Carrie E. Papa

The effectiveness of the Spot Vision Screener in detecting amblyopia risk factors

PURPOSE To evaluate the updated Spot Vision Screener (PediaVision, Welch Allyn, Skaneateles Falls, NY) in detecting amblyopia risk factors using 2013 guidelines of American Association for Pediatric Ophthalmology and Strabismus (AAPOS). METHODS In this prospective study, patients seen from June 2012 to November 2013 were tested with the Spot prior to examination by a pediatric ophthalmologist who was masked to test results. The following data were analyzed: age, subject testability, examination findings, and systemic and ocular pathology. Children were divided into three age groups to determine gold standard results according to the AAPOS guidelines. RESULTS A total of 444 children (average age, 72 months) were included. Compared to the ophthalmologists examination, the Spot sensitivity was 87.7% and the specificity was 75.9% in detecting amblyopia risk factors. Sensitivity did not differ significantly between age groups, although the positive predictive value improved in the older age groups. CONCLUSIONS In our study cohort, the Spot provided good specificity and sensitivity in detecting amblyopia risk factors according 2013 AAPOS criteria, with minor improvements with updated versions.

Photoscreeners in the pediatric eye office: compared testability and refractions on high-risk children.

PURPOSE To compare refractive data and testability of Spot (PediaVision) and Plusoptix A09 (Plusoptix, Inc) photoscreeners and to compare each device with traditional cycloplegic retinoscopy. DESIGN Prospective, interventional case series. METHODS After informed consent, patients underwent testing with the Spot and Plusoptix photoscreeners before their examination by a pediatric ophthalmologist masked to the results. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis. RESULTS A total of 265 children were enrolled (mean age, 6.0 ± 3.4 years). Both devices produced a computer printout result in 250 (94.3%) of the patients. The Spot photoscreener provided a refractive estimate in all computer printouts, whereas the Plusoptix, used binocularly, provided a refractive estimate in 75.2% (188/250) of the printouts. Compared with cycloplegic retinoscopy, both devices underestimated hyperopia or overestimated myopia (-1.35 diopters [D] and -0.64 D, Spot and Plusoptix, respectively) and overestimated astigmatism (0.36 D and 0.32 D, Spot and Plusoptix, respectively). The intraclass correlation coefficient for spherical equivalents indicated good agreement between cycloplegic retinoscopy and Spot (0.806) and excellent agreement between cycloplegic retinoscopy and Plusoptix (0.898). CONCLUSIONS The Spot photoscreener provided refractive data on a greater percentage of children. The photorefractors correlated with cycloplegic retinoscopy refractive findings for sphere and spherical equivalents, but underestimated hyperopia or overestimated myopia and overestimated astigmatism. The binocular refractions of Plusoptix agreed more closely with the refractions of our pediatric ophthalmologists.

Evaluation of the Spot Vision Screener in young children in Costa Rica.

BACKGROUND The Spot Vision Screener has demonstrated good sensitivity and specificity in the pediatric ophthalmology clinic setting. We sought to evaluate the updated Spot (version 2.0.16) in a general pediatric population through a collaboration of the Storm Eye Institute of the Medical University of South Carolina, the Clinica Dr Clorito Picado, and National Childrens Hospital of Costa Rica. We compared results of screening with the Spot and pediatric ophthalmologic examination and determined sensitivity and specificity of the Spot in detecting amblyogenic risk factors (ARFs) according to the 2013 AAPOS Vision Screening Committee guidelines for automated vision screeners. METHODS Children were screened with the Spot followed by a pediatric ophthalmologic examination. Cycloplegic refraction and motility findings were analyzed by age group to determine ARFs. RESULTS A total of 219 subjects, averaging 60 months of age (range, 20-119 mo) were included. The prevalence of ARFs in our population was 12.3% (27/219). The most common risk factor was astigmatism, with a prevalence of 8.7% (19/219). The Spot referred 43 children (19.6%). Sensitivity of the Spot was 92.6%; specificity, 90.6%. The positive predictive value was 58.1%; the negative predictive value, 98.9%. CONCLUSIONS The Spot demonstrated good sensitivity and specificity in detecting amblyopia risk factors in this general pediatric population.

Pilot Study and Review: Physiological Differences in BDNF, a Potential Biomarker in Males and Females with Autistic Disorder

Aims There is a need for more biologic research in autistic disorder (AD) to determine if biomarkers exist that would be useful for correlating to symptom severity and/or clinical improvement during treatment. Given the fact that AD is 4 times more common in males than females, gender differences in physiological biomarkers may be present. One potential biomarker that has begun to be studied is brain-derived neurotropic factor (BDNF), a peptide involved in the regulation of neuronal cell survival, differentiation, and plasticity, and possessing an ability to influence neurotransmitter systems by modulating gene expression. This pilot study examined whether serum BDNF differed according to gender in children with AD and whether differences were associated with a behavioral phenotype or severity of illness. Study Design Data for this investigation were collected during the participants’ baseline visit of an intervention study. Participants were males (n=29) and females (n=7), aged 5 to 12 years diagnosed with AD. Baseline serum BDNF concentration was determined for comparison to clinical ratings using an autism severity measure and the Pervasive Developmental Disorder-Behavior Inventory (PDD-BI). Results BDNF serum concentrations were higher in females (p<0.049). The baseline BDNF value corresponded significantly to hyperactivity in females (p<0.0002) but not in males. BDNF did not correlate with severity of disease in either gender. Conclusion Although this is a small study, a better understanding of the central role of BDNF may provide insight into the pathophysiology of the disease and elucidate why gender differences exist in prevalence and behavioral phenotype of AD.

