Pediatric photoscreening for strabismus and refractive errors in a high-risk population

Objective: To determine the accuracy of the MTI Photoscreener in detecting strabismus and refractive errors in children. Participants: One hundred children underwent MTI photoscreening followed by complete ophthalmologic examination, Six observers graded the photographs for strabismus, according to the location of the corneal light reflexes, and for refractive error, according to the size and location of the light crescent. Results: The sensitivity of the MTI Photoscreener in detecting any amblyogenic factor was 80% to 91%, with a specificity of 20% to 67%. The sensitivity and specificity for particular amblyogenic factors varied widely among observers. The ranges were as follows: strabismus, sensitivity = 23% to 50%, specificity = 76% to 96%; myopia, sensitivity = 89%, specificity = 48% to 76%; hyperopia, sensitivity = 20% to 80%, specificity = 88% to 96%; and astigmatism, sensitivity = 46% to 77%, specificity = 79% to 89%. Conclusions: These results suggest caution in relying on photoscreening to detect strabismus and refractive errors in children.