COMMUNITY PHOTOSCREENING OF 6-MONTH-OLD TO 9-MONTH-OLD INFANTS FOR AMBLYOPIOGENIC RISK-FACTORS

Photorefraction (PR) is gaining acceptance as potentially the most eff ective objective screening technique for amblyopia risk factors in the preverbal child. This study determined the validity and feasibility o f using the Auckland eccentric photorefractor in the detection of ambl yopiogenic factors in six to nine month old infants in an established community-based vision screening program. Photographs were analysed an d compared to results of clinical examination including cycloplegic re fraction. Amblyopia risk factors were present in 7.2% of the infants c linically examined. Analysis only of readable photographs in children who were also clinically examined, gave sensitivities ranging from 71% to 79%, and specificities ranging from 81% to 86%. Inclusion in the a nalysis of photofailures lowered sensitivity figures to 56% to 61%, an d specificity to 63% to 70%. Photofailures were predominantly due to p oor operator technique. Calculation of kappa scores indicated fair obs erver reliability. In conclusion, PR could provide a feasible and suff iciently reliable screening technique in the infant, but requires adeq uate training and auditing of screening personnel performance for opti mum effectiveness.