Biologic effects of stress and bonding in mother–infant pairs:

Objective Maternal stress in humans influences behavior of children and can be assessed using biological markers. Mothers and their one-month-old infants were recruited from an existing study to examine baseline maternal serum oxytocin and hypothalamic-pituitary-adrenal axis response to infant blood heel stick stress as measured by salivary cortisol in the dyads. Objectives were to explore (1) relationships between mother and infant cortisol levels, (2) gender differences in infant biologic cortisol response, and (3) the association of cortisol levels in the dyads and maternal oxytocin levels Methods Forty-two mother–infant dyads provided biologic samples and self-report data. Maternal oxytocin samples were obtained. Initial salivary cortisol was assessed in both the mother and infant, followed by a heel stick blood draw. Twenty minutes later, salivary cortisol was collected again from dyads. Results Self-report measures were negative for depression and risk for childhood neglect. Although oxytocin and baseline cortisol in the infants was higher in mothers that did some breast-feeding, there was no statistically significant difference (p = 0.2 and p = 0.1, respectively). Analyses showed (a) higher baseline cortisol in mothers was related to higher baseline cortisol in infants (p ≤ 0.0001), (b) following the stressor, female infants had a larger positive change in cortisol, after adjusting for baseline cortisol (p = 0.045), and (c) there was no relationship between dyad cortisol levels and maternal oxytocin. Conclusions Maternal and infant biologic stress measures are related. Female infants have a larger hypothalamic-pituitary-adrenal response to a blood draw stressor as measured by salivary cortisol than male infants.

Combining Automated Vision Screening With On-site Examinations in 23 Schools: ReFocus on Children Program 2012 to 2013

PURPOSE The Association for the Blind and Visually Impaired (ABVI) began the ReFocus on Children Program to assist school nurses in providing vision screening for at-risk children in the Charleston County School District in South Carolina. METHODS In 2012 to 2013, 2,750 low-income school children ages 3 to 5 years were screened using the Plusoptix Vision screener (Atlanta, GA). Further examinations were performed on 419 (56%) children referred and glasses prescribed and provided for 192 children (positive predictive value 46%). In 2013, teacher feedback questionnaires were sent to the 23 schools. RESULTS Teacher feedback questionnaires had a 49% response rate. Of teachers responding to the questionnaire, 70% reported the children liked wearing their glasses. Teachers provided observations of positive impact, including improved academic performance. CONCLUSIONS Nurses appreciated that the entire process was efficient and completed in school, simplifying care and follow-up. The authors encourage partnerships between schools, nonprofit agencies, and healthcare providers to improve screening and access to comprehensive vision care for young children.

Growth failure associated with early neglect: pilot comparison of neglected US children and international adoptees.

Abstract The long-lasting impact of different neglectful environments on growth in children is not well studied. Three groups of children, 3–10 years old, were recruited (n=60): previously institutionalized international adoptees living in stable home environments for at least 2 years (IA; n=15), children with a history of neglect born in the USA (USN; n=17), and controls (n=28). Children underwent physical examination, anthropometry, and collection of serum for growth parameters. Mean height standard deviation scores (SDS) were different (p<0.05). Age-adjusted head circumference (HC) was significantly smaller (p<0.05) in IAs. Insulin growth factor (IGF-1), a marker of growth hormone action, was higher in US neglected children. IGF-1 adjusted for age and weight SDS were different (p<0.05) between control and US neglect groups. The degree of growth failure in height and HC in IAs was more severe than neglected US children. These findings may reflect differences between the impact of chronic and intermittent deprivation on the growth hormone system.

Prospective Evaluation of Photoscreeners in the Pseudophakic Eyes of Children

PURPOSE To compare refractive data of Plusoptix AO9 (Plusoptix, Inc., Atlanta, GA) and Spot (Welch Allyn, Skaneateles Falls, NY) photoscreeners with retinoscopy in pseudophakic eyes of children. METHODS In this prospective study, patients underwent testing with the Plusoptix and Spot photoscreeners prior to their examination by a pediatric ophthalmologist masked to the results of both photoscreeners. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis. For bilateral pseudophakia, one randomly selected eye was included in the analysis. RESULTS Forty-four eyes were included, with a mean age of 7.4 ± 4.8 years. Refraction was estimated in all eyes using retinoscopy, but a refractive estimate was obtained in only 11.3% (5 of 44) of eyes using the Plusoptix binocularly and 63.6% (28 of 44) of eyes using the Spot. Compared to retinoscopy, the Plusoptix showed a mean difference of -0.80, 0.10, and -0.75 diopters (D) for sphere, cylinder, and spherical equivalent, respectively (P > .05). Comparable values for the Spot were 0.18, -0.26, and 0.05 D, respectively (P > .05). Compared to retinoscopy, the Plusoptix showed a mean absolute difference of 1.30, 0.80, and 1.25 D for sphere, cylinder, and spherical equivalent, respectively (P > .05). Similar values for the Spot were 1.38, 0.88, and 0.97 D, respectively (P > .05). CONCLUSIONS Refraction was estimated in a higher number of pseudophakic eyes of children using the Spot as compared to the Plusoptix. The Spot may be useful to evaluate myopic shift in pseudophakic eyes of children. [J Pediatr Ophthalmol Strabismus. 2016;53(3):146-149.].