Performance of Photoscreener in Detection of Refractive Error in All Age Groups and Amblyopia Risk Factors in Children in a Tribal District of Odisha: The Tribal Odisha Eye Disease Study (TOES) # 3.

Purpose: To evaluate effectiveness of Welch Allyn Spot Vision Screener in detecting refractive error in all age groups and amblyopia risk factors in children in a tribal district of India.

Methods: All participants received dry retinoscopy and photorefraction; children also received cycloplegic retinoscopy. Statistical analysis included Bland-Altman and coefficient of determination ( R 2 ).

Results: Photoscreener could not elicit a response in 113 adults and 5 children of 580 recruited participants. In Bland-Altman analysis mean difference of Spot screener spherical equivalent (SSSE) and dry retinoscopy spherical equivalent (DRSE) was 0.32 diopters (D) in adults and 0.18 D in children; this was an overestimation of hyperopia and underestimation of myopia. In Bland-Altman analysis of SSSE and cycloplegic retinoscopy spherical equivalent (CRSE) the mean difference was -0.30 D in children; this was an overestimation of myopia and underestimation of hyperopia. In regression analysis the relationship between SSSE and DRSE was poor in adults ( R 2 = 0.50) and good in children ( R 2 = 0.92). Cubic regression model for Spot versus cycloretinoscopy in children was: CRSE = 0.34 + 0.85 SSSE - 0.01 SSSE2 + 0.006 SSSE3 . It was 87% accurate. Sensitivity and specificity of Spot in detecting amblyopia risk factors (2013 American Association for Pediatric Ophthalmology and Strabismus [AAPOS] criteria) was 93.3% and 96.9% respectively. Sensitivity of Spot screener in detection of amblyopia was 72%.

Conclusions: Photoscreener has 87% accuracy in refraction in children. Its value could be used for subjective correction tests.

Translational Relevance: Photoscreening could complement traditional retinoscopy to address refractive error in children in a resource-limited facility region.