From the Guidelines
Performing visual acuity testing after Spot Vision Screener can significantly reduce false positive referrals in children aged 4 years and older. When the Spot Vision Screener flags a potential vision issue, following up with traditional visual acuity testing (such as eye charts like the HOTV or LEA symbols) helps confirm whether the child truly needs referral to an eye care specialist. This two-step approach is particularly effective for children 4 years and older who can more reliably participate in visual acuity testing, as noted in the pediatric eye evaluations preferred practice pattern 1.
The reduction in false positives occurs because automated vision screeners like Spot may detect refractive errors that don't necessarily impact functional vision or require intervention. By adding the visual acuity component, healthcare providers can assess whether the refractive error detected by the Spot screener actually affects the child's ability to see clearly at distance. This approach is practical in school and primary care settings, requiring minimal additional time while significantly improving screening specificity, as supported by the principles outlined in instrument-based pediatric vision screening policy statements 1.
For implementation, providers should consider using age-appropriate visual acuity testing methods and established referral criteria (typically 20/40 or worse for children 4-5 years old, and 20/30 or worse for older children) to determine which children with positive Spot results truly need specialist evaluation, in line with recommendations from ophthalmology guidelines 1.
Key considerations for effective implementation include:
- Using age-appropriate optotypes for visual acuity testing, such as LEA SYMBOLS or HOTV letters for younger children and Sloan letters for older children.
- Ensuring that visual acuity testing is performed monocularly with habitual refractive correction in place.
- Following established referral criteria to minimize unnecessary referrals while ensuring that children with true vision issues are identified and treated appropriately.
- Recognizing the importance of periodic vision screenings throughout childhood and adolescence to detect problems that may arise at later stages of development, as emphasized in pediatric eye evaluations preferred practice patterns 1.
By adopting this two-step approach, healthcare providers can enhance the accuracy of vision screening, reduce unnecessary referrals, and improve outcomes for children by ensuring that those who need specialist care receive it in a timely manner.
From the Research
Visual Acuity Testing after Spot Vision Screener
- The Spot Vision Screener is a tool used for detecting amblyopia risk factors in children 2.
- Studies have shown that the Spot Vision Screener has a high sensitivity and specificity for detecting amblyopia risk factors in children, particularly those aged 3 years and older 3, 2, 4.
- Performing visual acuity testing after the Spot Vision Screener may help reduce false positive referrals in children, particularly those aged 4 years and older, as it can provide a more accurate assessment of visual acuity 3, 5.
- A study found that combining the Spot Vision Screener with visual acuity testing resulted in a higher positive predictive value for detecting amblyopia risk factors and reduced visual acuity compared to using either method alone 3.
- Another study found that photorefraction with the Spot Vision Screener, in addition to visual acuity testing, led to the detection of more eye diseases in 3.5-year-old children 5.
Effectiveness of Visual Acuity Testing
- Visual acuity testing is an effective method for detecting correctable visual acuity deficits in school-age children and adolescents 6.
- A systematic review found that vision screening with provision of free spectacles results in a higher proportion of children wearing spectacles compared to vision screening with prescription only 6.
- The review also found that ready-made spectacles may be a useful alternative to custom-made spectacles in lower-income settings, with no significant difference in visual acuity or spectacle wearing between the two types of spectacles 6.
Age-Specific Considerations
- The Spot Vision Screener has been shown to be effective in detecting amblyopia risk factors in children as young as 6 months old, but its performance improves with increasing age 4.
- Children aged 4 years and older may benefit from visual acuity testing after the Spot Vision Screener to reduce false positive referrals and provide a more accurate assessment of visual acuity 3, 5.