Plusoptix photoscreener use for paediatric vision screening in Flanders and Iran

Abstract

Purpose: Photoscreening assesses risk factors for amblyopia, as an alternative to measurement of visual acuity (VA) to detect amblyopia, on the premise that its early correction could prevent development of amblyopia. We studied implementations of Plusoptix photoscreening in existing population-based screening in Flanders and Iran. Methods: In Flanders, VA is measured at age 3, 4 and 6, photoscreening was added to existing screening at age 1 and 2.5 years in 2013. In Iran, VA is measured at ages 3-6 years, photoscreening was added at ages 3-6 years between 2011 and 2016. Plusoptix use was analysed in the literature for detection of risk factors for amblyopia and amblyopia itself, for ages 0-3 and for 4-6. A questionnaire, containing seven domains: existing vision screening, addition of photoscreening, implementation in screening program, training, attendance, diagnosis and treatment, and costs was distributed. In Iran, screening procedures were observed on site. Results: Implementation of Plusoptix photoscreening was mainly analysed from questionnaires and interviews, its effectiveness from literature data. In Flanders, of 56 759 children photoscreened at age one (81% of children born in 2013), 9.2% had been referred, 13% of these were treated, mostly with glasses, resulting in an increase of 4-year-old children wearing glasses from 4.7% to 6.4%. In Iran, 90% of children aged 3-6 years participated in vision screening in 2016, but only those who failed the vision test were subjected to photoscreening. Conclusions: In Flanders, the use of Plusoptix photoscreening at ages 1 and 2.5 resulted in an increase of children wearing glasses, but it remains unknown how many cases of amblyopia have been prevented. Studies are needed to determine the relation between size and sort of refractive error and strabismus, and the increased chance to develop amblyopia.

Costs and effects of conventional vision screening and photoscreening in the Dutch preventive child health care system

“…For photoscreening, our cost estimates are less that reported in the literature (€5.35–7.20). 24 , 25 Reported time measurements in other studies are similar to ours (mean 2.5 min for photoscreening and 5.9 min for conventional vision screening in preschoolers; 26 1.7 min for autorefraction and 5.4 for conventional vision screening in children aged 3–6y, 27 and table 2 ). Hence, differences in cost estimates may be explained by differences in hourly rates of health personnel performing the screening.…”

Scope and costs of autorefraction and photoscreening for childhood amblyopia—a systematic narrative review in relation to the EUSCREEN project data

“…Audit data was rarely available or collected centrally. The Flanders region of Belgium seems an exception [ 101 ] and wide within-country variation was the rule. No country guidelines have mandated photoscreening alone.…”

“…Evidence from Flanders in Belgium and Portugal shows that early photoscreening can result in many more young children being given glasses [ 82 , 101 ]. In Flanders, the number of 4-year olds wearing glasses rose from 4.7% in 2012 to 6.4% in 2017 after the introduction of photoscreening but it is unknown how many cases of amblyopia were prevented.…”

Effectiveness of routine population‐wide orthoptic preschool vision screening tests at age 6–24 months in the Netherlands

“…In Flanders, Belgium, photoscreening has been introduced recently as a temporary add-on screening to VA measurements at one and two-and-a-half years of age. Implementation of photoscreening resulted in increase of prescriptions of glasses from 4.7% to 6.4% (Bostamzad et al 2020).…”