Validity of the Spot Vision Screener in detecting vision disorders in children 6 months to 36 months of age

J AAPOS. 2019 Oct;23(5):278.e1-278.e6. doi: 10.1016/j.jaapos.2019.06.008. Epub 2019 Sep 12.


Purpose: To evaluate the Spot Vision Screener in detecting targeted vision disorders compared to cycloplegic retinoscopy in children <3 years of age.

Methods: Children, ages 6 months to 36 months underwent vision screening using the Spot Vision Screener. Results were compared to results of comprehensive eye examinations. Validity of the Spot was evaluated by calculating the area under the curve (AUC); the receiver operating characteristics (ROC) were used to determine optimal sensitivity and specificity for detection of targeted vision disorders.

Results: A total of 249 children were included. The AUC for detecting targeted vision disorders as defined by the study specific criteria using the Spot was 0.790. Compared to cycloplegic retinoscopy, the Spot underestimated hyperopia by 1.02 D (95% CI, 0.86-1.17 D). For hyperopia ≥4.5 D spherical equivalent (n = 10), the mean difference between the Spot and cycloplegic retinoscopy was 3.46 D (95% CI, 1.95-4.98 D). In contrast, the Spot overestimated astigmatism compared to cycloplegic retinoscopy (-1.00 D vs -0.48 D; P < 0.001) by -0.52 D (95% CI, 0.43-0.62 D).

Conclusions: The Spot Vision Screener showed good overall validity in detecting targeted vision disorders. It was within 0.5 D and 1 D of cycloplegic retinoscopy with regard to low hyperopia and astigmatism. Higher hyperopic spherical equivalent refractive errors showed larger differences in mean values between the Spot and cycloplegic retinoscopy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Anisometropia / diagnosis
  • Area Under Curve
  • Astigmatism / diagnosis
  • Child, Preschool
  • Female
  • Humans
  • Hyperopia / diagnosis
  • Infant
  • Male
  • Myopia / diagnosis
  • ROC Curve
  • Retinoscopy / methods
  • Sensitivity and Specificity
  • Vision Disorders / diagnosis*
  • Vision Screening / instrumentation*