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Mayu Nishimura - One of the best experts on this subject based on the ideXlab platform.
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feasibility of a school based Vision Screening program to detect undiagnosed visual problems in kindergarten children in ontario
Canadian Medical Association Journal, 2020Co-Authors: Mayu Nishimura, Agnes M F Wong, Hele Dimaras, Daphne MaureAbstract:BACKGROUND: Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based Screening program to identify and treat kindergarten children with visual problems. METHODS: We conducted a prospective cohort study offering Vision Screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses). RESULTS: Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p INTERPRETATION: Many children in Ontario with a visual problem were not being identified by the status quo in 2015–2017. We found that in-school Vision Screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1.
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feasibility of a school based Vision Screening program to detect undiagnosed visual problems in kindergarten children in ontario
Canadian Medical Association Journal, 2020Co-Authors: Mayu Nishimura, Agnes M F Wong, Hele Dimaras, Daphne MaurerAbstract:BACKGROUND: Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based Screening program to identify and treat kindergarten children with visual problems. METHODS: We conducted a prospective cohort study offering Vision Screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses). RESULTS: Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p INTERPRETATION: Many children in Ontario with a visual problem were not being identified by the status quo in 2015–2017. We found that in-school Vision Screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1.
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choosing appropriate tools and referral criteria for Vision Screening of children aged 4 5 years in canada a quantitative analysis
BMJ Open, 2019Co-Authors: Mayu Nishimura, Agnes M F Wong, Ashley Cohen, Kevin E Thorpe, Daphne MaurerAbstract:Objectives To assess the diagnostic accuracy of five Vision Screening tools used in a school setting using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Design We compared the results of the five best evidence-based Screening tools available in 2014 to the results of a comprehensive eye exam with cycloplegic refraction by a licenced optometrist. Screening included Cambridge Crowded Acuity Cards, Plusoptix S12 and Spot photoscreeners, Preschool Randot Stereoacuity Test and the Pediatric Vision Scanner (PVS). Referral criteria followed AAPOS (2013) guidelines and published norms. Setting A large school in Toronto, Canada, with 25 split classrooms of junior kindergarten (JK: 4 year olds) and senior kindergarten (SK: 5 year olds) children. Participants Over 2 years, 1132 eligible children were enrolled at the school. After obtaining parental consent, 832 children were screened. Subsequently, 709 children had complete Screening and optometry exam data. Main outcome measures The presence/absence of a visual problem based on optometrist’s assessment: amblyopia, amblyopia risk factors (reduced stereoacuity, strabismus and clinically significant refractive errors) and any other ocular problem (eg, nystagmus). Results Overall, 26.5% of the screened children had a visual problem, including 5.9% with amblyopia. Using all five tools, Screening sensitivity=84% (95% CI 78 to 89), specificity=49% (95% CI 44 to 53), PPV=37% (95% CI 33 to 42), and NPV=90% (95% CI 86 to 93). The odds of having a correct Screening result in SK (mean age=68.2 months) was 1.5 times those in JK (mean age=55.6 months; 95% CI 1.1 to 2.1), with sensitivity improved to 89% (95% CI 80 to 96) and specificity improved to 57% (95% CI 50 to 64) among SK children. Conclusions A school-based Screening programme correctly identified 84% of those kindergarten children who were found to have a visual problem by a cyclopleged optometry exam. Additional analyses revealed how accuracy varies with different combinations of Screening tools and referral criteria.
Daphne Maurer - One of the best experts on this subject based on the ideXlab platform.
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feasibility of a school based Vision Screening program to detect undiagnosed visual problems in kindergarten children in ontario
Canadian Medical Association Journal, 2020Co-Authors: Mayu Nishimura, Agnes M F Wong, Hele Dimaras, Daphne MaurerAbstract:BACKGROUND: Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based Screening program to identify and treat kindergarten children with visual problems. METHODS: We conducted a prospective cohort study offering Vision Screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses). RESULTS: Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p INTERPRETATION: Many children in Ontario with a visual problem were not being identified by the status quo in 2015–2017. We found that in-school Vision Screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1.
