Performance of Two Photoscreeners Enhanced by Protective Cases

Samuel Joseph Martin, Hser Eh Htoo, Nay Hser, Robert W Arnold, Samuel Joseph Martin, Hser Eh Htoo, Nay Hser, Robert W Arnold

Abstract

Background: Photoscreeners provide valid, cost-effective early detection of amblyopia risk factors; however, they require proper illumination, flash intensity, pupil dilation and patient cooperation. The Kaleidos case for the 2WIN infrared photoscreener fixes focal distance, decreases luminance and provides electric power. GoCheck Kids (GCK) has developed a flash-concentrating case for the Apple iPhone 7 Plus smartphone to reduce exposure time.

Methods: In remote Burmese and urban Alaskan clinics, Kaleidos and GCK were used before a confirmatory eye examination using 2013 AAPOS uniform guidelines validation, including some older patients. 2WIN refraction was compared to a cycloplegic examination using J0 and J45 vector transformation.

Results: In total, 48 Burmese patients and 114 Alaskan patients aged 8±6 years were evaluated utilizing 2013 amblyopia risk factor guidelines. Kaleidos, with 13 Burmese inconclusives, had a sensitivity of 84%, specificity of 65% and positive predictive value (PPV) of 63%. GCK, with only six inconclusives, had a sensitivity of 63%, specificity of 83% and PPV of 73%, with sensitivity improving to 74% with central expert interpretation. Kaleidos closely matched cycloplegic refraction, with intraclass correlations of 0.47 for J0 vector and 0.57 for J45 vector. The protective cases provided clearer images and better pupil dilation than similar devices without cases.

Conclusion: Both devices detected amblyopia risk factors well. GCK gave fewer inconclusive results even with the Asian eyelid configuration, while Kaleidos matched sphere and cylinder refraction. The specialized housing enhanced the performance of the 2WIN and GCK photoscreeners, improving the speed and reliability of amblyopia screening and refraction, even in populous and luminous locations.

Clinical trials registry: NCT04068129.

Keywords: amblyopia; instrument-based screening; pediatric vision screening; validation.

Conflict of interest statement

Dr. Arnold coordinates the Alaska Blind Child Discovery (ABCD) project, which has received discounted vision screen technology from several vendors. He is the President of Glacier Medical Software, which markets the cloud-based NICU monitoring software ROP Check. Dr. Arnold is also the President of PDI Check, which has developed vision screening game for the Nintendo 3DS. Dr. Arnold is an investigator and protocol developer for PEDIG. Dr. Robert Arnold has a patent for PDI Check pending to Robert Arnold and Alex Damarjian. Sam Joseph Martin, Nay Hser and Hser Eh Htoo have no financial conflicts to disclose. The authors report no other conflicts of interest in this work.

© 2020 Martin et al.

Figures

Figure 1
Figure 1
Kaleidos enhanced housing for 2WIN photoscreening, with housing opened to allow manual control. (Parental permission given for use of all photographs).
Figure 2
Figure 2
GoCheck Kids iPhone 7 Plus with flash-concentrating case being used in a tent in Burma.
Figure 3
Figure 3
ROC curve. Performance of GoCheck Kids iPhone 7 Plus with flash-concentrating case (GCK, circles) and 2WIN photoscreener in Kaleidos enhancing case (Kaleidos, squares) validated against the age-enhanced 2013 AAPOS uniform amblyopia risk factor (ARF) guidelines (solid bold lines) and amblyopia (fine, dashed lines).
Figure 4
Figure 4
Kaleidos J0 vector analysis comparing Kaleidos refractions with cycloplegic retinoscopy.
Figure 5
Figure 5
J45 vector analysis comparing 2WIN photoscreening through Kaleidos protective case with uniform guidelines cycloplegic refraction.
Figure 6
Figure 6
Bland–Altman plot for J0 vectors comparing Kaleidos with retinoscopy.
Figure 7
Figure 7
Bland–Altman plot for J45 vectors comparing Kaleidos with retinoscopy.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/7259487/bin/OPTH-14-1427-g0001.jpg

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Source: PubMed

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