Evaluation of the PlusoptiX photoscreener in the examination of children with intellectual disabilities

PURPOSE: This study aimed to determine whether the plusoptiX vision screener (PVS) can be used to detect amblyogenic risk factors (ARFs) as defined by the American Association for Paediatric Ophthalmology and Strabismus Vision Screening Committee guidelines (2013) for automated vision screening devices. METHODS: In this cross-sectional study, children attending a special needs school underwent screening with the PVS and complete ophthalmologic examinations. Ophthalmologic examinations were used as the gold standard to compute the prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and testability. RESULTS: Forty-four children with special needs (mean age, 8.5 years; range, 4–18 years) were included. The PVS recommended referral of 31 cases (referral rate 70%). Thirty-nine of the 44 children (89%) met the referral-positive threshold for strabismus, reduced vision and/or amblyogenic factors on examination. The plusoptiX had a sensitivity of 40% (confidence interval [CI] 7%–83%), specificity of 78% (CI 55%–85%), PPV of 15% (CI 3%–46%), and NPV of 90.3% (CI 73%–97%). The PVS underestimated refractive errors by 0.67 to 0.71 D in the right (P < 0.001) and left eyes (P = 0.002). Testability was relatively low, with the PVS at 75% compared to the gold standard examination at 100%. CONCLUSION: We found that although the plusoptiX photoscreener might be a useful tool in pediatric vision screening, it might not perform as well in children with intellectual disabilities. Utilization of the PVS as a single screening device may fail to identify a considerable proportion of young children with ARFs or amblyopia.