Predictive value from pediatrician plusoptix screening: impact of refraction and binocular alignment.

Background: The positive predictive value (PPV) of conventional preschool acuity screening is about 50% whereas previous Polaroid photoscreening with experienced interpretation can achieve PPV greater than 85%. The Plusoptix photoscreener has immediate computer interpretation and a CPT code available to pediatricians.

Methods: Two Plusoptix SO9 were used in two pediatric group practices with previously validated refractive criteria and new manufacturer's binocular alignment criteria. CPT billing was monitored. Referred patients had prior gold-standard AAPOS examinations.

Results: 12% of 675 photoscreened preschoolers were referred. Of the 39 with AAPOS gold-standard exams, the PPV from strabismus referrals was 17%, while 26 of 27 refractive referrals had true amblyopia risk factors (PPV 96%). Screening CPT code 99174 reimbursement rose from zero to half of insurers in 15 months.

Conclusion: Plusoptix photoscreening is valid after adjusting the binocular alignment criteria. Such photoscreening should be employed by pediatric practices to detect and ultimately to reduce amblyopia vision impairment in children.