Spot视觉筛查仪在儿童斜视筛查中的应用

Application of the Spot Vision Screener in Strabismus Screening in Children

目的：探讨SpotTM在儿童斜视筛查中的可配合性及在斜视性弱视危险因素筛查中的筛查效率。方法：横断面研究。2015 年7-10 月在天津和平新世纪妇儿医院保健科体检的389 例儿童先后进行SpotTM及小儿眼科医师检查，依据SpotTM内设眼位异常推荐值确定出需要转诊的儿童，小儿眼科医师依据2013 年美国斜视与小儿眼科协会规定的视觉筛查转诊指南确定出具有斜视性弱视危险因素的儿童，最终评估SpotTM在斜视性弱视危险因素筛查中的敏感度、特异度、阳性预测值及阴性预测值。结果：389 例儿童入组，平均年龄（6.0±2.3）岁。97.4%的儿童能配合SpotTM检查，无法配合SpotTM检查直接转诊的10例儿童中7例患有眼部疾病。小儿眼科医师确定38例（9.8%）具有斜视性弱视危险因素；经SpotTM筛查，确定需转诊的眼位异常者49 例（12.6%）。SpotTM在斜视性弱视危险因素筛查中敏感度71.0%，特异度93.7%，阳性预测值55.3%，阴性预测值96.8%。结论：大多数儿童可配合SpotTM的检查，SpotTM在斜视性弱视危险因素的筛查中具有一定的临床应用价值。

Objective： To explore the effectiveness of the Spot vision screener in detecting childhood strabismus amblyopia risk factors （ARFs）. Methods： In this cross-sectional study, 389 children （mean age ± standard deviation,6.0 ± 2.3 years） were recruited from July to October 2015 at Department of Health Care, He Ping New Century International Women and Children＇s Hospital, these children were tested with the Spot vision screener prior to examination by a pediatric ophthalmologist. The screener refers children for strabismus based upon the measurement of “gaze” by the device. We compared the results of screening by the automated screener and by the pediatric ophthalmologist examination. Based upon the comparison, we determined the sensitivity, specificity,positive predictive value, and negative predictive value of the automated screener in detecting strabismus ARFs according to the 2013 American Association for Pediatric Ophthalmology and Strabismus （AAPOS） vision screening committee referral guidelines. Results： Ten children could not participate automated screening, among them, seven children due to the presence of ocular pathology. Of the remaining 379 children （97.4%）, the Spot vision screener referred 49 children （12.6%） for strabismus, while 38 （9.8%） were referred by the pediatric ophthalmologist. The Spot vision screener sensitivity was 71.0%, the specificity was 93.7%, the positive predictive value was 55.3%, and the negative predictive value was 96.8% in detecting strabismus ARFs. Conclusions： The Spot vision screener provided clinical data on a greater percentage of children than did the pediatric ophthalmologist. The Spot vision screener is a useful device in strabismus ARFs screening.