Vision Screening for Kindergarten Children: Investigating the Suresight (SS) Autorefractor Alternative

Purpose: Effective vision screening is important in identifying visual disorders that may impact children throughout their lifetime. The purpose of this study is to compare the sensitivity and specificity of combinations of 3 vision screening tools for detecting vision disorders in kindergarten children. Methods: 457 Boston Public Schools (BPS)kindergarten students were screened by paraprofessionals using the mandated Massachusetts (MA) protocol (MassVAT Lea Symbols and Random Dot E) and a SureSight (SS) autorefractor. All children who did not meet either MA protocol or SS pass criteria along with a matched number who had passed both were referred for a comprehensive eye exam by pediatric optometrists. The exam identified targeted conditions as defined previously by the Vision In Preschoolers Study Group. Primary outcome measures were the sensitivity and specificity of each tool or tool combination for detecting targeted vision disorders. Results: 131 children failed their screening, while 154 were consented and received the exam. Sensitivities and specificities for detecting targeted conditions were significantly better when using the SS + MassVAT (81% and 88%, respectively) compared to other tool combinations. Conclusions: Relative to the mandated MA protocol (60%), vision screening using SS autorefraction in combination with MassVAT Lea visual acuity (81%) yields a considerable improvement in the detection of targeted vision disorders in kindergarten children. This is true even when performed in “real world” screening environments by minimally trained screeners who would typically be responsible for completing school based screenings. This combined protocol should be considered as an alternative for kindergarten vision screening.