Objective vision screening using PlusoptiX for children aged 3-11 years in rural Turkey.

Background: This population based cross sectional study was conducted to detect amblyopia risk factors and myopia in a rural district of Northwestern Turkey by using PlusoptiX S12R (Photoscreener PlusoptiX Inc., Nuremberg, Germany).

Methods: Children from 38 rural schools in Caycuma district of Zonguldak Turkey underwent vision screening in their school using PlusoptiX S12 photoscreener. Data were analyzed using the factory default level 5 referral criteria targeting 80% sensitivity and 95% specificity. Referral, unable readings, and positive predictive value (PPV) were reported.

Results: Data from 2846 children were analyzed. Mean age was 7.9 years (±0.8) (range 36 months to 11 years). Three hundred ten (11%) were referred of whom 32% were read as 'unable'. 150 children (48% of the referred) received a gold standard examination. Positive predictive value of PlusoptiX was 69%. PPV was 83% when unable readings were excluded. 93 children with amblyopia risk factors were identified. Only 26% (n = 25) had received glasses priorly. 49 children had amblyopia of whom 33 were newly diagnosed.

Conclusions: PlusoptiX showed a reasonable level of positive predictive value in community setting and the device could be a useful tool for vision screening in preschoolers and schoolers. We found most of the amblyogenic refractive errors were underdiagnosed in rural school children leading to a call for action on vision screening.