{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:30:22Z","timestamp":1792531822410,"version":"4.5.0"},"reference-count":66,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/100002250","name":"Prevent Blindness America","doi-asserted-by":"publisher","award":["Joanne Angle Investigator Award"],"award-info":[{"award-number":["Joanne Angle Investigator Award"]}],"id":[{"id":"10.13039\/100002250","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["336694"],"award-info":[{"award-number":["336694"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,9,5]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the diagnostic accuracy of five vision screening tools used in a school setting using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We compared the results of the five best evidence-based screening tools available in 2014 to the results of a comprehensive eye exam with cycloplegic refraction by a licenced optometrist. Screening included Cambridge Crowded Acuity Cards, Plusoptix S12 and Spot photoscreeners, Preschool Randot Stereoacuity Test and the Pediatric Vision Scanner (PVS). Referral criteria followed AAPOS (2013) guidelines and published norms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A large school in Toronto, Canada, with 25 split classrooms of junior kindergarten (JK: 4 year olds) and senior kindergarten (SK: 5 year olds) children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Over 2 years, 1132 eligible children were enrolled at the school. After obtaining parental consent, 832 children were screened. Subsequently, 709 children had complete screening and optometry exam data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The presence\/absence of a visual problem based on optometrist\u2019s assessment: amblyopia, amblyopia risk factors (reduced stereoacuity, strabismus and clinically significant refractive errors) and any other ocular problem (eg, nystagmus).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 26.5% of the screened children had a visual problem, including 5.9% with amblyopia. Using all five tools, screening sensitivity=84% (95% CI 78 to 89), specificity=49% (95%\u2009CI 44 to 53), PPV=37% (95% CI 33 to 42), and NPV=90% (95% CI 86 to 93). The odds of having a correct screening result in SK (mean age=68.2 months) was 1.5 times those in JK (mean age=55.6 months; 95%\u2009CI 1.1 to 2.1), with sensitivity improved to 89% (95% CI 80 to 96) and specificity improved to 57% (95% CI 50 to 64) among SK children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A school-based screening programme correctly identified 84% of those kindergarten children who were found to have a visual problem by a cyclopleged optometry exam. Additional analyses revealed how accuracy varies with different combinations of screening tools and referral criteria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-032138","type":"journal-article","created":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T18:07:10Z","timestamp":1569521230000},"page":"e032138","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Choosing appropriate tools and referral criteria for vision screening of children aged 4\u20135 years in Canada: a quantitative analysis"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9581-8400","authenticated-orcid":false,"given":"Mayu","family":"Nishimura","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Cohen","sequence":"additional","affiliation":[{"name":"Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Thorpe","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne","family":"Maurer","sequence":"additional","affiliation":[{"name":"Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,9,26]]},"reference":[{"key":"2025121223422758000_9.9.e032138.1","unstructured":"American Academy of Ophthalmology Pediatric Ophthalmology\/Strabismus Panel . 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