Preschool children's vision screening in New Zealand

a retrospective evaluation of referral accuracy

Miriam A Langeslag-Smith, Alain C Vandal, Vincent Briane, Benjamin Thompson, Nicola S Anstice

Research output: Contribution to journalArticle

6 Citations (Scopus)
2 Downloads (Pure)

Abstract

OBJECTIVES: To assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand. DESIGN: Retrospective longitudinal study. METHODS: B4 School Check vision screening records (n=5572) were compared with hospital eye department data for children referred from screening due to impaired acuity in one or both eyes who attended a referral appointment (n=556). False positive screens were identified by comparing screening data from the eyes that failed screening with hospital data. Estimation of false negative screening rates relied on data from eyes that passed screening. Data were analysed using logistic regression modelling accounting for the high correlation between results for the two eyes of each child. PRIMARY OUTCOME MEASURE: Positive predictive value of the preschool vision screening programme. RESULTS: Screening produced high numbers of false positive referrals, resulting in poor positive predictive value (PPV=31%, 95% CI 26% to 38%). High estimated negative predictive value (NPV=92%, 95% CI 88% to 95%) suggested most children with a vision disorder were identified at screening. Relaxing the referral criteria for acuity from worse than 6/9 to worse than 6/12 improved PPV without adversely affecting NPV. CONCLUSIONS: The B4 School Check generated numerous false positive referrals and consequently had a low PPV. There is scope for reducing costs by altering the visual acuity criterion for referral.

Original languageEnglish
Article numbere009207
Pages (from-to)1-7
Number of pages7
JournalBMJ Open
Volume5
Issue number11
DOIs
Publication statusPublished - 27 Nov 2015
Externally publishedYes

Fingerprint

Vision Screening
Preschool Children
New Zealand
Referral and Consultation
Urban Population
Vision Disorders
Hospital Departments
Visual Acuity
Longitudinal Studies
Appointments and Schedules
Retrospective Studies
Logistic Models
Costs and Cost Analysis

Cite this

Langeslag-Smith, Miriam A ; Vandal, Alain C ; Briane, Vincent ; Thompson, Benjamin ; Anstice, Nicola S. / Preschool children's vision screening in New Zealand : a retrospective evaluation of referral accuracy. In: BMJ Open. 2015 ; Vol. 5, No. 11. pp. 1-7.
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abstract = "OBJECTIVES: To assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand. DESIGN: Retrospective longitudinal study. METHODS: B4 School Check vision screening records (n=5572) were compared with hospital eye department data for children referred from screening due to impaired acuity in one or both eyes who attended a referral appointment (n=556). False positive screens were identified by comparing screening data from the eyes that failed screening with hospital data. Estimation of false negative screening rates relied on data from eyes that passed screening. Data were analysed using logistic regression modelling accounting for the high correlation between results for the two eyes of each child. PRIMARY OUTCOME MEASURE: Positive predictive value of the preschool vision screening programme. RESULTS: Screening produced high numbers of false positive referrals, resulting in poor positive predictive value (PPV=31{\%}, 95{\%} CI 26{\%} to 38{\%}). High estimated negative predictive value (NPV=92{\%}, 95{\%} CI 88{\%} to 95{\%}) suggested most children with a vision disorder were identified at screening. Relaxing the referral criteria for acuity from worse than 6/9 to worse than 6/12 improved PPV without adversely affecting NPV. CONCLUSIONS: The B4 School Check generated numerous false positive referrals and consequently had a low PPV. There is scope for reducing costs by altering the visual acuity criterion for referral.",
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Preschool children's vision screening in New Zealand : a retrospective evaluation of referral accuracy. / Langeslag-Smith, Miriam A; Vandal, Alain C; Briane, Vincent; Thompson, Benjamin; Anstice, Nicola S.

In: BMJ Open, Vol. 5, No. 11, e009207, 27.11.2015, p. 1-7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preschool children's vision screening in New Zealand

T2 - a retrospective evaluation of referral accuracy

AU - Langeslag-Smith, Miriam A

AU - Vandal, Alain C

AU - Briane, Vincent

AU - Thompson, Benjamin

AU - Anstice, Nicola S

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2015/11/27

Y1 - 2015/11/27

N2 - OBJECTIVES: To assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand. DESIGN: Retrospective longitudinal study. METHODS: B4 School Check vision screening records (n=5572) were compared with hospital eye department data for children referred from screening due to impaired acuity in one or both eyes who attended a referral appointment (n=556). False positive screens were identified by comparing screening data from the eyes that failed screening with hospital data. Estimation of false negative screening rates relied on data from eyes that passed screening. Data were analysed using logistic regression modelling accounting for the high correlation between results for the two eyes of each child. PRIMARY OUTCOME MEASURE: Positive predictive value of the preschool vision screening programme. RESULTS: Screening produced high numbers of false positive referrals, resulting in poor positive predictive value (PPV=31%, 95% CI 26% to 38%). High estimated negative predictive value (NPV=92%, 95% CI 88% to 95%) suggested most children with a vision disorder were identified at screening. Relaxing the referral criteria for acuity from worse than 6/9 to worse than 6/12 improved PPV without adversely affecting NPV. CONCLUSIONS: The B4 School Check generated numerous false positive referrals and consequently had a low PPV. There is scope for reducing costs by altering the visual acuity criterion for referral.

AB - OBJECTIVES: To assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand. DESIGN: Retrospective longitudinal study. METHODS: B4 School Check vision screening records (n=5572) were compared with hospital eye department data for children referred from screening due to impaired acuity in one or both eyes who attended a referral appointment (n=556). False positive screens were identified by comparing screening data from the eyes that failed screening with hospital data. Estimation of false negative screening rates relied on data from eyes that passed screening. Data were analysed using logistic regression modelling accounting for the high correlation between results for the two eyes of each child. PRIMARY OUTCOME MEASURE: Positive predictive value of the preschool vision screening programme. RESULTS: Screening produced high numbers of false positive referrals, resulting in poor positive predictive value (PPV=31%, 95% CI 26% to 38%). High estimated negative predictive value (NPV=92%, 95% CI 88% to 95%) suggested most children with a vision disorder were identified at screening. Relaxing the referral criteria for acuity from worse than 6/9 to worse than 6/12 improved PPV without adversely affecting NPV. CONCLUSIONS: The B4 School Check generated numerous false positive referrals and consequently had a low PPV. There is scope for reducing costs by altering the visual acuity criterion for referral.

KW - Child, Preschool

KW - False Negative Reactions

KW - False Positive Reactions

KW - Female

KW - Humans

KW - Logistic Models

KW - Longitudinal Studies

KW - Male

KW - New Zealand

KW - Predictive Value of Tests

KW - Referral and Consultation/standards

KW - Retrospective Studies

KW - Schools

KW - Vision Disorders/diagnosis

KW - Vision Screening/standards

KW - Visual Acuity

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DO - 10.1136/bmjopen-2015-009207

M3 - Article

VL - 5

SP - 1

EP - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 11

M1 - e009207

ER -