Predictive value from pediatrician plusoptix screening: impact of refraction and binocular alignment

Area of Science:

• Ophthalmology
• Pediatric Optometry
• Vision Screening Technology

Background:

• Conventional preschool acuity screening has a positive predictive value (PPV) of approximately 50%.
• Previous Polaroid photoscreening with expert interpretation achieved PPV over 85%.
• The Plusoptix photoscreener offers immediate computer interpretation and a CPT code for pediatricians.

Purpose of the Study:

• To evaluate the validity of the Plusoptix photoscreener using established refractive and new binocular alignment criteria in pediatric practices.
• To assess the positive predictive value (PPV) of referrals generated by the Plusoptix device.
• To monitor the reimbursement trends for the screening CPT code 99174.

Main Methods:

• Two Plusoptix SO9 devices were utilized in two pediatric group practices.
• Screening employed validated refractive criteria and manufacturer's binocular alignment criteria.
• Referred patients underwent gold-standard American Association for Pediatric Ophthalmology and Strabismus (AAPOS) examinations.

Main Results:

• 12% of 675 photoscreened preschoolers were referred for further examination.
• The PPV for strabismus referrals was 17%.
• 26 out of 27 refractive referrals demonstrated true amblyopia risk factors, yielding a PPV of 96% for refractive errors. Reimbursement for CPT code 99174 increased significantly.

Conclusions:

• Plusoptix photoscreening is a valid tool for preschool vision screening when binocular alignment criteria are adjusted.
• Pediatric practices should adopt Plusoptix photoscreening to enhance early detection of amblyopia.
• This technology has the potential to reduce vision impairment in children through timely intervention.