School bus accommodation-relaxing skiascopy

Figures & data

Table 1 Compared refractive values for spherical equivalent (Sph Eq) hyperopia (hyper) and astigmatism (cyl) greater than 0.7 diopters for right eye and left eyes (R and L). Median and 90% CIs are given. Medians compared between SBA-RS and cycloplegic refractions (bus and C; upper of each Mann–Whitney z value) and Retinomax compared to cycloplegic refraction (RM and C; lower of each z with p= probability). Patients with developmental delays compared for impact on relaxing accommodation

		Rx >0.7 D		Median	CI 5%	CI 95%	n	Mann–Whitney		Delays
								z	p	z	p
Sph Eq	R	hyper	bus	2.50	0.50	6.75	264	1.59	0.11	0.73	0.47
	R	hyper	C	2.75	0.88	6.88	264
	R	hyper	RM	1.88	−2.25	6.13	93	4.71	<0.01	2.12	0.03
	L	hyper	bus	2.44	0.25	6.75	264	1.53	0.13	1.21	0.23
	L	hyper	C	2.50	0.50	7.00	264
	L	hyper	RM	2.00	−1.88	6.50	93	3.34	<0.01	2.45	0.01
cyl	R	cyl	bus	1.50	0.00	3.50	116	2.05	0.04
	R	cyl	C	1.50	0.75	3.50	116
	R	cyl	RM	1.75	0.25	4.00	44	0.57	0.57
	L	cyl	bus	1.13	0.00	3.50	116	1.38	0.17
	L	cyl	C	1.25	0.25	3.75	115
	L	cyl	RM	1.88	0.25	3.50	42	1.45	0.15
J0	R	cyl	bus	0.75	−0.50	1.75	88	1.78	0.07
	R	cyl	C	0.62	−0.50	1.73	116
	R	cyl	RM	0.91	−0.06	2.12	35	3.72	<0.01
	L	cyl	bus	0.71	−0.48	1.72	88	1.65	0.1
	L	cyl	C	0.60	−0.46	1.82	116
	L	cyl	RM	0.99	−0.12	1.80	35	3.28	<0.01
J45	R	cyl	bus	0.00	−0.65	0.34	88	0.86	0.39
	R	cyl	C	−0.04	−0.66	0.34	116
	R	cyl	RM	0.04	−0.80	0.56	35	3.48	<0.01
	L	cyl	bus	0.00	−0.51	0.50	88	0.37	0.71
	L	cyl	C	0.00	−0.55	0.56	116
	L	cyl	RM	0.03	−0.52	0.60	35	0.55	0.59

Table 2 Regressions: For each refractive component comparing a noncycloplegic screen with either bus (SBA-RS) or Retinomax with cycloplegic actual refraction. Refractive values of hyperopia (hyp) and astigmatism (cyl) sorted to those greater than 0.7 diopters (Rx>0.7)