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choosing appropriate tools and referral criteria for Vision Screening of children aged 4 5 years in canada a quantitative analysis
BMJ Open, 2019Co-Authors: Mayu Nishimura, Agnes M F Wong, Ashley Cohen, Kevin E Thorpe, Daphne MaurerAbstract:Objectives To assess the diagnostic accuracy of five Vision Screening tools used in a school setting using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Design We compared the results of the five best evidence-based Screening tools available in 2014 to the results of a comprehensive eye exam with cycloplegic refraction by a licenced optometrist. Screening included Cambridge Crowded Acuity Cards, Plusoptix S12 and Spot photoscreeners, Preschool Randot Stereoacuity Test and the Pediatric Vision Scanner (PVS). Referral criteria followed AAPOS (2013) guidelines and published norms. Setting A large school in Toronto, Canada, with 25 split classrooms of junior kindergarten (JK: 4 year olds) and senior kindergarten (SK: 5 year olds) children. Participants Over 2 years, 1132 eligible children were enrolled at the school. After obtaining parental consent, 832 children were screened. Subsequently, 709 children had complete Screening and optometry exam data. Main outcome measures The presence/absence of a visual problem based on optometrist’s assessment: amblyopia, amblyopia risk factors (reduced stereoacuity, strabismus and clinically significant refractive errors) and any other ocular problem (eg, nystagmus). Results Overall, 26.5% of the screened children had a visual problem, including 5.9% with amblyopia. Using all five tools, Screening sensitivity=84% (95% CI 78 to 89), specificity=49% (95% CI 44 to 53), PPV=37% (95% CI 33 to 42), and NPV=90% (95% CI 86 to 93). The odds of having a correct Screening result in SK (mean age=68.2 months) was 1.5 times those in JK (mean age=55.6 months; 95% CI 1.1 to 2.1), with sensitivity improved to 89% (95% CI 80 to 96) and specificity improved to 57% (95% CI 50 to 64) among SK children. Conclusions A school-based Screening programme correctly identified 84% of those kindergarten children who were found to have a visual problem by a cyclopleged optometry exam. Additional analyses revealed how accuracy varies with different combinations of Screening tools and referral criteria.
Audrey Novak - One of the best experts on this subject based on the ideXlab platform.
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baltimore Vision Screening project phase 2
Ophthalmology, 1998Co-Authors: Mark W Preslan, Audrey NovakAbstract:Background: Vision Screening in preschool and school age children remains a valuable method of identifying potentially treatable visual abnormalities, as well as refractive errors in the school age population. A major difficulty in conducting these types of programs is the inconsistent follow-up encountered frequently in children identified by the Screening program. The Baltimore Vision Screening Project was designed to address the issue of access to care for a group of inner city elementary school students by providing on-site evaluation and treatment. Methods: A standard Vision-Screening protocol was administered to prekindergarten and kindergarten students attending an inner city elementary school and access to care provided at the school. Children identified by the Screening were examined at the school, and appropriate treatment was prescribed. The second phase of the study details a return to the school 1 year after the initial Screening. The purpose of this was to reassess the level of visual morbidity in this population and to evaluate the effects of providing treatment in the previous year. Results: Two hundred eighty-five children were screened during the 1994–1995 school year. Visual morbidity statistics from the follow-up year were similar to those of the previous Screening: 5.3% diagnosed with amblyopia, 3.2% with strabismus, and 7.4% with refractive errors. Forty of the 68 children identified, examined, and treated in the previous year still were attending the school during the follow-up investigation. Compliance with recommended treatment was 30% in this group, with only 20% of the students passing the Vision Screening the following year. Conclusions: The follow-up Screening confirmed the presence of significant visual morbidity in this group of preschool and kindergarten students. Nearly two thirds of the students had not complied with the recommended treatment or spectacle wear or both, despite providing immediate access to this care through the Vision-Screening program.
