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Validation of photoscreening technology in the general pediatrics office: a prospective study
Jana Bregman1, Sean P Donahue2
1Vanderbilt Eye Institute, Nashville, Tennessee; Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
This study shows photoscreening is effective for detecting vision problems in children aged 12-72 months. The tool accurately identifies amblyopia risk factors (ARFs) during well-child visits, supporting its use in primary care.
Area of Science:
- Ophthalmology
- Pediatrics
- Medical Technology
Background:
- Photoscreening instruments are validated in specialized clinics but lack validation by general pediatricians.
- This study presents the first prospective, multisite evaluation of a commercial photoscreener in a general pediatric setting.
- The medical home environment is a key setting for early childhood vision screening.
Purpose of the Study:
- To evaluate the effectiveness of a commercially available photoscreener in a general pediatric setting.
- To determine the referral rate and positive predictive values (PPVs) for amblyopia risk factors (ARFs).
- To provide prospective evidence supporting photoscreening as a tool for early childhood vision screening.
Main Methods:
- Over 3,100 children aged 12 months to 5 years were screened at well-child examinations across 11 practices.
- Children receiving a "refer" result underwent comprehensive eye exams, while a subset of "pass" controls were also examined.
- Sensitivity and specificity were determined using cycloplegic retinoscopy as the gold standard.
Main Results:
- The overall referral rate was 10%.
- Amblyopia risk factors (ARFs) were confirmed in 47% of referred children, with varying positive predictive values (PPVs) based on guidelines (2013 vs. 2003).
- 13.2% of referred children with follow-up had amblyopia; no children who passed screening had ARFs.
Conclusions:
- Results replicate previous field studies and support recommendations from major pediatric organizations.
- Photoscreening is an effective tool for identifying potential vision issues in children aged 12-72 months within the medical home.
- Prospective evidence supports the integration of photoscreening into routine pediatric care for early detection of vision abnormalities.
Background:
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.
Methods:
Eleven practices in Middle Tennessee recruited over 3,100 children between 12 months and 5 years 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.
Results:
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 ≤36 months (n = 79) did not differ from those 37-72 months (n = 57). No child who passed screening and had a follow-up examination had any ARFs.
Conclusions:
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 12-72 months.
