ABSTRACT
BACKGROUND: New photoscreening models promise to detect amblyopia risk factors early in hopes of reducing permanent pediatric monocular and binocular vision impairment. The 3 commercially available interpreted photoscreeners had not yet been compared. METHODS: This is a prospective, observational screening study following AAPOS guidelines on pediatric patients with and without developmental delays. 270 patients in a pediatric eye practice aged 4.7 +/- 4 years with 7% special needs. From December 2011 through March 2012, the Plusoptix, the iScreen, and the Pediavision SPOT were applied before confirmatory exam in a clinical pediatric eye practice. RESULTS: The inconclusive rate ranged from 1-4% (iScreen) to 12% (Plusoptix). Sensitivity ranged from 72% (iScreen) to 84% (Plusoptix) and specificity ranged from 68% (SPOT) to 94% (Plusoptix). The iScreen can provide results in 99% of high risk patients. CONCLUSIONS: In this cohort with high pre-screening prevalence, the 2011 photoscreeners had favorable validation that is expected to improve with further clinical study. Pediatricians have practical technology with a recognized procedure code to assist in amblyopia reduction.
Subject(s)
Refractive Errors , Vision Screening , Amblyopia/diagnosis , Child , Humans , Infant , Prospective Studies , Refractive Errors/diagnosis , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
BACKGROUND: The positive predictive value (PPV) of conventional preschool acuity screening is about 50% whereas previous Polaroid photoscreening with experienced interpretation can achieve PPV greater than 85%. The Plusoptix photoscreener has immediate computer interpretation and a CPT code available to pediatricians. METHODS: Two Plusoptix SO9 were used in two pediatric group practices with previously validated refractive criteria and new manufacturer's binocular alignment criteria. CPT billing was monitored. Referred patients had prior gold-standard AAPOS examinations. RESULTS: 12% of 675 photoscreened preschoolers were referred. Of the 39 with AAPOS gold-standard exams, the PPV from strabismus referrals was 17%, while 26 of 27 refractive referrals had true amblyopia risk factors (PPV 96%). Screening CPT code 99174 reimbursement rose from zero to half of insurers in 15 months. CONCLUSION: Plusoptix photoscreening is valid after adjusting the binocular alignment criteria. Such photoscreening should be employed by pediatric practices to detect and ultimately to reduce amblyopia vision impairment in children.
