Agreement between the Spot Vision Screener and cycloplegic retinoscopy for toddlers with astigmatism

Background: We investigated the agreement between the Spot Vision Screener (Welch Allyn) and gold standard cycloplegic retinoscopy in infants and toddlers, with special attention to astigmatism. Methods: Participants were children 12-35 months of age who failed a routine photoscreening using the Spot conducted at a recent well-child visit and who subsequently received a cycloplegic eye examination through the Spectacle Prescribing in Early Childhood Study (SPECS). Results: The final sample included 410 children, with an average age of 20.24 months. The Spot mean spherical equivalent value (M) was significantly less hyperopic than cycloplegic retinoscopy M (+0.35 D vs +0.80 D, t[409] < 0.001), and mean Spot Vision Screener cylinder (CYL) was significantly higher than cycloplegic retinoscopy CYL (1.84 D. vs 1.58 D, t[409] < 0.001). Conclusions: Cycloplegic retinoscopy found more hyperopic, or conversely, less myopic sphere power, in 60% of participants at the clinically significant level of >0.50 D. When using the Spot, this could result in under-referral to an eye care professional for moderate to high hyperopia. About 1 in 4 subjects showed higher clinically significant cylinder (>1.00 D) using the Spot compared with cycloplegic retinoscopy, which could result in over-referral for astigmatism when using the 2013 criteria for astigmatism.