Comparison between the PlusoptiX and IScreen Photoscreeners in Detecting Amblyopic Risk Factors in Children


Purpose: To compare the accuracy of plusoptiX A08 photoscreener (PPS) and iScreen 3000 photoscreener (IPS) in objectively screening for amblyopic risk factors in children age 5 months to 13 years old. Methods: Cross-sectional study of 148 children who received photoscreenings via PPS and IPS and a comprehensive pediatric ophthalmic examination in our office. Patients were considered to have amblyogenic risk factors based on the AAPOS referral criteria guidelines. Results: 45 percent of patients undergoing a pediatric ophthalmology examination were found to have amblyopia or amblyogenic risk factors. In this study, PPS demonstrated an overall sensitivity of 75.4%, specificity of 68.0%, positive predictive value (PPV) of 67.1%, and negative predictive value (NPV) of 76.1%. However, IPS photoscreener had an overall sensitivity of 66.2%, specificity of 87.6%, PPV of 81.8%, and NPV of 75.5%. Discussion: The accuracy of PPS and IPS was compared in different age groups. The sensitivity and specificity were analyzed according to varied amblyogenic risk factors. The statistic results of this study were compared to those of previous studies, including Vision in Preschoolers (VIP) Study and the Iowa PhotoScreening Program. Conclusion: PPS and IPS proved to be useful tools in the objective vision screening in children. PPS was found to have a higher sensitivity, and IPS showed a higher specificity and PPV in detecting amblyopic risk factors. In conclusion, one device may be more beneficial over the other, depending on the patient population and office settings.

