Assessment of the Spot vision screener performance in detecting amblyopia and strabismus in Nepal: a prospective diagnostic accuracy study.
Publication/Presentation Date
10-9-2026
Abstract
BACKGROUND: Photoscreening can quickly detect amblyopia and strabismus, but there is little data on the performances of screening devices in low-income countries. The goal of this study was to assess the diagnostic accuracy of the Spot vision screener in Nepal.
METHODS: This prospective study enrolled a random sample of children 3-8 years of age seen in a pediatric ophthalmology clinic in Nepal. A trained ophthalmic assistant screened each child with using the Spot. A fellowship-trained pediatric ophthalmologist masked to screening results examined the children and to determine whether amblyopia or strabismus was present. This examination was the reference standard for diagnostic accuracy.
RESULTS: Of 219 consecutive children seen in the clinic, 109 were randomly selected for enrollment, of whom 91 were enrolled (mean age, 6.4 ± 1.4 years; 63.2% male). Twenty (22%) were diagnosed with amblyopia; 7 (7.7%), with strabismus. Of the 91, 31 (34.1%) failed the Spot screening according to standardized examination failure criteria. For detecting amblyopia, failure on the Spot for any reason had a sensitivity of 90.0% (95% CI, 68.3%-98.8%) and specificity of 81.7% (70.7%-89.9%). For detecting strabismus, failure on the Spot for any reason had a sensitivity of 71.4% (29.0%-96.3%), and specificity of 69.0% (58.0%-78.7%). For amblyopia or strabismus, sensitivity was 83.3% (62.9%-95.3%), and specificity was 83.6% (72.5%-91.5%). Positive predictive value in the clinic population was 64.5% (45.4%-80.8%) and negative predictive value was 93.3% (83.8%-98.2%).results CONCLUSIONS: In this cohort, the Spot vision screener had relatively high sensitivity and moderate specificity for detecting amblyopia and strabismus, demonstrating its ability to correctly identify the majority of cases in a low-resource setting, although over-referral may result from its relatively low specificity and inaccurate autorefraction values.
First Page
105318
Last Page
105318
ISSN
1528-3933
Published In/Presented At
Shrestha, M., Bhandari, G., Bhandari, S., He, J., Aromin, K., Ying, G. S., Keenan, J. D., & Oatts, J. T. (2026). Assessment of the Spot vision screener performance in detecting amblyopia and strabismus in Nepal: a prospective diagnostic accuracy study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 105318. Advance online publication. https://doi.org/10.1016/j.jaapos.2026.105318
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
42854827
Department(s)
Department of Pediatrics
Document Type
Article