Performance of Glow Fixation GoCheck Kids and 2WIN Photoscreeners and Retinomax to Uncover Hyperopia

Abstract

Background: A low-detail, glowing fixation device was added to GoCheck Kids (GCK) photoscreener in the hope of unmasking hyperopia and amblyopia risk factors (ARF).

Methods: Pediatric eye patients were screened by GCK and 2WIN photoscreeners, and Retinomax autorefractor before being compared to AAPOS ARFs.

Results: Screening was attempted by 131 children who then had school bus accommodation-relaxing skiascopy (SBA-RS) before cycloplegic examination. By 2013 AAPOS uniform guidelines, sensitivity/specificity for GCK was 87%/68%, for 2WIN 87%/71% and for Retinomax 79%/68%. Detection of amblyopia had sensitivity/specificity by GCK of 78%/63%, for 2WIN 79%/65% and for Retinomax 77%/68%. Inconclusive screens were seven for GCK, six for 2WIN and 13 for Retinomax. Mean hyperopia for GCK (+2.49±0.74 D) was similar to cycloplegic refraction (+2.93±0.72 D) and SBA-RS (+2.80±0.82 D) while GCK was slightly more than Retinomax (+1.59±0.93 D, p=0.13) but significantly more than 2WIN (+1.02±0.49 D, p<0.01).

Conclusion: GCK, 2WIN and Retinomax had similar validity detecting uniform amblyopia risk factors and amblyopia itself. The nondetailed glow fixation device allowed GCK to uncover substantial hyperopia while the detailed flashing fixation devices on 2WIN and Retinomax seemed to stimulate accommodation in some hyperopic children.

Clinical trials registry: NCT04297969. Data Access: http://www.abcd-vision.org/references/GCK%20glow%202WIN%20deidentify.pdf.

Précis: A glow fixation device on a smart phone photoscreener allowed robust detection of hyperopia.

Keywords: amblyopia risk factor; hyperopia; photoscreener; vision screening.

Conflict of interest statement

Miss Alexa Levitt reports grants from Ingram Scholars Program, during the conduct of the study; in addition, Miss Alexa Levitt has a patent glowing fixation device pending; and at the time this study was conducted she was an intern at GoCheck and finishing her undergraduate degree at Vanderbilt University. The Ingram Scholars Program (undergraduate merit scholarship program) awarded her the necessary funding to support her travel expenses from Nashville, TN (where the GoCheck office is) to Anchorage, AK (where Alaska Blind Child Discovery is). She worked with Dr Robert Arnold in his clinic on behalf of the Clinical team at GoCheck. Dr Arnold is a board member of Glacier Medical Software and PDI Check. He coordinates the Alaska Blind Child Discovery project and is an unpaid member of an advisory board to several photoscreeners including GoCheck Kids and Adaptica. Dr Arnold is an investigator and protocol developer with the NIH-supported Pediatric Eye Disease Investigator Group. Dr Arnold is a nonpaid advisory board member for PlusoptiX and iScreen, during the conduct of the study. He coordinates remote medical mission outreach that has received donations from several vendors for Burma Vision, outside the submitted work. In addition, Dr Robert W Arnold has a patent PDI Check pending to Robert W. Arnold and Alex Damarjian. The authors report no other conflicts of interest in this work.

© 2020 Levitt et al.

Figures

Figure 1

Three vision screening devices. GoCheck Kids (GCK) with flash concentrating case (foreground right) and a second GCK modified with white box containing the nondetailed slowly changing glow fixation device (foreground left). In the background left is the Righton Retinomax, on the right Adaptica 2WIN and center the school bus accommodation-relaxing skiascopy.

Figure 2

ROC curve for three objective vision screeners. Receiver operating characteristic (ROC) curve showing GoCheck Kids iPhone 7+ in flash concentrating case with glow fixation device (GCK), the Adaptica 2WIN and the Retinomax.

Figure 3

Hyperopia detected by photoscreeners. Linear correlations for the three vision screen devices, GoCheck Kids with glow fixation (GCK), Adaptica 2WIN and Retinomax (RM) and school bus accommodation-relaxing skiascopy (bus) compared to spherical equivalent cycloplegic refraction on left side of graph. On right side of graph, whisker plots demonstrate the degree of hyperopia measured by each technique with boxes encompassing the 25% and 75% with central horizontal bar the median and vertical bars extending to the range.

Figure 4

Bland–Altmann Plot analysis comparing cycloplegic refraction to two photoscreeners (GoCheck Kids (GCK) with glow fixation and Adaptica 2WIN) and Retinomax remote autorefractor and school bus accommodation-relaxing skiascopy (SBA-RS). These patients all had a spherical equivalent of 0.5 D or greater hyperopia with cycloplegic refraction. Each patient had readings with all four compared screening modalities.