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small target random dot stereogram and binocular suppression testing for preschool Vision Screening
Journal of Pediatric Ophthalmology & Strabismus, 1996Co-Authors: Kurt Simons, Kelly Elhatton Avery, Audrey NovakAbstract:BACKGROUND: New, small-target (< 1 degree) random dot stereogram (STRDS) and binocular suppression (STBS) tests appropriate for preschool Vision Screening were developed to correct the shortcomings of previous such tests, particularly missed cases of anisometropic amblyopia such as found with some RDS-based testing. METHODS: In Experiment 1, the tests were administered to 14 patients with current or a recent history of moderate (< or = 20/60) anisometropic amblyopia, or with accommodative esotropia or monofixation syndrome. All subjects had good binocularity (< or = 100" contour stereoacuity). In Experiment 2, the new tests were administered in a Screening setting to a group of 112 three- to five-year-olds to determine testability. Visual acuity, cover testing, and photoScreening were administered as control measures. RESULTS: In Experiment 1, eleven of the 14 patients failed both tests. Two anisometropic amblyopes passing one or both tests had an acuity < or = 20/30 in the worse eye and < or = 25" stereoacuity. Three anisometropic amblyopia patients failing the STRDS passed another RDS test with similar disparity but a larger target size, confirming a report34 that anisometropic amblyopes may pass RDS testing with parafoveal stereopsis despite the presence of central suppression. The STRDS and STBS tests indicated 80% and 96% specificity, respectively, with the original methodologies; STRDS specificity increased to 95% with retesting with a different methodology. Administration time was 30 sec to 60 sec per test. CONCLUSION: Small-target RDS or suppression testing may be more effective for strabismus and amblyopia Screening of preschoolers than previous RDS test formats.
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baltimore Vision Screening project
Ophthalmology, 1996Co-Authors: Mark W Preslan, Audrey NovakAbstract:Purpose: This study estimates the prevalence of common visual disorders (amblyopia, strabismus, refractive errors) in a group of inner-city school children. In addition, the study addresses the issue of access to care for Vision-Screening programs, specifically for children with recognized difficulties in obtaining routine medical care. Methods: School children from an inner-city elementary school were enrolled into a prospective Vision-Screening program combining the identification arm (Screening) and diagnostic/treatment arm (ophthalmic examination). The Screening consisted of Snellen E optotypes presented at a 10-foot test distance. Each child failing the Vision Screening was examined by an ophthalmologist at the school using a standard protocol. This allowed the authors to examine all children identified through the Vision-Screening program. Results: Six-hundred eighty children were screened during the 1993 to 1994 school year. Eleven percent (76) failed the Vision Screening and were examined, 68 of whom failed the ophthalmic examination. The estimated prevalence of visual morbidity was as follows: amblyopia, 3.9%; strabismus, 3.1%; and refractive errors, 8.2%. Conclusion: Amblyopia, strabismus, and refractive errors were found in relatively high frequencies for this population sample of inner-city children. These findings underscore the necessity of comprehensive Vision-Screening programs that integrate follow-up care. Children with limited access to specialized eye care must be provided with a mechanism for obtaining these services.
Sean P Donahue - One of the best experts on this subject based on the ideXlab platform.
