Paediatric vision screening in the primary care setting in Ontario

Le, Tran; Raashid, Rana Arham; Colpa, Linda; Noble, Jason; Ali, Asim; Wong, Agnes M. F.

doi:10.1093/pch/pxx148

Cited by 11 publications

(5 citation statements)

References 24 publications

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“…As Plusoptix is an user-friendly device, it can be easily performed both at specialized and primary care levels [ 20 , 22 ]. At a specialized level, the pediatric ophthalmologist can use the Plusoptix over spectacles as an initial screening tool to rapidly assess whether a myopic child has decreased their VA. At a primary care level, Plusoptix seems to be even more useful, especially because vision screening in this setting is time-consuming and has low reimbursement, besides many physicians report to be not adequately trained to perform VA testing [ 23 ]. By routinely performing Plusoptix in children over spectacles and considering the calculated cutoff points, physicians can easily and rapidly identify children who may require referral to update glasses prescription.…”

Section: Discussionmentioning

confidence: 99%

Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener

Guimaraes,

Vieira,

Boas

2024

Int Ophthalmol

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Introduction With high increase in myopia prevalence, we aimed to assess whether Plusoptix_A09 can be used in myopic children over spectacles to predict visual acuity (VA) and myopic refraction changes. Methods Myopic children underwent a complete ophthalmological examination. Plusoptix_A09 was performed over spectacles. VA changes, refraction changes and time since previous glasses prescription, were determined. Age, current or past history of amblyopia, presence of strabismus and self-perception of VA changes were registered. Results In total, 199 patients were included. Spherical power (SP) and spherical equivalent (SE) measured by Plusoptix_A09 over spectacles predicted both VA changes (p < 0.001) and refraction changes (p < 0.001). Values of SP < − 0.06D or SE < − 0.22D indicated a VA decrease (AUC > 0.9, p < 0.01) for sensitivity and specificity of 85.1%, 82.1% and 82.6%, 83.3%, respectively. Age and ophthalmological comorbidities did not influence Plusoptix_A09 measurements (p > 0.05). Plusoptix_A09 over spectacles was a stronger predictor of VA changes when compared to children's self-perception, either in 4–9-year-old patients (p < 0.001 versus p = 0.628) and in 10–18-year-old children (OR < = 0.066 versus OR = 0.190). A decrease in SP and SE of − 0.10D in Plusoptix_A09 predicted a myopia progression of − 0.04D and − 0.05D, respectively. Conclusion/Relevance This study unveiled new features for the Plusoptix, a worldwide available photoscreener used in amblyopia screening. When Plusoptix is performed in children with their glasses on, it can rapidly predict myopia progression. For each decrease of − 0.10D in Plusoptix, a myopia progression of -0.05D is expected. Moreover, Plusoptix is more reliable than children's self-perception of visual acuity changes, making it a useful tool either in primary care or ophthalmology practice

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Section: Discussionmentioning

confidence: 99%

Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener

Guimaraes,

Vieira,

Boas

2024

Int Ophthalmol

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“…Transition probabilities were derived from published data in the literature and Statistics Canada and from published and unpublished patient-level data from the Kindergarten Vision Testing Program (Table 1). The risk of developing amblyopia or experiencing treatment failure increased with increasing age …”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

et al. 2023

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ImportanceScreening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown.ObjectiveTo evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government’s perspective.Design, Setting, and ParticipantsAn economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors.Main Outcomes and MeasuresFor each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained.ResultsSchool screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, −0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively.Conclusions and RelevanceIn this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

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“…As Plusoptix is an user-friendly device, it can be easily performed both at specialized and primary care levels 19,21 . At a specialized level, the pediatric ophthalmologist can use the Plusoptix over spectacles as an initial screening tool to rapidly assess if a myopic child has decreased their VA. At a primary care level, Plusoptix seems to be even more useful, especially because vision screening in this setting is time consuming and has low reimbursement, besides many physicians report to be not adequately trained to perform VA testing 22 . By routinely performing Plusoptix in children over spectacles and considering the calculated cutoff points, physicians can easily and rapidly identify children who may require referral to update glasses prescription.…”

Section: Va Changesmentioning

confidence: 99%

Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener

Guimarães

Vieira

Boas

2023

Preprint

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Introduction: With high increase in myopia prevalence, we aimed to assess if Plusoptix_A09 can be used in myopic children over spectacles to predicted visual acuity (VA) and myopic refraction changes. Methods: Myopic children underwent a complete ophthalmological examination. Plusoptix_A09 was performed over spectacles. VA changes, refraction changes and time since previous glasses prescription, were determined. Age, current or past history of amblyopia, presence of strabismus and self-perception of VA changes were registered. Results: 199 patients were included. Spherical power (SP) and spherical equivalent (SE) measured by Plusoptix_A09 over spectacles predicted both VA changes (p<.001) and refraction changes (p<.001). Values of SP<-0.06D or SE<-0.22D indicated a VA decrease (AUC>0.9, p<0.01) for sensitivity and specificity of 85.1%, 82.1% and 82.6%, 83.3%, respectively. Age and ophthalmological comorbidities did not influence Plusoptix_A09 measurements (p>0.05). Plusoptix_A09 over spectacles was a stronger predictor of VA changes when compared to children's self-perception, either in 4-9-year-old patients (p<.001 versus p=.628) and in 10-18-year-old children (OR<=0.066 versus OR=0.190). A decrease in SP and SE of -0.10D in Plusoptix_A09 predicted a myopia progression of -0.04D and -0.05D, respectively. Conclusion/Relevance: This study unveiled new features for the Plusoptix, a worldwide available photoscreener used in amblyopia screening. When Plusoptix is performed in children with their glasses on, it can rapidly predict myopia progression. For each decrease of -0.10D in Plusoptix, a myopia progression of -0.05D, is expected. Moreover, Plusoptix is more reliable than children's self-perception of visual acuity changes, making it a useful tool either in primary care or ophthalmology practice.

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Paediatric vision screening in the primary care setting in Ontario

Abstract: Strategies to improve vision screening are necessary given that early intervention is crucial to prevent treatable causes of vision loss in children.

Cited by 11 publications

References 24 publications

Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener

Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener

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