—Drs McIntyre and LaRoche correctly address some of the concerns that we had in our evaluation of a screening device in a referral center. Our patients had a higher percentage of abnormal conditions and were more apt to be suspicious of examination techniques and uncooperative for testing. We believe that the children's prior experience with ophthalmologic examinations contributed to our lower success rate in young children and, in part, to the higher number of false-positive results, which were the result of inaccuracies in fixation and alignment rather than defects in the optics of the device. This problem could be circumvented by the use of either instant-development film or a video camera, both of which would allow the tester the ability to retest positives and to reduce the false-positive rate.Even if testing in the general population shows similar rates of sensitivity and specificity as well as positive predictive
Morgan KS, Johnson WD. Clinical Evaluation of a Photorefractor-Reply. Arch Ophthalmol. 1988;106(8):1031–1032. doi:10.1001/archopht.1988.01060140183008
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