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Practical Validation Of Plusoptix, Iscreen, SPOT and Icheckkids Photoscreeners In Young and Developmentally Delyed Pediatric Patients

Monday, October 28, 2013
Orlando Ballroom N (Hyatt Regency Orlando, formerly the Peabody)
Robert Arnold, MD, Alaska Blind Child Discovery, Anchorage, AK

Purpose

With the publication of new AAP photoscreening guidelines and CPT code 99174, pediatric practices are pondering which of the new photoscreening devices would work best to reduce amblyopia in their practice environment?  There are a variety of ways to validate objective vision screeners.

Methods

Consecutive young patients in a pediatric eye practice had comprehensive exams and four state-of-the-art photoscreeners (iScreen, Pediavision SPOT, Plusoptix and iCheckKids (iPhone app)) consistent with the 2003 and 2012 AAPOS Vision screen Amblyopia Risk Factor guidelines.  Referral criteria were develped for the specific needs of Alaska Pediatric screening.

Results

108 patients aged 6-130 months (mean 46 months) had prescreening probability 56%. The Sensitivity/specificity for each was: iScreen 75%/88%, SPOT 80%/85%, Plusoptix 83%/88% and the iCheckKids with DCC interpretation: 81%/91%.  These were similar for preschoolers and for developmentally delayed children.  Additional statistics reflect the desire to reduce inconclusive screen interpretations.

Conclusion

These 4 portable photoscreeners performed well.  Each device has advantages with adjustable interpretation by Plusoptix and SPOT, rapid aim and image with online interpretation with iScreen and hand-held iPod Touch portability with iCheckKids.  All devices are expected to improve with enhanced interpretation paradigms.  Additional validation efforts include pediatric offices and community screening.  Recent technological developments in devices and interpretation combined with reimbursement and guidelines promise to improve early screening for amblyopia.