Photoscreening is a pediatric vision screening technique wherein a camera and flash are used to determine refractive errors and identify risk factors for amblyopia.1
A photoscreener detects amblyopic risk factors such as hyperopia, myopia, and anisometropia and estimates their severity.
The American Academy of Pediatrics (AAP) now recommends photoscreening beginning at ages 1-3.2
Learn why the AAP recommends photoscreening and why so many pediatricians have made the decision to add the test to their care protocol.
The Vision Screening Void
The Centers For Disease Control And Prevention (CDC) reports that “vision disability is the single most prevalent disabling condition among children.”3
Early vision screening is integral to a child’s early health and development, especially in regards to the prevention and treatment of amblyopia, the #1 cause of preventable vision loss in children.4
Regular vision screening assessments in early childhood reduce the risk of persistent amblyopia at 7 years of age by more than 50%.5
However, fewer than 20% of children receive adequate vision screening even though the technology is readily available.6
As a result, “amblyopia remains the most common cause of monocular visual impairment among children.”
Vision Screening at Well-Child Visits
Vision screens conducted by pediatricians at annual well-child visits often include a red reflex examination with an ophthalmoscope and a visual acuity test.7
However, examinations with ophthalmoscopes may not be sufficient to determine if amblyopic risk factors are present.6
Results that appear normal using an ophthalmoscope may have amblyogenic risk factors, especially if the amblyopia is not strabismic.
Also, deprivational and refractive amblyopia are more difficult to find using an ophthalmoscope.
And while visual acuity is the preferred method for vision screening past the age of 5, studies have shown that there is a 0% positive predictive value for traditional visual acuity testing at 3-4 years of age.7 At this age, children are too young to fully understand a visual acuity test, limiting its effectiveness.
Considering that 15-20% of children have amblyopic risk factors and 3-4% have amblyopia, pediatricians are lacking a detection tool that effectively screens children too young for a visual acuity test.1
The Solution: Photoscreening for Amblyopia Prevention
Photoscreening is a pediatric vision screening technique wherein a camera is used to determine refractive errors and identify risk factors for amblyopia.1
Photoscreening detects amblyopic risk factors such as hyperopia, myopia, and anisometropia and measures their severity.
If a child is measured as having a high risk for amblyopia, they should be referred to a pediatric ophthalmologist or optometrist so they can be tested directly for amblyopia and receive proper treatment.
Only screens that present risk factors in accordance with the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 guidelines for referral threshold are identified as risks.1
Dr. Sean Donahue, chief of pediatric ophthalmology at Vanderbilt University, summarizes photoscreening well:
“The advent of photoscreening technology provides a mechanism to be used in conjunction with or to supplant traditional ocular examinations with eye charts to detect the risk factors for amblyopia and other treatable refractive errors.
Photoscreening provides a means to perform a quicker and more efficient vision screening than traditional methods.
The availability of handheld photoscreening devices, such as GoCheck Kids, significantly improves the portability, accessibility, and affordability of such devices.”6
How Photoscreening Works
The software analyzes the image and identifies asymmetry and anomalies within the red reflex that help determine the child’s risk for amblyopia.
If risk factors are present and they exceed the AAPOS referral guidelines, they will be highlighted in red.
Some photoscreeners have the ability to fax the results or integrate directly with an EHR.
Photoscreening Is Recommended And Researched
Photoscreening allows pediatricians to catch amblyopia risk factors before a child can comprehend a visual acuity (Snellen chart) test.8
Even in late preschool and kindergarten, one study places the positive predictive value of visual acuity at only 50%.
This led to excessive false positives and to all true cases of amblyopia being missed.8
For patients ages 1-3, rather than visual acuity testing, photoscreening is now recommended by the AAP, the American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Ophthalmology, and the American Association of Certified Orthoptists.2
The AAP states in their most recent vision screening policy report, “Instrument-based screening, if available, should be first attempted between 12 months and 3 years of age and at annual well-child visits until acuity can be tested directly…”6
To summarize the AAP recommendations:2
- Annual photoscreening is now recommended for children beginning at ages 1-3.
- Visual Acuity Testing is now recommended for children beginning at age 4 when possible.
Photoscreening Is On The Rise
Photoscreening is becoming a standard of pediatric care. At GoCheck Kids, we now have over 2,500 pediatricians using our photoscreener to detect amblyopia risk factors in children too young for a visual acuity test.
Our customers range from pediatric offices in almost every state to large medical groups spanning multiple states or regions.
Regardless of the size or location of our customers, they all experience this “Aha” moment the first time they catch a child with significant amblyopic risk factors.
Hearing these stories is why we wake up every morning. Knowing that we are helping so many pediatricians protect children’s potential keeps us innovating.
Here are some pediatricians recalling their “Aha” GoCheck moment:
“The ophthalmologist is hopeful that her amblyopia will diminish. It is likely that GoCheck played a vision-saving role in this child: the patient was only 2 years old at the time of diagnosis. It is likely that her visual defect would not have been discovered until she was old enough to fail a Snellen test, at which point the Amblyopia would have been irreversible.”
-Dr, Phillipa Gordon, Pediatrician
“With an ophthalmoscope, the ‘red reflex’ was equal bilaterally and normal. So without the GoCheck Kids photoscreener – even with my exam – I would have never considered sending this kid for referral.”
-Dr. Kody Findstad, Pediatrician
“GoCheck Kids won over our whole office as each of us had started catching children for the first time. Every one of our providers has their own story. Mine was an 18-month-old with severe bilateral amblyopia. Her parents had no idea and we wouldn’t have caught her with traditional techniques.”
-Stephanie Messercold, Pediatric Physician’s Assistant
How Many Amblyopic Children Is Your Practice Missing?
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