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Predictive value of photoscreening and traditional screening of preschool children
April A Salcido1, Joel Bradley, Sean P Donahue
1Vanderbilt University College of Arts and Science, Vanderbilt University School of Medicine, 8000 Medical Center East, Nashville, TN 37232-8808, USA.
Insights
Photoscreening is a faster and more effective method for detecting vision problems in young children compared to traditional screening. This study suggests photoscreening should be considered for widespread use in preschool vision screening programs.
Area of Science:
- Pediatric ophthalmology
- Vision screening technologies
Background:
- Early detection of amblyogenic factors in preschool children is crucial for preventing permanent vision impairment.
- Traditional vision screening methods in pediatric offices have limitations in accuracy and efficiency.
Purpose of the Study:
- To compare the effectiveness and efficiency of photoscreening versus traditional vision screening for 3- and 4-year-old children.
- To evaluate the positive predictive value (PPV) of each screening method.
Main Methods:
- A randomized trial comparing MTI PhotoScreener with traditional acuity and stereopsis tests (HOTV charts/Random Dot E) in six pediatric clinics.
- Trained pediatricians and staff administered screenings during well-child exams over 12-month periods.
- Referred children underwent comprehensive eye examinations with cycloplegic refraction.
Main Results:
- Photoscreening was significantly faster (2.5 vs 5.9 minutes, P < 0.01).
- Referral rates were similar (3.8% vs 4.5%), but photoscreening had a higher PPV (73% vs 0% confirmed amblyogenic factors).
- Untestable rates were comparable, though higher with photoscreening in one clinic due to unreadable results.
Conclusions:
- Photoscreening demonstrates superior time efficiency and a higher positive predictive value for identifying vision issues in 3- and 4-year-olds.
- Traditional screening methods showed limitations in validating findings in this age group.
- The findings support further investigation into widespread implementation of photoscreening for preschool vision assessment.
Purpose:
To compare the usefulness of traditional vision screening and photoscreening of 3- and 4-year-old children in the pediatrician's office.
Methods:
Following training of pediatricians and office staff, six pediatric clinics used both the MTI PhotoScreener (Medical Technology Industries, LLC, Riviera Beach, FL) and traditional acuity and stereopsis screening materials (HOTV charts/Random Dot E tests as recommended by established AAP-MCHB-PUPVS guidelines) during well-child exams. Clinics used one testing method for a 6-month period and switched to the other for the following 6 months, in a randomized manner. Referred children received a complete eye examination with cycloplegic refraction by local ophthalmologists or optometrists who forwarded the results to Vanderbilt Ophthalmology Outreach Center. Amblyogenic factors were defined using standardized published criteria.
Results:
Six hundred five children were screened with the photoscreener and 447 were screened with traditional techniques. Mean time for screening was less with the photoscreener: 2.5 versus 5.9 minutes ( P < 0.01). Untestable rates were similar (18% vs 10%, respectively P = NS), but higher with the photoscreener due to one clinic's 70% unreadable rate. Referral rates were also similar: 3.8% versus 4.5%. The positive predictive value (PPV) rate differed greatly. With follow-up results obtained from 56% of referred children, 73% of photoscreening referred children (8/11 examined) had amblyogenic factors confirmed on formal eye exams, whereas all children referred using traditional screening methods (10/10 examined) were normal.
Conclusion:
Photoscreening is more time efficient than traditional screening and has a significantly higher PPV in 3- and 4-year-old children. This study was unable to validate traditional screening techniques in this preschool age group. If these results can be replicated, support for traditional vision screening must undergo intense scrutiny, and attention should be turned toward making photoscreening feasible for widespread implementation.
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