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Journal of Ophthalmology
Volume 2019, Article ID 3267151, 5 pages
Research Article

Adequacy of the Fogging Test in the Detection of Clinically Significant Hyperopia in School-Aged Children

1Department of Ophthalmology, São João Hospital, Porto, Portugal
2Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
3Department of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal

Correspondence should be addressed to Jorge Meira; moc.liamg@ariemsegroj

Received 17 February 2019; Revised 16 May 2019; Accepted 18 June 2019; Published 5 August 2019

Academic Editor: Antonio Queiros

Copyright © 2019 João Esteves Leandro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. To evaluate the efficacy of the “fogging test,” performed with a +2 diopters (D) lens, in the exclusion of clinically significant hyperopia in school-aged children. Methods. We studied 54 children between 5 and 11 years of age, with 10/10 best-corrected bilateral visual acuity (VA) without significant degree of correction. VA was assessed in each eye with a “bilateral” +2 D sphere over-refraction followed by cycloplegic retinoscopy. The capacity of the test to detect hyperopia of ≥+2 D and ≥+1.5 D was evaluated by examining the respective receiver operating characteristic (ROC) curves and sensitivity and specificity values for different cutoff values of VA. Results. For the detection of hyperopia ≥+2 D, the area under the ROC curve (AUC) was 0.955 (). The VA cutoff with best discriminative capacity was ≥5/10, with a sensitivity of 100%, specificity of 79%, positive predictive value (PPV) of 57%, and negative predictive value (NPV) of 100%. In respect of ≥+1.5 D hyperopia, the test capacity was lower (AUC = 0.832; ). The best VA cutoff was also of ≥5/10, with a PPV of 81% and a NPV of 85%. Conclusion. The accuracy of the test was high for the evaluation of ≥+2 D hyperopia but lower for ≥+1.5 D hyperopia. For the detection of ≥+2 D hyperopia, the VA cutoff of <5/10 may permit the exclusion of clinically significant hyperopia in selected children, without the need for cycloplegia. For the same cutoff, the PPV was low, meaning that in children with ≥5/10 VA cycloplegic refraction remains obligatory.