TABLE 7

Diagnostic Accuracy of Preschool Vision-Screening Tests

TestTarget ConditionSensitivity (95% CI)Specificity (95% CI)PLR (95% CI)NLR (95% CI)
Visual acuity tests
    Crowded Lea symbols visual acuity test (4 studies)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.61 (0.56–0.66)a0.90 (0.88–0.92)a6.1 (4.8–7.6)a0.43 (0.38–0.50)a
        Bertuzzi et al31 (2006)Amblyogenic risk factors0.96 (0.78–1.00)b0.83 (0.75–0.90)b5.7 (3.8–8.6)b0.05 (0.01–0.36)b
5.9 (5.7–6.1)c0.15 (0.05–0.43)c
        Miller et al46 (1999)Significant refractive error0.91 (0.82–0.96)d0.44 (0.37–0.52)d1.6 (1.4–1.9)d0.21 (0.10–0.43)d
        Miller et al47 (2001)Astigmatism0.93 (0.87–0.97)d0.51 (0.44–0.57)d1.9 (1.6–2.2)d0.14 (0.08–0.27)d
    Crowded HOTV visual acuity test (1 study)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.54 (0.49–0.59)a0.89 (0.87–0.91)a4.9 (3.9–6.1)a0.52 (0.46–0.58)a
Stereoacuity tests
    Random dot E stereogram (3 studies)
        Chang et al32 (2007)Amblyopia0.20r0.98r11.4r0.81r
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.42 (0.37–0.47)a0.90 (0.88–0.92)a4.2 (3.3–5.3)a0.65 (0.59–0.71)a
        Hope and Maslin40 (1990)Refractive error or strabismus0.89 (0.52–1.0)0.76 (0.68–0.82)3.6 (2.5–5.2)0.15 (0.02–0.94)
4.2 (3.6–11.4)c0.65 (0.15–0.81)c
    Stereo Smile II (1 study)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.44 (0.39–0.49)a0.91 (0.89–0.93)a4.9 (3.9–6.1)a0.62 (0.56–0.67)a
Ocular alignment test
    Cover-uncover test (1 study)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.16 (0.12–0.20)0.98 (0.97–0.99)7.9 (4.6–14.0)0.86 (0.82–0.90)
Combined clinical tests (5 studies)
    Kennedy et al43 (1995)Amblyogenic risk factors0.09 (0.04–0.20)1.00 (0.99–1.0)17 (5.5–54)0.91 (0.84–0.99)
    Barry and Konig29 (2003)Amblyopia or amblyogenic risk factors0.91 (0.71–0.99)0.94 (0.92–0.95)15 (11–19)0.10 (0.03–0.36)
    Newman and East50 (1999)Amblyopia1.00 (0.78–1.0)0.93 (0.91–0.95)14 (10–19)0.03 (0.002–0.51)
    Shallo-Hoffmann et al53 (2004)Amblyogenic risk factors0.73 (0.13–0.98)0.94 (0.90–0.96)12 (4.7–28)0.28 (0.03–2.4)
    Chui et al33 (2004)Amblyogenic risk factors0.67 (0.41–0.87)0.86 (0.79–0.92)4.8 (2.8–8.4)0.39 (0.20–0.75)
14 (4.8–17)c0.28 (0.03–0.91)c
Autorefractors
    Retinomax (4 studies)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.64 (0.60–0.67)a0.90 (0.88–0.91)a6.1 (5.2–7.0)a0.41 (0.37–0.45)a
        Barry and Konig28 (2001)Amblyopia0.80 (0.44–0.98)0.58 (0.53–0.62)1.9 (1.4–2.6)0.35 (0.10–1.2)
3.4 (1.9–6.1)c0.38 (0.35–0.41)c
