SENSITIVITY OF THE MTI PHOTOSCREENER FOR AMBLYOGENIC FACTORS IN INFANCY AND EARLY-CHILDHOOD

Background: Screening for amblyogenic factors in infancy by pediatrici ans is unsatisfactory, as they hardly ever detect ametropia or microst rabismus. As photoscreening seems to be a helpful method to detect eve n small squint angles and refractive errors, we tested the MTI photosc reener for its sensitivity with respect to amblyogenic factors. Patien ts and methods: One hundred and twelve children aged 6-48 months were first examined with the MTI photoscreener. Then each child underwent c omplete medical examination by an ophthalmologist and an orthoptist. T he examination included the Hirschberg test (corneal reflex evaluation ), the Bruckner test (fundus red reflex), and, where possible, the Lan g stereotest, the cover test and visual acuity assessment, as well as a motility test, biomicroscopy, ophthalmoscopy in mydriasis and refrac tometry in cycloplegia. Exclusion criteria were any organic pathologic al results, manifest strabismus, ametropia greater than or equal to 2 D and astigmatism greater than or equal to 1 D. An orthoptist, a pedia trician and two ophthalmologists independently evaluated the Polaroid pictures according to the criteria given in the handbook of the MTI ph otoscreener.Results: For 10 children the evaluation with the MTI photo screener was not possible despite the fact that photographs were retak en several times. Thirteen photographs showing obvious pathologic find ings despite their poor quality were included. Eighty-three of the rem aining 102 children failed the eye examination according to the above- mentioned criteria. The mean sensitivity of the MTI photoscreener was determined to be 82.8%. The ability to correctly identify the absence of any amblyogenic factors (specificity) was 61.8%. Conclusions: Sensi tivity was high when compared to the usually low detection rate during pediatric examinations. Due to the low specificity, effectiveness was poor. Therefore an ophthalmological examination should be included in the preventive screening during infancy and early childhood.