Journal of pediatric ophthalmology and strabismus · 2019
How Many Plusoptix S04 Measures Yield the Most Sensitive Amblyopia Screening?
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Guimarães Sandra, Soares Andreia, Costa Patrício, Silva Eduardo
Аннотация
PURPOSE: To analyze how the Plusoptix S04 (Plusoptix, Atlanta, GA), a widely used technology for amblyopia screening, predicts amblyopia.
METHODS: A total of 1,547 children aged 3 to 4 years underwent a non-invasive eye examination in a whole population screening. The Plusoptix was measured binocularly three consecutive times. Seven models were developed: the first (P1), second (P2), and third (P3) measure of Plusoptix, the mean of P1, P2, and P3 (Pmean123), the maximal value of P1, P2, and P3 (Pmax123), the mean of P1 and P2 (Pmean12), and the maximal value of P1 and P2 (Pmax12).
RESULTS: Internal consistency was excellent for sphere, cylinder (alpha = 0.92 vs 0.97), aniso-sphere, and aniso-cylinder (alpha = 0.87 vs 0.86). All models predicted amblyopia (P < .001); there was 2.3% new diagnosis and 5.1 events per variable. A bootstrap analysis with 1,000 samples confirmed the stability of the model. Astigmatism (P < .001; odds ratio [OR] = 2.1 to 3.6) and aniso-sphere (P < .001; OR = 3.6 to 9.0) predicted amblyopia. Although sphere, when measurable, did not predict amblyopia (P > .19; OR = 1.2 to 1.3), the likelihood of amblyopia presence was 100 times higher when the Plusoptix displayed "hyper." All receiver operating characteristic (ROC) curves were significant (P < .001), with no differences between them (all P > .16). Adjusting the cut-off from ROC curves for the highest sensitivity, Pmax12 referred 31.9% and 16.1% fewer patients than P1 and Pmean12, respectively. A third measure revealed accommodation-related false-negative results; therefore, adding measurements showed no benefit.
CONCLUSIONS: This was the first study to assess the Plusoptix's prediction of amblyopia. When aiming for maximal sensitivity, the Plusoptix refers many children (> 20% children in all models). The first measure refers more children than two measures. Non-measurable results must be considered abnormal because the chance of amblyopia presence was high. [J Pediatr Ophthalmol Strabismus. 2019;56(5):305-312.].
METHODS: A total of 1,547 children aged 3 to 4 years underwent a non-invasive eye examination in a whole population screening. The Plusoptix was measured binocularly three consecutive times. Seven models were developed: the first (P1), second (P2), and third (P3) measure of Plusoptix, the mean of P1, P2, and P3 (Pmean123), the maximal value of P1, P2, and P3 (Pmax123), the mean of P1 and P2 (Pmean12), and the maximal value of P1 and P2 (Pmax12).
RESULTS: Internal consistency was excellent for sphere, cylinder (alpha = 0.92 vs 0.97), aniso-sphere, and aniso-cylinder (alpha = 0.87 vs 0.86). All models predicted amblyopia (P < .001); there was 2.3% new diagnosis and 5.1 events per variable. A bootstrap analysis with 1,000 samples confirmed the stability of the model. Astigmatism (P < .001; odds ratio [OR] = 2.1 to 3.6) and aniso-sphere (P < .001; OR = 3.6 to 9.0) predicted amblyopia. Although sphere, when measurable, did not predict amblyopia (P > .19; OR = 1.2 to 1.3), the likelihood of amblyopia presence was 100 times higher when the Plusoptix displayed "hyper." All receiver operating characteristic (ROC) curves were significant (P < .001), with no differences between them (all P > .16). Adjusting the cut-off from ROC curves for the highest sensitivity, Pmax12 referred 31.9% and 16.1% fewer patients than P1 and Pmean12, respectively. A third measure revealed accommodation-related false-negative results; therefore, adding measurements showed no benefit.
CONCLUSIONS: This was the first study to assess the Plusoptix's prediction of amblyopia. When aiming for maximal sensitivity, the Plusoptix refers many children (> 20% children in all models). The first measure refers more children than two measures. Non-measurable results must be considered abnormal because the chance of amblyopia presence was high. [J Pediatr Ophthalmol Strabismus. 2019;56(5):305-312.].