Objective The purpose of this study was to compare the effectiveness of vision screening for amblyogenic factors performed by a paediatrician compared with a comprehensive eye examination.
Methods and Subjects From 1341 subjects (the 2003 Cohort of children born in Sao Vicente, Capo Verde), 1301 (97.02%) received an ophthalmic evaluation during a paediatric visit, testing: visual acuity >0.5 (HOTV); stereopsis (Lang II); eye alignment (cover test); retinal red reflex; cycloplegic autorefractometry/refractive errors were classified as emmetropic, myopic/hyperopic (>+3D or –1D sphere) and astigmatic (>2D cylinder). Children were classified as normal (five tests negative) or pathological. Non-collaborative children were re-tested. 1174 of those children (87.54%) underwent a subsequent comprehensive eye examination done by an ophthalmologist, who added fundus examination.
Results Paediatricians identified 117 (9.96%) children as pathological (HOTV, 45 (3.83%); Lang II, 18 (1.53%); cover test, 45 (3.83%); red reflex, 23 (1.96%); autorefraction, 115 (9.79%) multiple positivity obtained). The ophthalmologist identified 107 (9.11%) (myopic, 29 (2.47%); hyperopic, 18 (1.53%); astigmatic, 42 (3.58%); mist defect, 18 (1.53%)). Comparing results from paediatricians and the ophthalmologist, sensitivity was 0.77 and specificity was 0.96.
Conclusions Ophthalmic screening conducted by paediatricians using visual acuity and eye alignment tests and autorefraction is an accurate method to identify refractive errors and amblyogenic factors. Replacing the red reflex test with an automated refractometer will give an objective quantification of refractive errors, reducing the time of visit and further improving the effectiveness of the screening.