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Wang, J. and Suh, D. (2013) Comparison between the PlusoptiX and IScreen Photoscreeners in Detecting Amblyopic Risk Factors in Children. Open Journal of Ophthalmology, 3, 7-12. doi: 10.4236/ojoph.2013.31003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. I. Ehrlich, R. D. Reinecke and K. Simons, “Preschool Vision Screening for Amblyopia and Strabismus. Pro grams, Methods, Guidelines, 1983,” Survey of Ophthal mology, Vol. 28, No. 3, 1983, pp. 145-163. doi:10.1016/0039-6257(83)90092-9
[2] K. Simons, “Preschool Vision Screening: Rationale, Me thodology and Outcome,” Survey of Ophthalmology, Vol. 41, No. 1, 1996, pp. 3-30. doi:10.1016/S0039-6257(97)81990-X
[3] K. Attebo, P. Mitchell, R. Cumming, W. Smith, N. Jolly and R. Sparkes, “Prevalence and Causes of Amblyopia in an Adult Population,” Ophthalmology, Vol. 105, No. 1, 1998, pp. 154-159. doi:10.1016/S0161-6420(98)91862-0
[4] C. Powell and S. R. Hatt, “Vision Screening for Amblyo pia in Childhood,” Cochrane Database of Systematic Re views, No. 3, 2009, Article ID: CD005020.
[5] J. R. Thompson, G. Woodruff, F. A. Hiscox, N. Strong and C. Minshull, “The Incidence and Prevalence of Am blyopia Detected in Childhood,” Public Health, Vol. 105, No. 6, 1991, pp. 455-462. doi:10.1016/S0033-3506(05)80616-X
[6] M. Eibschitz-Tsimhoni, T. Friedman, J. Naor, N. Eib schitz and Z. Friedman, “Early Screening for Amblyoge nic Risk Factors Lowers the Prevalence and Severity of Amblyopia,” Journal of AAPOS, Vol. 4, No. 4, 2000, pp. 194-199. doi:10.1067/mpa.2000.105274
[7] J. H. Groenewoud, A. M. Tjiam, V. K. Lantau, W. C. Hoogeveen, J. T. de Faber, R. E. Juttmann, H. J. de Ko ning and H. J. Simonsz,, “Rotterdam AMblyopia Screen ing Effectiveness Study: Detection and Causes of Am blyopia in a Large Birth Cohort,” Investigative Ophthal mology & Visual Science, Vol. 51, No. 7, 2010, pp. 3476-3484. doi:10.1167/iovs.08-3352
[8] The Pediatric Eye Disease Investigator Group, “A Ran domized Trial of Atropine vs. Patching for Treatment of Moderate Amblyopia in Children,” Archives of Ophthal mology, Vol. 120, No. 3, 2002, pp. 268-278. doi:10.1001/archopht.120.3.268
[9] M. X. Repka, R. T. Kraker, R. W. Beck, J. M. Holmes, S. A. Cotter, E. E. Birch, W. F. Astle, D. L. Chandler, J. Fe lius, R. W. Arnold, D. R. Tien and S. R. Glaser, “A Ran domized Trial of Atropine vs. Patching for Treatment of Moderate Amblyopia: Follow-Up at Age 10 Years,” Ar chives of Ophthalmology, Vol. 126, No. 8, 2008, pp. 1039-1044. doi:10.1001/archopht.126.8.1039
[10] V. G. Kirk, M. M. Clausen, M. D. Armitage and R. W. Arnold, “Preverbal Photoscreening for Amblyogenic Fac tors and Outcomes in Amblyopia Treatment: Early Ob jective Screening and Visual Acuities,” Archives of Oph thalmology, Vol. 126, No. 4, 2008, pp. 489-492. doi:10.1001/archopht.126.4.489
[11] R. G. Teed, C. M. Bui, D. G. Morrison, R. L. Estes and S. P. Donahue, “Amblyopia Therapy in Children Identified by Photoscreening,” Ophthalmology, Vol. 117, No. 1, 2010, pp. 159-162. doi:10.1016/j.ophtha.2009.06.041
[12] K. Taylor and S. Elliott, “Interventions for Strabismic Am blyopia,” Cochrane database of systematic reviews, No. 8, 2011, Article ID: CD006461.
[13] S. P. Donahue and J. B. Ruben, et al., “US Preventive Ser vices Task Force Vision Screening Recommendations,” Pediatrics, Vol. 127, No. 3, 2011, pp. 569-570. doi:10.1542/peds.2011-0020
[14] R. Chou, T. Dana and C. Bougatsos, “Screening for Vi sual Impairment in Children Ages 1-5 Years: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation,” Agency for Healthcare Research and Quality (US), Rockville, 2011.
[15] A. Kemper, R. Harris, T. A. Lieu, C. J. Homer and B. L. Whitener, “Screening for Visual Impairment in Children Younger than Age 5 Years: A Systematic Evidence Re view for the U.S. Preventive Services Task Force,” Agen cy for Healthcare Research and Quality (US), Rockville, 2004.
[16] T. C. Wall, W. Marsh-Tootle, H. H. Evans, C. A. Farga son, C. S. Ashworth and J. M. Hardin, “Compliance with Vision-Screening Guidelines among a National Sample of Pediatricians,” Ambulatory Pediatrics, Vol. 2, No. 6, 2002, pp. 449-455. doi:10.1367/1539-4409(2002)002<0449:CWVSGA>2.0.CO;2
[17] P. Y. Tong, E. Enke-Miyazaki, R. E. Bassin, J. M. Tie lsch, D. R. Stager Sr., G. R. Beauchamp and M. M. Parks, “Screening for Amblyopia in Preverbal Children with Pho toscreening Photographs. National Children’s Eye Care Foundation Vision Screening Study Group,” Ophthalmo logy, Vol. 105, No. 5, 1998, pp. 856-863.
[18] Committee on Practice and Ambulatory Medicine and Section on Ophthalmology, “Use of Photoscreening for Children’s Vision Screening,” Pediatrics, Vol. 109, No. 3, 2002, pp. 524-525. doi:10.1542/peds.109.3.524
[19] S. Q. Longmuir, W. Pfeifer, A. Leon, R. J. Olson, L. Short and W. E. Scott, “Nine-Year Results of a Volunteer Lay Network Photoscreening Program of 147,809 Chil dren Using a Photoscreener in Iowa,” Ophthalmology, Vol. 117, No. 10, 2010, pp. 1869-1875. doi:10.1016/j.ophtha.2010.03.036
[20] N. S. Matta, R. W. Arnold, E. L. Singman and D. I. Sil bert, “Can a Photoscreener Help Us Remotely Evaluate and Manage Amblyopia?” American Orthoptic Journal, Vol. 61, No. 1, 2011, pp. 124-127. doi:10.3368/aoj.61.1.124
[21] A. S. A. Moghaddam, A. Kargozar, M. Zarei-Ghanavati, M. Najjaran, V. Nozari and M. T. Shakeri, “Screening for Amblyopia Risk Factors in Preverbal Children Using the Plusoptix Photoscreener: A Cross-Sectional Population Based Study,” British Journal of Ophthalmology, 2011,
[22] S. P. Donahue, J. D. Baker, W. E. Scott, P. Rychwalski, D. E. Neely, P. Tong, D. Bergsma, D. Lenahan, D. Rush, K. Heinlein, R. Walkenbach and T. M. Johnson, “Lions Clubs International Foundation Core Four Photoscreening: Results from 17 Programs and 400,000 Preschool Chil dren,” Journal of AAPOS, Vol. 10, No. 1, 2006, pp. 44-48. doi:10.1016/j.jaapos.2005.08.007
[23] N. S. Matta, E. L. Singman and D. I. Silbert, “Perfor mance of the Plusoptix S04 Photoscreener for the Detec tion of Amblyopia Risk Factors in Children Aged 3 to 5,” Journal of AAPOS, Vol. 14, No. 2, 2010, pp. 147-149.
[24] S. P. Donahue, R. W. Arnold and J. B. Ruben, “Preschool Vision Screening: What Should We Be Detecting and how Should We Report It? Uniform Guidelines for Re porting Results of Preschool Vision Screening Studies,” Journal of AAPOS, Vol. 7, No. 5, 2003, pp. 314-316.
[25] P. Schmidt, M. Maguire, V. Dobson, G. Quinn, E. Ciner, L. Cyert, M. T. Kulp, B. Moore, D. Orel-Bixler, M. Red ford and G. S. Ying, “Comparison of Preschool Vision Screening Tests as Administered by Licensed Eye Care Professionals in the Vision in Preschoolers Study,” Oph thalmology, Vol. 111, No. 4, 2004, pp. 637-650.
[26] M. M. Clausen and R. W. Arnold, “Pediatric eye/vision screening. Referral Criteria for the Pedia Vision plus Op tix S 04 Photoscreener Compared to Visual Acuity and Digital Photoscreening. Kindergarten Computer Photo screening,” Binocular Vision and Strabismus Quarterly, Vol. 22, No. 2, 2007, pp. 83-89.
[27] W. L. Ottar, W. E. Scott and S. I. Holgado, “Photoscreen ing for Amblyogenic Factors,” Journal of Pediatric Oph thalmology and Strabismus, Vol. 32, No. 5, 1995, pp. 289-295.

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