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Objective Maternal stress in humans influences behavior of children and can be assessed using biological markers. Mothers and their one-month-old infants were recruited from an existing study to examine baseline maternal serum oxytocin and hypothalamic-pituitary-adrenal axis response to infant blood heel stick stress as measured by salivary cortisol in the dyads. Objectives were to explore (1) relationships between mother and infant cortisol levels, (2) gender differences in infant biologic cortisol response, and (3) the association of cortisol levels in the dyads and maternal oxytocin levels Methods Forty-two mother–infant dyads provided biologic samples and self-report data. Maternal oxytocin samples were obtained. Initial salivary cortisol was assessed in both the mother and infant, followed by a heel stick blood draw. Twenty minutes later, salivary cortisol was collected again from dyads. Results Self-report measures were negative for depression and risk for childhood neglect. Although oxytocin and baseline cortisol in the infants was higher in mothers that did some breast-feeding, there was no statistically significant difference ( p = 0.2 and p = 0.1, respectively). Analyses showed (a) higher baseline cortisol in mothers was related to higher baseline cortisol in infants ( p ≤ 0.0001), (b) following the stressor, female infants had a larger positive change in cortisol, after adjusting for baseline cortisol ( p = 0.045), and (c) there was no relationship between dyad cortisol levels and maternal oxytocin. Conclusions Maternal and infant biologic stress measures are related. Female infants have a larger hypothalamic-pituitary-adrenal response to a blood draw stressor as measured by salivary cortisol than male infants.

Purpose: The Association for the Blind and Visually Impaired (ABVI) began the ReFocus on Children Program to assist school nurses in providing vision screening for at-risk children in the Charleston County School District in South Carolina. Methods: In 2012 to 2013, 2,750 low-income school children ages 3 to 5 years were screened using the Plusoptix Vision screener (Atlanta, GA). Further examinations were performed on 419 (56%) children referred and glasses prescribed and provided for 192 children (positive predictive value 46%). In 2013, teacher feedback questionnaires were sent to the 23 schools. Results: Teacher feedback questionnaires had a 49% response rate. Of teachers responding to the questionnaire, 70% reported the children liked wearing their glasses. Teachers provided observations of positive impact, including improved academic performance. Conclusions: Nurses appreciated that the entire process was efficient and completed in school, simplifying care and follow-up. The authors encourage partnerships between schools, nonprofit agencies, and healthcare providers to improve screening and access to comprehensive vision care for young children. [ J Pediatr Ophthalmol Strabismus. 2015;52(1):20–24.]

Purpose To compare refractive data and testability of Spot (PediaVision) and Plusoptix A09 (Plusoptix, Inc) photoscreeners and to compare each device with traditional cycloplegic retinoscopy. Design Prospective, interventional case series. Methods After informed consent, patients underwent testing with the Spot and Plusoptix photoscreeners before their examination by a pediatric ophthalmologist masked to the results. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis. Results A total of 265 children were enrolled (mean age, 6.0 ± 3.4 years). Both devices produced a computer printout result in 250 (94.3%) of the patients. The Spot photoscreener provided a refractive estimate in all computer printouts, whereas the Plusoptix, used binocularly, provided a refractive estimate in 75.2% (188/250) of the printouts. Compared with cycloplegic retinoscopy, both devices underestimated hyperopia or overestimated myopia (−1.35 diopters [D] and −0.64 D, Spot and Plusoptix, respectively) and overestimated astigmatism (0.36 D and 0.32 D, Spot and Plusoptix, respectively). The intraclass correlation coefficient for spherical equivalents indicated good agreement between cycloplegic retinoscopy and Spot (0.806) and excellent agreement between cycloplegic retinoscopy and Plusoptix (0.898). Conclusions The Spot photoscreener provided refractive data on a greater percentage of children. The photorefractors correlated with cycloplegic retinoscopy refractive findings for sphere and spherical equivalents, but underestimated hyperopia or overestimated myopia and overestimated astigmatism. The binocular refractions of Plusoptix agreed more closely with the refractions of our pediatric ophthalmologists.

Background The Spot Vision Screener has demonstrated good sensitivity and specificity in the pediatric ophthalmology clinic setting. We sought to evaluate the updated Spot (version 2.0.16) in a general pediatric population through a collaboration of the Storm Eye Institute of the Medical University of South Carolina, the Clinica Dr Clorito Picado, and National Children's Hospital of Costa Rica. We compared results of screening with the Spot and pediatric ophthalmologic examination and determined sensitivity and specificity of the Spot in detecting amblyogenic risk factors (ARFs) according to the 2013 AAPOS Vision Screening Committee guidelines for automated vision screeners. Methods Children were screened with the Spot followed by a pediatric ophthalmologic examination. Cycloplegic refraction and motility findings were analyzed by age group to determine ARFs. Results A total of 219 subjects, averaging 60 months of age (range, 20-119 mo) were included. The prevalence of ARFs in our population was 12.3% (27/219). The most common risk factor was astigmatism, with a prevalence of 8.7% (19/219). The Spot referred 43 children (19.6%). Sensitivity of the Spot was 92.6%; specificity, 90.6%. The positive predictive value was 58.1%; the negative predictive value, 98.9%. Conclusions The Spot demonstrated good sensitivity and specificity in detecting amblyopia risk factors in this general pediatric population.

Purpose To determine whether the Spot Vision Screener effectively detects amblyopia risk factors (ARFs) in patients with developmental disability using the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods Children with developmental disability presenting for complete pediatric ophthalmologic examination were prospectively enrolled between June 2012 and March 2016. The following data were analyzed: presence of ARFs according to the AAPOS guidelines, refraction, eye alignment, and other ocular pathology. Results A total of 100 children (average age, 5.7 years; range, 2.2- 9.2 years) were included. The prevalence of ARFs in this cohort was 38%. The sensitivity of the Spot Vision Screener in detecting amblyopia risk factors was 84%; the specificity, 62%. The positive predictive value was 58%; the negative predictive value, 86%. Conclusions In our study cohort the Spot Vision Screener provided good sensitivity and adequate specificity for a screening examination. Automated screeners may be useful in screening children with developmental disability.

Background The Spot Vision Screener, a new automated screener designed for use in schools and pediatric offices, refers children for strabismus based on the device's measurement of “gaze.” We sought to evaluate its ability to detect manifest strabismus of ≥8 Δ in primary position, which criteria is specified by the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus for detection of amblyopia risk factors by automated vision screeners. Methods In this prospective study, new and returning patients seen in the pediatric ophthalmology clinic underwent screening with the Spot Vision Screener (version 1.1.51) prior to a complete examination by a pediatric ophthalmologist. A Research Electronic Data Capture database was created for results of Spot referral status and examination. Patients who were referred by the Spot for gaze were included as test positives. Patients found to have constant strabismus of ≥8 Δ in primary position by the physician were considered referral positive. Results A total of 444 children (average age, 72 months; range, 11-221 months) were included. Of these, 93 (20.9%) met the referral-positive threshold for strabismus criteria on examination by the pediatric ophthalmologist. The sensitivity of the Spot to detect AAPOS-threshold strabismus was 77.17%; the specificity, 93.73%. Positive predictive value was 76.34%; negative predictive value, 94.0%. Conclusions The Spot demonstrates good sensitivity and excellent specificity for detecting AAPOS-threshold strabismus.