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Alaska Blind Child Discovery

A cooperative, charitable research project to vision screen every preschool Alaskan

Persistent Pediatric Presbyopia

AAPOS has a good list of anatomic risk factors for amblyopia[1] but they pale in comparison with determination of persistent blur.
This most likely correlates with insufficiently accommodated hyperopia in one or both eyes, in one or more merida.{ ABCD considers this the most common amblyopia Risk Factor.}
Therefore, how do objective screening technology stimulate accommodation?
MTI has blinking LEDs.
PlusOptiX , iScreen and SPOT have the cool sounds and blinking lights.
Welch Allyn has rotating green lights.
ADBC have no specific fixation other than "look at the camera."
Most normal children will yield no photoscreen crescent when a camera is presented. Unless they are fatigued or less than 9 months old.
Some children (i.e Down's) will not accommodate even with 3 diopters of cycloplegic plus. Like an older presbyope[2].
PlusOptix probably can stimulate accommodation better than Welch Allyn. ADBC may least stimulate accommodation. This will yield different values for a relatively small subset of children. A child who is able to occasionally accommodate (ie. Plusoptix 0.75) probably will have pretty good acuity. (These are the false negative photoscreens with OK acuity but True Positive AAPOS criteria less than perfect sensitivity in VIPS[3]) The child who fails to accommodate will have amblyopia for which spectacles will help.
1. Donahue S, Arnold R, Ruben JB. Preschool vision screening: What should we be detecting and how should we report it? Uniform guidelines for reporting results from studies of preschool vision screening. J AAPOS 2003;7:314-316.
2. Arnold RW. Pseudo-false positive eye/vision photoscreening due to accommodative insufficiency. A serendipitous benefit for poor readers? Binoc Vis and Strabismus Quart 2004;19:75-80.
3. VIPS. Comparison of preschool vision screening tests as administered by licensed eye care professionals in the vision in preschoolers study. Ophthalmology 2004;111:637-650.
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