SCREENING FOR AMBLYOPIA IN PREVERBAL CHILDREN WITH PHOTOSCREENING PHOTOGRAPHS

Objective: This study aimed to determine the ability of healthcare pro fessionals and lay volunteers to grade photoscreening photographs. Des ign: The study design was a cross-sectional study. Participants and In tervention: One hundred children 3 years of age or younger received a complete ophthalmologic examination and were photographed using the Me dical Technology Innovations (MTI) photoscreener, Twenty-six children had normal examination results, and the remaining 74 children had cond itions that are of interest for pediatric screening, including strabis mus, refractive error, media opacities, and ptosis. Eighteen volunteer s, including pediatric ophthalmologists, pediatricians, ophthalmic tec hnicians, health department nurses, Prevention of Blindness Society pe rsonnel, and Lions Club volunteers, graded each of the 100 photoscreen ing photographs. Main Outcome Measures: Sensitivity and specificity of vision screening and of photograph grading were measured. Results: Re sults from various graders yielded sensitivities ranging from 37% to 8 8% and specificities ranging from 40% to 88%. No single grader achieve d sensitivity and specificity both greater than 70%. The grading of th e manufacturer's representative had a sensitivity of 43% and a specifi city of 85%. Sensitivity decreased to 31% for strabismus and 18% for r efractive error when the correct type of strabismus or refractive erro r was required to be considered true-positives. Results were not posit ively correlated with the ophthalmologic knowledge of the participant. Conclusions: The wide variability in sensitivities and specificities among graders indicates inconsistent photograph interpretation skills or deficient screening guidelines or both. For off-axis photoscreening as implemented by the MTI system to become a useful vision-screening method, additional photograph interpretation skill transfer may be ben eficial, although not necessarily sufficient.