitivity of the Spot Vision Screener for detecting refractive errors increased after the screening criteria were optimized.
Conclusions: The Spot Vision Screener was efficient in detecting anisometropia in Chinese preschool children. The Spot Vision Screener without cycloplegia underestimated the spherical value of hyperopia and the difference was larger when the cycloplegic hyperopia increased. The performance of the Spot Vision Screener without cycloplegia in detecting cycloplegic hyperopia was not complete. The instrument referral criteria of the Spot Vision Screener should be adjusted according to clinical practice, but it is not simple and users should do it with expert assistance. [J Pediatr Ophthalmol Strabismus. 2021;58(3):146-153.].