The UCI EyeMobile Preschool Vision Screening Program: Refractive Error and Amblyopia Results from the 2019–2020 School Year

Abstract

To introduce the University of California Irvine (UCI) EyeMobile for Children preschool vision screening program and describe the ophthalmic examination results of children who failed screening with the PlusoptiX S12C photoscreener during one school year. Patients and Methods: Children aged 30-72 months were screened with the PlusoptiX using ROC mode 3 during the 2019-2020 school year. Children who failed screening were referred for comprehensive eye examination on the EyeMobile mobile clinic. Presence of amblyopia risk factors (ARFs), amblyopia, and refractive error was determined via retrospective review of records. Amblyopia was defined as unilateral if there was ≥ 2-line interocular difference in the best-corrected visual acuity (BCVA) and as bilateral if BCVA was < 20/50 for children < 4 years old and < 20/40 for children ≥ 4 years old. ARFs were defined using 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) instrument-based screening guidelines. Results: 5226 children were screened during the study period. Of the 546 children who failed screening, 350 (64%) obtained consent and were examined. Mean age of examined children was 4.45 years. Amblyopia was found in 8% of examined children, with unilateral amblyopia seen in 79% of amblyopic subjects. Glasses were prescribed to 246 (70.3%) children. Of the 240 children who received cycloplegic examinations, 43% had hyperopia and 30% had myopia. The positive predictive value (PPV) of the PlusoptiX screening for ARFs in children who received cycloplegic examinations was 70.4%. Conclusion: A significant proportion of Orange County preschoolers with refractive errors and amblyopia have unmet refractive correction needs. The PlusoptiX S12C photoscreener is an adequate screening device for the UCI EyeMobile for Children program, although modification of device referral criteria may lead to increased PPV. Further research is necessary to understand and overcome the barriers to childhood vision care in our community.

UCI EyeMobile Exam Findings from School Children Following on-Site Screening

“…The earlier study details vision screening performed using the Plusoptix, which had a significantly lower exam referral rate of 10.4% (546/5226), while ours using the Retinomax had a rate of 28.0% (1425/5074). 17 The following is a comparison of refractive errors found during examination by the previous study and ours: emmetropia (27.1% vs 40.2%), hyperopia (42.5% vs 35.4%), myopia (30.4% vs 24.4%), and astigmatism (81.3% vs 71.8%). Our study found higher emmetropia and lower rates of refractive errors, likely due to the higher sensitivity of the Retinomax, with a tendency to over-refer for exams as shown by a recent comparative study of both devices.…”

“…Notably, the rate of no-show (28.1%) was improved from the initial study (36.9%) analyzing the 2019–2020 school year. 17 The remarkably low number of strabismic amblyopic subjects might be influenced by initial screening based principally on refraction, using the Retinomax device; therefore to better screen for strabismus, a recently developed and studied device, the Blinq vision scan with capabilities to detect even micro-strabismus, could be incorporated into our screening protocol. 40 Staff will also be trained and equipped to evaluate and screen for strabismus.…”

“…Children were then referred for a free comprehensive eye examination in the UCI EyeMobile clinic upon meeting the referral criteria established by a prior Retinomax-based EyeMobile screening study. 12 , 16 The Retinomax exam referral criteria applied is as follows: sphere ≥ +1.75 diopters (D) or sphere ≤ –3.25 D, cylinder ≤ –1.50 D, or interocular difference with Δsphere ≥1.50 D or with Δcylinder ≥1.00 D. 12 , 16 , 17 Eye examinations were performed upon receipt of parental informed consent. Children who passed the autorefractor vision screening but required new spectacles with their current prescription were fitted for new frames.…”