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preschool Vision Screening where we have been and where we are going
American Journal of Ophthalmology, 2018Co-Authors: Evan Silverstein, Sean P DonahueAbstract:Purpose To discuss the evolution of instrument-based Screening to detect amblyopia and its risk factors, and to summarize the importance of preschool Vision Screening. Design Expert commentary. Methods Author experiences were supplemented by a review and interpretation of pertinent medical literature. Results Amblyopia remains a public health problem, as it is a common cause of monocular visual impairment. As a disease, amblyopia detection is best obtained by appropriate Vision Screening rather than by yearly mandated comprehensive eye examinations for all children; the US Preventative Services Task Force (USPSTF) recently reaffirmed their recommendations for Vision Screening in preschool children. Vision Screening devices have evolved over the past 4 decades ranging from photoscreeners that use instantaneously developing film, to autorefractors that detect amblyopia risk factors, to nerve fiber layer scanners that detect the microtropia that nearly always accompanies amblyopia. When it is detected early, effective treatment for amblyopia can be initiated. Conclusions Amblyopia is a reversible cause of Vision loss in children. Vision Screening devices and Screening programs have been extensively studied—experts and literature agree: Vision Screening devices and programs are cost-effective, are efficient, and are effective methods for amblyopia detection. The authors support the regular use of instrument-based Vision Screening in the medical home for all children until they reach a developmental stage where they can participate reliably in optotype-based Vision Screening.
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procedures for the evaluation of the visual system by pediatricians
Pediatrics, 2016Co-Authors: Sean P Donahue, Cynthia BakerAbstract:Vision Screening is crucial for the detection of visual and systemic disorders. It should begin in the newborn nursery and continue throughout childhood. This clinical report provides details regarding methods for pediatricians to use for Screening.
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guidelines for automated preschool Vision Screening a 10 year evidence based update
Journal of Aapos, 2013Co-Authors: Sean P Donahue, Brian W Arthur, Daniel E Neely, Robert W Arnold, David I Silbert, James B RubenAbstract:Summary In 2003 the American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee proposed criteria for automated preschool Vision Screening. Recent literature from epidemiologic and natural history studies, randomized controlled trials of amblyopia treatment, and field studies of Screening technologies have been reviewed for the purpose of updating these criteria. The prevalence of amblyopia risk factors (ARF) is greater than previously suspected; many young children with low-magnitude ARFs do not develop amblyopia, and those who do often respond to spectacles alone. High-magnitude ARFs increase the likelihood of amblyopia. Although depth increases with age, amblyopia remains treatable until 60 months, with decline in treatment effectiveness after age 5. US Preventive Services Task Force Preventative Services Task Force guidelines allow photoScreening for children older than 36 months of age. Some technologies directly detect amblyopia rather than ARFs. Age-based criteria for ARF detection using photoScreening is prudent: referral criteria for such instruments should produce high specificity for ARF detection in young children and high sensitivity to detect amblyopia in older children. Refractive Screening for ARFs for children aged 12-30 months should detect astigmatism >2.0 D, hyperopia >4.5 D, and anisometropia >2.5 D; for children aged 31-48 months, astigmatism >2.0 D, hyperopia > 4.0 D, and anisometropia >2.0 D. For children >49 months of age original criteria should be used: astigmatism >1.5 D, anisometropia>1.5 D, and hyperopia >3.5 D. Visually significant media opacities and manifest (not intermittent) strabismus should be detected at all ages. Instruments that detect amblyopia should report results using amblyopia presence as the gold standard. These new American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee guidelines will improve reporting of results and comparison of technologies.
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modification of plusoptix referral criteria to enhance sensitivity and specificity during pediatric Vision Screening
Journal of Aapos, 2011Co-Authors: Niraj R Nathan, Sean P DonahueAbstract:Purpose To determine the impact of using several different proposed sets of referral criteria on the specificity and sensitivity of the plusoptiX S08 photoscreener for detecting amblyopia risk factors. Methods During a 2-month period, 144 children ages 9 months to 14 years were screened at the Tennessee Lions Eye Center before receiving a comprehensive eye examination and cycloplegic refraction. Three previously published sets of referral criteria were used for Screening, including the manufacturer’s criteria and the criteria proposed by Arthur and colleagues, which are nearly identical to the gold standard examination failure thresholds proposed by the Vision Screening Committee of the American Association of Pediatric Ophthalmology and Strabismus (AAPOS). Modifications of these criteria also were evaluated. The Screening results obtained by the plusoptiX S08 were compared with the results from the gold standard pediatric ophthalmologic examination, and the respective sensitivities and specificities of each set of referral criteria in detecting amblyopia risk factors identified by the AAPOS Vision Screening Committee were calculated. Results The manufacturer’s criteria yielded high sensitivity (100%) but very low specificity (37%). The Arthur criteria, which used the values for the AAPOS-defined amblyopia risk factors as referral criteria, maintained sensitivity (89%) and greatly improved specificity (76%). Two modifications of the Arthur criteria further increased specificity with minimal loss of sensitivity. Conclusions The manufacturer’s criteria have excellent sensitivity but low specificity, warranting modification; other criteria increase specificity with minimal effect on sensitivity.
