Objective vision screening in 3-year-old children at a multispecialty practice

Abstract

Vision screening is rarely effectively accomplished for 3-year-olds as part of pediatric well-child examinations. We investigate changes in screening rates and positive predictive values of referrals for 3-year-olds after introducing a photoscreener to a multispecialty group practice. The vision screening results of 3-year-old children undergoing routine well-child examinations between 2007 and 2013 were retrospectively reviewed. From 2007 to 2009, the only method available for vision screening was the Kindergarten Eye Test Chart. From 2010 to 2013 a PlusOptix photoscreener was also available. Rates of vision screening before and after PlusOptix adoption were compared. All children who failed screening were referred to a single pediatric ophthalmologist. Referral rates, follow-up rates, and positive predictive values were determined for PlusOptix photoscreening. Cases were defined by cycloplegic retinoscopy using the 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) vision screening recommendations for amblyopia risk factors. Of 593 children seen for their 3-year well-child examination between 2007-2009, before introduction of a photoscreener, 59 (10%) received vision screening. The screening rate increased to 766 of 958 (80%) between 2010 and 2013, after introduction of the PlusOptix (P < 0.001). Only 49% of children had a reliable first screening with PlusOptix, and the average number of screenings to obtain a reliable result was 2.39. The positive predictive value of PlusOptix referrals was 51% for amblyopia risk factors and 41% for potential amblyopia. Availability of a photoscreener can increase the rate of vision screening for 3-year-old children in a multispecialty practice.