The W.H.E.E.L.S. Preschool Vision Screening Program’s Initial Outcomes for 12,402 Children Screened Using the Plusoptix Photoscreener

Abstract

Objective. To report the results of the W.H.E.E.L.S. Prevent Blindness Mid-Atlantic vision screening program that targets preschoolers using the Plusoptix Photoscreener (Plusoptix Inc., Nuremburg, Germany). Methods. Trained program staff members conducted vision screenings at up to 113 preschool programs in the Richmond metropolitan area for four consecutive years; a cross-sectional analysis was performed. Results and Discussion. From September 2010 to March 2014, 15,075 preschoolers have been offered a free vision screening; 12,402 (82%) have been screened. A total of 3,018 (24%) have failed the screening and were recommended to follow up with an eye care specialist for a comprehensive examination; only 30% reported complying. Significant refractive errors were more frequently the cause for a failed screening. Conclusions. The W.H.E.E.L.S. program has identified a high number of preschoolers with significant amblyopic risk factors that were previously unknown to be present. Undesirably low follow-up reporting outcomes from children who fail a vision screening examination were consistent with other reports. Nevertheless, having a mobile vision screening program that uses photoscreening technology in targeting children prior to school entry is an efficient and cost-effective way to detect vision disorders in a timely manner.

Comparison of the pediatric vision screening program in 18 countries across five continents

“…1). The final analysis was performed on 36 articles that reported implementation in 18 countries from 5 continents (Table 2), comprising North America ( n = 2),19, 27, 28, 29, 30, 31, 32, 33, 34, 35 Asia ( n = 8),3, 21, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46 Oceania ( n = 2),16, 17 Europe ( n = 4),6, 20, 47, 48, 49, 50 and Africa ( n = 2) 51, 52. Objectives of screening program were dissected based on target age groups according to their learning stages and target conditions.…”

“…Type I approach was implemented in approximately 44% (8 out of 18) of the countries 3, 17, 20, 36, 37, 41, 44, 52. Screening for risk factors (Type III) was applied in three countries (Canada, the United States, and Iran) 19, 29, 31, 38. Since the implementation of a mass pediatric vision screening program involves significant economic investment, further analysis was performed comparing the implementation approach with socioeconomic status (based on per capita gross national income in 2014) 53 .…”

“…All countries (100%) used a chart-based approach to screen conditions related to reduce vision (Types I and II) specifically among children at preschool and school-aged. Screening for risk factors (Type III) using the instrument-based approach was applied in three countries (11%) 19, 29, 38. Screening for binocular vision and/or ocular health (Type II) including general observation, Hirschberg test, pupillary reflex, red reflex, stereotest, and questionnaire were implemented in ten countries (Australia, Canada, Italy, Japan, South Korea, the Netherlands, the United Kingdom, the United States, Egypt, and Iran) 6, 16, 27, 45, 46, 47, 48, 55.…”

“…Objectives of existing pediatric vision screening programs varied with different age groups and conditions 3, 6, 16. Inconsistencies in implementation were commonly observed in the testing approach3, 17, 18, 19 and vision screeners 3, 20, 21. Pediatric vision screening programs often received an ad hoc level of support from governing authorities and financial allocation due to lack of evidence in the cost findings and the effectiveness of the program 10 .…”