Validated portable pediatric vision screening in the Alaska Bush. A VIPS-like study in the Koyukon.

BACKGROUND Photoscreening and remote autorefraction showed promise in the urban "Vision in PreSchoolers Study." We transported a comparative screening with confirmation program to a remote part of interior Alaska. METHODS Eighty children from villages in the Koyukon region received onsite three-pronged vision screening followed by gold-standard confirmatory exams. Each had patched HOTV acuity, photoscreening and Suresight remote autorefraction. RESULTS There was a high prevalence of amblyopia and vision disorders in these villages. Acuity testing was moderately valid but not useful for children under four years old. Suresight has specificity over 90 percent with sensitivity of 60 percent. Photoscreening had specificity over 95 percent and sensitivity of 70 percent and was better than Suresight for children under age four. CONCLUSION The Welch Allyn Suresight had similar high validity in the Koyukon as in Vision in Preschoolers (VIPS) and provides immediate, onsite results. Photoscreening, particularly with commercial digital flash cameras and specific interpretation, is a cost effective screening tool particularly for younger children.