Validation of photoscreening technology in the general pediatrics office: a prospective study

Abstract

Photoscreening instruments have been widely validated in pediatric ophthalmology clinics and field studies; however, validation by general pediatricians is lacking. We performed the first prospective, multisite evaluation of a commercially available photoscreener in the medical home. Eleven practices in Middle Tennessee recruited over 3,100 children between 12months and 5years to be screened at well-child examinations. Participants were those who received a "refer" result; controls received a "pass." Referred children received a comprehensive eye examination with cycloplegic retinoscopy. A subset of control children underwent eye examinations in an attempt to determine sensitivity and specificity. The overall referral rate was 10%. Amblyopia risk factors (ARFs) were confirmed in 47% of referred children, with positive predictive values (PPVs) of 77.8% for suspected hyperopia, 60% for myopia, 50% for anisometropia, and 44.8% for astigmatism by the 2013 guidelines of the American Association of Pediatric Ophthalmology and Strabismus Vision Screening Committee. Using the 2003 guidelines, the overall PPV was 60.3%; PPVs were determined for suspected hyperopia (77.8%), myopia (60%), anisometropia (67.6%), and astigmatism (61.2%). Of referred children who received follow-up, 18 (13.2%) had amblyopia. PPVs for children ≤36months (n=79) did not differ from those 37-72months (n=57). No child who passed screening and had a follow-up examination had any ARFs. Our results replicate those of previously published field studies and support recent United States Preventive Services Task Force and American Academy of Pediatrics position statements. They provide prospective evidence that photoscreening is an effective tool for children aged 12-72months.