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Efficient referral thresholds in autorefraction-based preschool screening.

Eugene A Lowry¹, Alejandra G de Alba Campomanes¹

¹Department of Ophthalmology, University of California, San Francisco, San Francisco, California.

American Journal of Ophthalmology

|March 3, 2015

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Developing stricter referral criteria for preschool vision screening using autorefraction can lower costs and identify more at-risk children. This study found modeled criteria to be more cost-effective than existing methods.

Area of Science:

Ophthalmology
Public Health
Health Economics

Background:

Preschool vision screening is crucial for early detection of visual impairments.
Current referral criteria may not be optimally cost-effective.
Autorefraction offers a potential tool for efficient screening.

Purpose of the Study:

To determine economically efficient referral criteria for preschool vision screening using autorefraction.
To compare the cost-effectiveness of different referral criteria.

Main Methods:

Retrospective economic evaluation of a preschool vision-screening protocol using autorefraction (Retinomax).
Data from two cities (San Francisco and Oakland) were analyzed.
Modeled referral criteria were developed and tested for cost-effectiveness against existing criteria.

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Main Results:

Modeled referral criteria derived from San Francisco data resulted in a cost of $258 per case detected in Oakland.
This was more cost-effective than original criteria ($424) and Vision in Preschoolers study criteria ($371).
Positive predictive values varied by refractive error, ranging from 7% for myopia to 56% for astigmatism.

Conclusions:

Implementing more stringent referral criteria can reduce the cost per case detected in preschool vision screening.
Optimized criteria can enable the detection of more at-risk children within existing financial constraints.
This approach supports efficient resource allocation in pediatric eye care programs.