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us preventive services task force Vision Screening recommendations
Pediatrics, 2011Co-Authors: Sean P Donahue, James B RubenAbstract:We commend the recent recommendation by the US Preventative Services Task Force (USPSTF) for Vision Screening of all children at least once between the ages of 3 and 5 years.1 Amblyopia is the leading cause of monocular visual impairment in US children. Several high-quality, randomized controlled clinical studies have shown that amblyopia treatment is highly successful.2 Early detection is critical, because there is a window for successful treatment. Hence, this recommendation is an important step toward the elimination of a major preventable cause of lifelong visual loss. The USPSTF recommendation is consistent with the American Academy of Pediatrics “Recommendations for Preventive Pediatric Health Care,”3 and Bright Futures Guidelines for Health SuperVision of Infants Children and Adolescents ,4 both of which recommend universal Screening for Vision at the 3-, 4-, and 5-year health superVision visits. Although we support the task force recommendation to provide Vision Screening for children aged 3 to 5 years, we are concerned about the finding of “insufficient evidence” (I) for Screening children under the age of 3. Figure 1 in the recommendation1 notes that current practice for these younger children is “assessment … Address correspondence to Sean P. Donahue, MD, PhD, Departments of Pediatrics, Ophthalmology, and Neurology, Vanderbilt University Medical Center/Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN 37232-8808. E-mail: sean.donahue{at}vanderbilt.edu
Kurt Simons - One of the best experts on this subject based on the ideXlab platform.
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preschool Vision Screening summary of a task force report
Pediatrics, 2000Co-Authors: Eugenie E Hartmann, Velma Dobson, Louise Hainline, Wendy Marshtootle, Graham E Quinn, Mark S Ruttum, Paulette P Schmidt, Kurt SimonsAbstract:Vision Screening to detect eye problems in school-aged children dates back at least a century.1 Calls to screen specifically for amblyopia, generally defined as monocular decreased acuity, began appearing by the 1950s.2 However, it was not until the 1960s, when animal research indicated that cortical plasticity was limited to a period early in life, that emphasis was placed on Vision Screening in the preschool years. Since that time, a variety of preschool Screening programs have been adopted in various countries,3 ranging from the systematic and thorough efforts of Scandinavian countries that evaluate Screening methods and outcome from infancy through preschool ages,3,4 to the diversity of Screening standards (Table 1) and Screening programs found in different jurisdictions across the United States.5,6 View this table: Table 1. Current Recommendations for Preschool Vision Screening Programs Recommendations for health-related Screening programs, developed by the World Health Organization,7 require that a disorder suitable for mass Screening should have a high prevalence in the population, should result in significant impairment to the individual, and should be treatable at the time of its detection. Although the Scandinavian experience and other data make clear the effectiveness of preschool Screening in reducing visual morbidity from amblyopia,8–10 fundamental questions remain about specific issues, ranging from Screening methodology to quantitative measures of both efficacy and cost-effectiveness of such Screening. These questions were recently brought to focus by a report from the United Kingdom questioning the utility of preschool Vision Screening.11–13 Although both the data interpretation and conclusions of this report have been questioned,14–23 it has given impetus to a reexamination of the why and how of preschool Vision Screening. Recognizing the growing list of questions about preschool Vision Screening and the lack of consistency in preschool Vision Screening recommendations and programs in the United States, Congress urged …
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preschool Vision Screening rationale methodology and outcome
