Validating performance of Certified Medical Assistants in detecting amblyogenic risk factors in preschool children by using Bruckner test and HOTV chart.

Srijana Adhikari

Purpose: Preschool vision screening is still a new concept in Nepal. There is need for developing cost effective tools for detecting amblyogenic risk factors.Certified Medical Assistants (CMAs) are health personnel who work in village health posts and have direct access to rural population.This study was conducted to find out the effectiveness of vision screening by CMAs using simple tools like HOTV chart and Bruckner test.

Methods: The study was carried out in two phases. In first phase, 20 Certified Medical Assistants from each VDC( Village Development Centre) of Bhaktapur districts were given training on visual acuity test by using HOTV chart at 3 meter distance, Bruckner test by using direct ophthalmoscope. In the second phase, children aged 3-7 years were examined by trained CMAs.These children underwent gold standard examination by two Pediatric Ophthalmologists blind to CMA's findings.

Result: There were 528 children examined.Mean age was 5.26 yrs with SD 1.376 .The overall sensitivity of CMA examination was was 68% and the specificity was 98%. While determining test characteristics of different tools, HOTV test was found more effective (80% sensitivity and 98% specificity) than Bruckner test (54% sensitivity and 89% specificity).

Conclusion: In developing countries like Nepal where access for regular eye examination is a rare possibility, vision screening by Certified Medical Assistants can help in detection and early referral of children having amblyogenic risk factors.