Screening for amblyogenic factors using a volunteer lay network and the MTI PhotoScreener - Initial results from 15,000 preschool children in a statewide effort

Purpose: To describe the results from a statewide preschool vision screenin g program using the MTI PhotoScreener (Medical Technology and Innovations, Inc., Cedar Falls, IA), Design: Cross-sectional study. Participants: A total of 15,059 children aged 6 to 47 months enrolled in ch ildcare and preschool settings throughout the state of Tennessee, Methods: Volunteers from local Lions Clubs took photoscreening photographs of children in a statewide effort. Photographs were interpreted at the Vand erbilt Ophthalmic Photography Reading Center using predetermined criteria. Children who failed the screening were referred to community ophthalmologis ts or optometrists who performed a comprehensive evaluation and forwarded t he results to the authors, Main Outcome Measures: Referral rate, unreadable rate, and predictive value positive (PVP), Results: During the 2 years of the screening program, 15,059 children were screened in 850 screenings. The screening referred 1013 children (6.7%), an d 704 photographs (4.7%) were unreadable. Children who failed the screening had a significant abnormality (strabismus, anisometropia, high hypermetrop ia, high astigmatism, or high myopia) in 320 of the 531 cases where adequat e follow-up results were reported. The PVP ranged from 84% when a diagnosis of strabismus was suggested by the photoscreen reading to 41% for astigmat ism. Despite intense attention to follow-up, many children who failed the s creening never received a formal eye examination. Conclusions: The MTI PhotoScreener can be used by volunteers to screen pres chool children and can have a high PVP in organized settings, provided that meticulous attention is paid to photograph interpretation and quality cont rol. The PVP of the MTI PhotoScreener depends on the diagnosis suggested wh en the photograph is read. Significant obstacles exist in obtaining care fo r those who fail screening. Ophthalmology 2000;107: 1637-1646 (C) 2000 by t he American Academy of Ophthalmology.