Survey of Ophthalmology, 1996Co-Authors: Kurt SimonsAbstract:Although population outcome studies support the utility of preschool Screening for reducing the prevalence of amblyopia, fundamental questions remain about how best to do such Screening. Infant photoScreening to detect refractive risk factors prior to onset of esotropia and amblyopia seems promising, but our current understanding of the natural history of these conditions is limited, thus limiting the prophylactic potential of early Screening. Screening for strabismic, refractive and ocular disease conditions directly associated with amblyopia is more clearly proven, but the diversity of equipment, methods and subject populations studied make it difficult to draw precise summary conclusions at this point about the efficacy of photoScreening. Sensory-based testing of preschool-age children exhibits a similar combination of promise and limitations. The visual acuity tests most widely used for this purpose are prone to problems of testability and false negatives. Moreover, the utility of random-dot stereograms has been confused by misapplication, and new small-target binocularity tests, while attractive, are as yet inadequately field-proven. The evaluation standard for any Screening modality is treatment outcome. However, variables in amblyopia classification and quantitative definition differences, timing of presentation, nonequivalent treatment comparisons, and compliance variability have been uncontrolled in virtually all extant studies of amblyopia treatment outcome, making it difficult or impossible to evaluate either the relative efficacy of different treatment regimens for amblyopia or the effects of age on treatment outcome within the preschool age range. The latter issue is a central one, since existence of such an age effect is the primary rationale for Screening at younger rather than older preschool ages. The relatively low prevalence of amblyopia makes it difficult to achieve a high Screening yield in terms of predictive value, but functionally increasing prevalence by selective Screening of high risk populations causes further problems. Unless a "supertest" can be devised, with very high sensitivity and specificity, health policy decisions will be required to determine which of these two characteristics should be emphasized in Screening programs. Performance of Screening tests can be optimized, however, with adequate training, perhaps via instructional videotapes.
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small target random dot stereogram and binocular suppression testing for preschool Vision Screening
Journal of Pediatric Ophthalmology & Strabismus, 1996Co-Authors: Kurt Simons, Kelly Elhatton Avery, Audrey NovakAbstract:BACKGROUND: New, small-target (< 1 degree) random dot stereogram (STRDS) and binocular suppression (STBS) tests appropriate for preschool Vision Screening were developed to correct the shortcomings of previous such tests, particularly missed cases of anisometropic amblyopia such as found with some RDS-based testing. METHODS: In Experiment 1, the tests were administered to 14 patients with current or a recent history of moderate (< or = 20/60) anisometropic amblyopia, or with accommodative esotropia or monofixation syndrome. All subjects had good binocularity (< or = 100" contour stereoacuity). In Experiment 2, the new tests were administered in a Screening setting to a group of 112 three- to five-year-olds to determine testability. Visual acuity, cover testing, and photoScreening were administered as control measures. RESULTS: In Experiment 1, eleven of the 14 patients failed both tests. Two anisometropic amblyopes passing one or both tests had an acuity < or = 20/30 in the worse eye and < or = 25" stereoacuity. Three anisometropic amblyopia patients failing the STRDS passed another RDS test with similar disparity but a larger target size, confirming a report34 that anisometropic amblyopes may pass RDS testing with parafoveal stereopsis despite the presence of central suppression. The STRDS and STBS tests indicated 80% and 96% specificity, respectively, with the original methodologies; STRDS specificity increased to 95% with retesting with a different methodology. Administration time was 30 sec to 60 sec per test. CONCLUSION: Small-target RDS or suppression testing may be more effective for strabismus and amblyopia Screening of preschoolers than previous RDS test formats.
