Effective low-cost pediatric vision screening by naive nonophthalmic examiners using the 'Arclight' device

Rujuta Gore; Jenny N Wang; Christopher D Yang; Miranda An; Stephen C Hunter; Kourosh Shahraki; Andrew Blaikie; Donny W Suh

doi:10.4103/IJO.IJO_3027_23

Effective low-cost pediatric vision screening by naive nonophthalmic examiners using the 'Arclight' device

Indian J Ophthalmol. 2024 Jul 11. doi: 10.4103/IJO.IJO_3027_23. Online ahead of print.

Authors

Rujuta Gore¹, Jenny N Wang², Christopher D Yang², Miranda An², Stephen C Hunter³, Kourosh Shahraki², Andrew Blaikie⁴, Donny W Suh²

Affiliations

¹ Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, IL, US.
² Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, US.
³ University of California Riverside School of Medicine, Riverside, CA, US.
⁴ Global Health Team, School of Medicine, University of St Andrews, St Andrews, UK.

PMID: 38990632
DOI: 10.4103/IJO.IJO_3027_23

Abstract

Purpose: To explore whether a low-cost ophthalmoscope (Arclight) can be used by naive nonophthalmic examiners to effectively screen for pediatric eye disease.

Methods: Fifty-four children (108 eyes) were examined by five medical students using an Arclight. Gold standard examination was performed by an ophthalmologist using a slit lamp and indirect ophthalmoscope. Examinations performed included ophthalmoscopy of the optic disc, estimation of the cup-to-disc ratio (CDR), corneal light reflex test (CRT), Bruckner's reflex test (BRT), and evaluation of refractive error. We determined the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the nonophthalmologist's Arclight exam compared to the gold standard findings of comprehensive evaluation by pediatric ophthalmologists.

Results: Using the Arclight, the optic nerve exam was successfully completed in 65% of patients. CDRs above and below 0.5 could be determined with 66.7% sensitivity and 84.4% specificity. Arclight CRT measurements were significant (P < .00001) predictors of strabismus, with 80% sensitivity, 95.1%, specificity, 80% PPV, and 95.1% NPV. BRT was not a significant predictor of amblyopia, with a 34.6% sensitivity, 85.7% specificity, 69.2% PPV, and 58.5% NPV. Refractive error was estimated with a success rate of 81% for emmetropia, 38% for myopia, and 21% for hyperopia. The Arclight ease-of-use was rated on average as 4.4 (SD = 0.9) on a scale of 1 to 5, with 1 being the hardest and 5 being the easiest.

Conclusions: Our study shows the Arclight as an affordable and effective alternative to the traditional ophthalmoscope for assessing eye disease in children. This device can improve eye health services in under-resourced regions.