        Miller et al46 (1999)Significant refractive error0.91 (0.82–0.96)d0.86 (0.80–0.91)d6.7 (4.5–9.8)d0.11 (0.05–0.22)d
        Miller et al47 (2001)Astigmatism0.93 (0.88–0.96)d0.95 (0.91–0.98)d18 (10–34)d0.08 (0.04–0.13)d
    SureSight autorefractor (3 studies)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.85 (0.81–0.88)f0.62 (0.59–0.65)f2.2 (2.0–2.4)f0.24 (0.19–0.30)f
0.63 (0.59–0.65)a,d0.90 (0.88–0.92)a,d6.3 (5.2–7.7)a,d0.41 (0.36–0.47)a,d
        Kemper et al41 (2005)Amblyogenic risk factors0.85 (0.69–0.95)0.52 (0.40–0.63)1.8e0.29e
        Rogers et al52 (2008)Amblyogenic risk factors0.97 (0.88–1.0)f0.38 (0.24–0.54)f1.6 (1.2–2.0)f0.09 (0.02–0.37)f
0.79 (0.67–0.89)d,g0.64 (0.48–0.78)d,g2.2 (1.4–3.4)d,g0.32 (0.18–0.52)d,g
1.8 (1.6–2.2)c,f0.24 (0.09–0.29)c,f
    Topcon PR 2000 (1 study)
        Williams et al58 (2000)Spherical error > 3.75 D0.50 (0.33–0.67)0.95 (0.90–0.98)9.6 (4.5–20)0.53 (0.38–0.73)
Anisometropia0.74 (0.52–0.90)0.95 (0.91–0.98)15 (7.5–32)0.27 (0.14–0.55)
Astigmatism0.47 (0.28–0.66)0.96 (0.92–0.99)12 (5.2–30)0.55 (0.40–0.78)
    PlusOptix/Power Refractor (6 studies)
        Dahlmann-Noor et al36 (2009)Decreased visual acuity, strabismus, and ptosis0.45 (0.29–0.62)1.0 (0.98–1.0)230 (14–3680)0.56 (0.42–0.74)
        Arthur et al27 (2009)Amblyogenic risk factors0.83 (0.67–0.93)0.95 (0.92–0.98)18 (10–33)0.17 (0.08–0.36)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.54 (0.49–0.59)a0.90 (0.88–0.92)a5.4 (4.4–6.6)a0.51 (0.46–0.57)a
        Ehrt et al38 (2007)Amblyogenic risk factors0.71 (0.59–0.82)0.78 (0.68–0.86)3.2 (2.2–4.9)0.37 (0.25–0.54)
        Matta et al45 (2008)Amblyogenic risk factors0.98 (0.85–1.0)0.68 (0.51–0.81)3.0 (1.9–4.7)f0.04 (0.01–0.26)f
0.98 (0.85–1.0)0.88 (0.74–0.96)8.4 (3.7–19)a,d0.03 (0.00–0.20)a,d
5.4 (3.0–230)c0.17 (0.04–0.56)c
        Dahlmann-Noor et al37 (2009)Myopia0.88 (0.30–1.0)0.96 (0.89–0.99)21 (7.8–55)0.13 (0.01–1.7)
Hyperopia0.20 (0.10–0.35)0.99 (0.92–1.0)26 (1.6–450)0.81 (0.70–0.94)
Astigmatism0.75 (0.36–0.96)0.93 (0.86–0.97)11 (4.7–24)0.27 (0.08–0.89)
Anisometropia0.50 (0.31–0.69)0.87 (0.77–0.93)3.7 (1.9–7.1)0.58 (0.40–0.84)
Photoscreeners
    MTI photoscreener (8 studies)
        Ottar et al51 (1995) and Donahue et al59 (2002)Amblyogenic risk factors0.82 (0.76–0.87)0.91 (0.88–0.93)8.7 (6.9–11)0.20 (0.15–0.27)
        Rogers et al52 (2008)Amblyogenic risk factors0.95 (0.86–0.99)0.88 (0.74–0.96)8.0 (3.5–18)0.06 (0.02–0.18)
        Tong et al56 (2000)Amblyogenic risk factors0.56 (0.50–0.62)0.91 (0.84–0.96)6.4 (3.4–12)0.48 (0.42–0.56)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.37 (0.32–0.42)0.94 (0.92–0.95)6.2 (4.7–8.1)0.67 (0.62–0.72)
