Sensitivity and specificity of visual acuity screening for refractive errors in school children

PURPOSE: To examine the optimal cutoff point for the use of the visual acuity test to screen for refractive errors in schoolchildren. METHODS: In a sample of schoolchildren between 7 and 9 years old, visual acuity testing was performed using modified ETDRS charts monocularly without optical aids by trained personnel. Cycloplegic autorefraction was performed in each eye. The screening efficacy of using various cutoff points for referring children for further optometric/ ophthalmic assessment was studied. Myopia was defined as a spherical equivalent of at least -0.5 D, hyperopia a spherical equivalent of at least +2.0 D, and astigmatism a cylinder of at least -1.0 D in at least one eye. The sensitivity, specificity, and predictive values were calculated using each patient as a case; a receiver operator curve was plotted. RESULTS: A total of 1,028 children were tested. A satisfactory sensitivity/specificity profile was obtained using a referral criterion of visual acuity worse than or equal to 0.28 logarithm of the minimum angle of resolution in at least one eye. In this scenario, the sensitivity and specificity of this screening test were 72% (95% confidence interval [CI], 68 to 76) and 97% (95%CI, 95 to 98), respectively. The positive and negative predictive values were 96% (95%CI, 93 to 98) and 78% (95%CI, 75 to 82), respectively. CONCLUSIONS: The modified ETDRS visual acuity chart can be used to predict refractive errors in schoolchildren in Singapore in a sensitive and specific manner using a referral criterion of worse than or equal to 0.28 logarithm of the minimum angle of resolution