Age-based refinement of referral criteria for photoscreening

Objective: To evaluate examination results from preschool children referred from photoscreening, and to adjust referral criteria for suspected astigma tism. Design: Cross-sectional study and noncomparative case series. Participants: Thirty-one thousand fifty-three preschool children. Methods: Analysis of (1) referral rate and unreadable photograph rate for a ll children screened, (2) examination results and treatment plan for all ch ildren referred for suspected astigmatism, and (3) examination results and treatment for all referred children aged less than 1 year. Main Outcome Measures: Referral rate, unreadable photograph rate, predictiv e value positive, treatment plan. Results: The referral rate dropped from 7.8% for children 6 to 11 months to 5.3% for all other ages. The unreadable photograph rate declined exponenti ally from 12.1% for children aged 6 to 11 months to 1.1% for children aged 4 years. The predictive value positive of a photoscreen referral for all ch ildren in the 6- to 11-month age group was 30%, and only 12 of the 94 refer red children were treated. The predictive value positive for children less than 1 year of age referred with suspected astigmatism was even lower (25%) , and only one child in this age group was treated. The predictive value po sitive increased with age, and a higher percentage of older children were t reated. For children at least 3 years old referred for suspected astigmatis m, the predictive value positive was 67% when the examination was performed by a pediatric ophthalmologist. Strabismus, anisometropia, and high hyperm etropia were diagnosed in such patients age 2 and older but never in younge r children. Conclusions: Children less than 1 year of age have a much lower pass rate f rom photoscreening than do older children because of a higher referral rate and higher unreadable rate in this age group. When these children are exam ined, significant pathosis is usually absent, and intervention is rarely in itiated. Most children age 2 and older who are referred for suspected astig matism have a high likelihood of significant pathosis. It is probably unnec essary to examine children less than age 2 when their photoscreening sugges ts only astigmatism; conversely, referrals should still be provided for the se children when their screening suggests other potentially amblyogenic fac tors. (C) 2001 by the American Academy of Ophthalmology.