        Cooper et al35 (1999)Amblyopia0.62 (0.56–0.68)h0.83 (0.80–0.86)h3.7 (2.8–4.9)h0.45 (0.37–0.55)h
        Berry et al30 (2001)Amblyogenic risk factors0.83 (0.61–0.95)0.68 (0.48–0.84)2.6 (1.4–4.5)0.26 (0.10–0.65)
        Weinand et al57 (1998)Amblyogenic risk factors0.83 (0.72–0.94)h0.66 (0.42–0.74)h2.4 (1.6–3.0)h0.26 (0.14–0.38)h
6.2 (2.4–8.7)c0.26 (0.06–0.67)c
        Miller et al47 (2001)Significant refractive error0.66 (0.59–0.73)a0.71 (0.64–0.78)a2.3 (1.8–2.9)a0.48 (0.38–0.60)a
        Ottar et al51 (1995) and Donahue et al59 (2002)Higher-magnitude amblyogenic risk factors0.50 (0.39–0.61)0.98 (0.97–0.99)33 (18–58)0.51 (0.41–0.63)
    iScreen Photoscreener (2 studies)
        Kennedy and Thomas44 (2000)Amblyogenic risk factors0.92 (0.88–0.95)0.89 (0.83–0.94)8.6 (5.4–14)0.09 (0.06–0.13)
        VIP Study Group55 (2004)Amblyogenic risk factors or significant nonamblyogenic refractive error0.37 (0.32–0.42)0.94 (0.92–0.95)6.2 (4.7–8.1)0.67 (0.62–0.72)
7.3 (6.2–8.6)c0.25 (0.09–0.67)c
    Visiscreen 100 photoscreener (2 studies)
        Cogen and Ottemiller34 (1992)Amblyogenic risk factors0.85 (0.55–0.98)0.94 (0.87–0.98)14 (6.3–32)0.16 (0.05–0.59)
        Morgan and Johnson49 (1987)Amblyogenic risk factors0.91 (0.76–0.98)0.74 (0.52–0.90)3.5 (1.7–7.0)0.12 (0.04–0.36)
7.0 (3.5–14)c0.14 (0.12–0.16)c
    Fortune Optical VRB-100 photoscreener (1 study)
        Cooper et al35 (1999)Amblyopia0.64 (0.60–0.69)h0.81 (0.76–0.86)h3.5 (2.5–4.9)h0.44 (0.37–0.52)h
    Computer photoscreener (1 study)
        Guo et al39 (2000)Amblyogenic risk factors0.95 (0.90–0.98)0.90 (0.84–0.95)9.6 (5.7–16)0.06 (0.03–0.11)
    Otago (noncommercial) photoscreener (3 studies)
        Kennedy et al43 (1995)Amblyogenic risk factors0.46 (0.22–0.72)1.0 (0.99–1.0)110 (38–310)0.54 (0.33–0.89)
        Kennedy and Sheps42 (1989)Amblyogenic risk factors0.94 (0.87–0.98)0.94 (0.89–0.98)16 (8.2–32)0.06 (0.03–0.14)
        Molteno et al48 (1993)Amblyogenic risk factors0.89 (0.86–0.91)0.61 (0.55–0.66)2.3 (2.0–2.6)0.18 (0.14–0.22)
16 (2.3–110)c0.18 (0.06–0.54)c
  • a Based on 90% specificity.

  • b Based on 0.80 acuity score cutoff.

  • c Values are median (range).

  • d Excluded from calculation of median.

  • e CIs not calculable.

  • f Based on manufacturer's referral criteria.

  • g Based on VIP Study 90% specificity criteria.

  • h Based on median results from multiple readers (numbers in parentheses are ranges).