The yield and challenges of charitable state-wide photoscreening.

Introduction: State-wide cooperative programs for pediatric vision screening utilizing the MTI photoscreener and centralized interpretation were established in Alaska (The Alaska Blind Child Discovery, ABCD) and in Tennessee (Tennessee Lions Outreach).

Methods: Details of setup, implementation and interpretation of the state-wide MTI photoscreening programs are compared through 2002. The absolute numbers of children screened and the breakdown in interpretation categories are presented.

Results: ABCD screened 14,000 children while Tennessee Lions screened 100,800. Similarities between ABCD and Tennessee programs were funded by Lions Clubs and other charitable and public health organizations, community screening and each had coordinated centralized image interpretation and notification. The programs differed by clinic focus (Tennessee Lions organized pre-schools while ABCD used village and community health fairs and schools), parent notification (Tennessee Lions communicated through pre- schools and ABCD mailed directly to parents), and image interpretation (Tennessee used VOIC age-based and pupil-size crescents while ABCD used "delta-center crescent"). Predictive value positive was 73% for Tennessee and 89% for ABCD. Tennessee achieved better followup on referrals after a specific coordinator was employed. Image interpretation breakdown for ABCD: Tennessee Lions Outreach were anisometropia (29%:34%), high hyperopia (33%:16%), astigmatism (18%:30%), strabismus (7%:15%), myopia (5%:2%), cataract (0.7%:0.2%). Two state-wide programs detected 3216 amblyopic children at a charity borne-cost of 1.5 million dollars. If the parents persisted with appropriate amblyopia therapy, the expected societal value was estimated at 17 million dollars. Lacking societal mandate and funding, these concerted charitable efforts only achieved a community penetration rate of 10% to 14%.

Conclusion: National adoption of preschool vision screening by a method with similar or even better validity and cost effectiveness as MTI photoscreening, ideally in the pediatric medical home, is warranted.