Component	Side	Rx>0.7	Delay	Compare	Slope	CI 95%	Intercept	Spearman
Spherical Eq	R	All	All	Bus	0.98	0.96, 1.01	0.14	0.97
	R	All	All	RM	0.79	0.71, 0.87	1.01	0.81
	L	All	All	Bus	0.99	0.97, 1.02	0.17	0.97
	L	All	All	RM	0.86	0.79, 0.93	0.91	0.87
	R	hyp	Normal	Bus	0.97	0.88, 1.07	0.52	0.94
	R	hyp	Normal	RM	1.02	0.89, 1.15	0.35	0.96
	R	hyp	Delay	Bus	0.9	0.76, 1.03	0.69	0.92
	R	hyp	Delay	RM	0.94	0.63, 1.25	0.61	0.92
	L	hyp	Normal	bus	0.99	0.91, 1.1	0.49	0.94
	L	hyp	Normal	RM	0.91	0.78, 1.04	0.79	0.85
	L	hyp	Delay	bus	0.93	0.76, 1.1	0.62	0.90
	L	hyp	Delay	RM	0.47	−0.60,1.5	1.6	0.32
Cylinder power	R	cyl	All	Bus	0.81	0.73, 0.89	0.58	0.80
	R	cyl	All	RM	0.65	0.52, 0.77	0.83	0.74
	L	cyl	All	Bus	0.86	0.79, 0.94	0.38	0.84
	L	cyl	All	RM	0.77	0.67, 0.88	0.48	0.84
J0 vector	R	cyl	All	Bus	0.92	0.84, 0.99	0.14	0.87
	R	cyl	All	RM	0.75	0.60, 0.89	0.26	0.76
	L	cyl	All	Bus	0.9	0.82, 0.98	0.12	0.87
	L	cyl	All	RM	0.76	0.64, 0.88	0.24	0.83
J45 vector	R	cyl	All	Bus	0.98	0.87, 1.1	−0.01	0.80
	R	cyl	All	RM	0.66	0.51, 0.81	−0.09	0.71
	L	cyl	All	Bus	0.92	0.82, 1.03	−0.01	0.79
	L	cyl	All	RM	0.67	0.47, 0.86	−0.06	0.63

Table 3 Discrepancies between SBA-RS and Retinomax for spherical equivalent more than 1D diffference (sphEq), astigmatism cylinder power more than 1 diopter (cyl) and astigmatism axis beyond 10° (axis). Chi-square value z and probability p

	SBA-RS		Retinomax		z		p
	R	L	R	L	R	L	R	L
Axis >10°	17%	17%	30%	27%	2.56	2.15	0.01	0.03
cyl >1D	11%	8%	25%	18%	3.82	3.65	<0.01	<0.01
sphEq >1D	7%	10%	36%	35%	8.99	7.63	<0.01	<0.01

Figure 1 The school bus accommodation-relaxing skiascopy (SBA-RS) technique being utilized by author RWA in a remote Burma clinic demonstrating a higher plus lens over the nonstreaked eye to produce fogging effect (written informed parental consent given to share photo).

Figure 2 Linear regression for spherical equivalent comparing two screening methods (abscissa) SBA-RS (open black circles and solid black regression line) and Retinomax (solid gray diamonds with dashed gray regression line) compared to cycloplegic refraction in diopters (ordinate).

Figure 3 Linear regressions for SBA-RS versus cycloplegic spherical equivalent refraction for patients with and without developmental delays separating those with hyperopia (spherical equivalent greater than 0.7 D).

Figure 4 Linear regression for astigmatism cylinder power comparing two screening methods (abscissa) SBA-RS (open black circles and solid black regression line) and Retinomax (solid gray diamonds with dashed gray regression line) compared to cycloplegic refraction in diopters (ordinate).

Figure 5 Linear regression for astigmatism J0 vector comparing two screening methods (abscissa) SBA-RS (open black circles and solid black regression line) and Retinomax (solid gray diamonds with dashed gray regression line) compared to cycloplegic refraction in diopters (ordinate).

Figure 6 Linear regression for astigmatism J45 vector comparing two screening methods (abscissa) SBA-RS (open black circles and solid black regression line) and Retinomax (solid gray diamonds with dashed gray regression line) compared to cycloplegic refraction in diopters (ordinate).

Figure 7 Bland–Altman plot comparing patients with astigmatism 0.75 and greater measured by school bus accommodation relaxing skiascopy (SBA-RS) and cycloplegic refraction for J0 vector.

Figure 8 Bland–Altman plot of J45 vector for patients with astigmatism 0.75 diopters and greater measured with SBA-RS compared to cycloplegic refraction.

Figure 9 Receiver operating characteristic (ROC) curve for screening cycloplegic refractive amblyopia risk dactors (ARF) with school bus accommodation-relaxing skiascopy (SBA-RS, black) and Retinomax (gray). Two published uniform gold-standard guidelines from the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2003 (solid squares) and age-stratified from 2013 (dashed circles).