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The Compared Predictive Value of Brückner, Acuity, and Strabismus from Pediatric Referrals

Background Although pediatric vision screening now passes evidence-based scrutiny, and has recent AAP guidelines, routine acuity testing in pediatric offices may still perform poorly. Methods From 6/2002 through 8/2005, all children aged 0–6 directly referred by pediatric caregivers to one pediatric ophthalmologist were compared as to referral indication: failed acuity, strabismus, and positive Brückner test. AAPOS gold standard exam criteria was applied and compared to community photoscreening. Results By referral indication, the following are numbers and predictive values: acuity (n = 80, PPV 51%), Brückner (n = 74, PPV = 89%), strabismus (n = 432, PPV = 81%). Community photoscreening referred n = 392 with PPV = 91%. The objective tests and strabismus queries were not age-dependent. Conclusion The pediatric home best conforms to WHO guidelines due to case-continuous finding and assistance with treatment compliance particularly for strabismus. Objective tests outperform acuity testing in referral for refractive amblyopia including Brückner test in experienced hands. Observation and history best refers strabismus.