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TORONTO – Using an automated photorefractor-based vision screening in preschool-age children reduced referrals to ophthalmologists and optometrists by one-third, compared with standard chart-based screening, according to a nonrandomized trial conducted in Boston. The handheld device that was used requires minimal cooperation from the child and also checks ocular alignment.
“This device requires almost zero cooperation from the child. The nurse or assistant holds the device and the child has to look at it for about two seconds, as opposed to several minutes to do a chart-based test,” reported Louis Vernacchio, MD, at the 2018 Pediatric Academic Societies meeting.
They found a 33.7% decline in initial ophthalmology and optometry visits after practices switched from chart-based vision screening to the hand-held screening device.
“Optometry and ophthalmology is the No. 1 specialist to whom our patients of all ages are referred to in our pediatric network, and the No. 1 diagnosis was normal vision, so in most cases, there’s nothing wrong, and they’re clogging up the system.”
Instrument-based vision screening has been shown to have high sensitivity and specificity, compared with ophthalmic vision screening, and has much better testability in young children than traditional eye chart–based screening.
In previously reported data, Dr. Vernacchio’s group showed that, with instrument-based vision screening, completed screening rates among children aged 3-5 years improved. The most marked improvement was in the 3-year-olds, among whom completed screening rates increased from 39% with chart-based screening to 87% with instrument screening. (Modest JR et al. Pediatrics. 2017 Jul;140[1]. pii: e20163745.) Family satisfaction is also improved with the automated method.
The automated vision screening device used in the study was the Spot Vision Screener produced by Welch Allyn.
“Our nurses are in heaven with these devices, so besides the billing that you can do, you can save staff time and easily justify the cost of the device. My office now has 4 or 5 of these devices because it just saves so much time to have them readily available.”
Professional societies endorse automated vision screening
Amblyopia is seen in 2 or 3 children per 100 in the United States, reported Dr. Vernacchio. Chart-based vision screening is notoriously difficult to accomplish in young children and there is both a risk of missing amblyopia in those who do not cooperate and a risk of overreferral because of poor performance on the test.
Recently, the American Academy of Pediatrics, the U.S. Preventive Services Task Force, and others have endorsed the use of instrument-based vision screening in place of chart-based screening for children aged 3-5 years based on evidence of improved testability and acceptable sensitivity and specificity.
The Spot Vision Screener has a retail cost between $6000 and $7000, according to Dr. Vernacchio. “Many” insurance companies will pay a separate fee for vision screening using an instrument, but others bundle the screening into a well visit, he noted.
“So, you can actually calculate the time to recover the cost of the device based on your payer practices,” he said. Another option is a smart phone app that uses a subscription model, in which the test results are interpreted by the company within a few minutes with a per test charge of about .99 cents.
“The Holy Grail is whether this process will reduce the incidence of amblyopia,” said Dr. Vernacchio. That study is next on his to-do list, he said, but “it’s going to take longer to answer that question.”
The authors reported no conflicts of interest. There was no external funding.
TORONTO – Using an automated photorefractor-based vision screening in preschool-age children reduced referrals to ophthalmologists and optometrists by one-third, compared with standard chart-based screening, according to a nonrandomized trial conducted in Boston. The handheld device that was used requires minimal cooperation from the child and also checks ocular alignment.
“This device requires almost zero cooperation from the child. The nurse or assistant holds the device and the child has to look at it for about two seconds, as opposed to several minutes to do a chart-based test,” reported Louis Vernacchio, MD, at the 2018 Pediatric Academic Societies meeting.
They found a 33.7% decline in initial ophthalmology and optometry visits after practices switched from chart-based vision screening to the hand-held screening device.
“Optometry and ophthalmology is the No. 1 specialist to whom our patients of all ages are referred to in our pediatric network, and the No. 1 diagnosis was normal vision, so in most cases, there’s nothing wrong, and they’re clogging up the system.”
Instrument-based vision screening has been shown to have high sensitivity and specificity, compared with ophthalmic vision screening, and has much better testability in young children than traditional eye chart–based screening.
In previously reported data, Dr. Vernacchio’s group showed that, with instrument-based vision screening, completed screening rates among children aged 3-5 years improved. The most marked improvement was in the 3-year-olds, among whom completed screening rates increased from 39% with chart-based screening to 87% with instrument screening. (Modest JR et al. Pediatrics. 2017 Jul;140[1]. pii: e20163745.) Family satisfaction is also improved with the automated method.
The automated vision screening device used in the study was the Spot Vision Screener produced by Welch Allyn.
“Our nurses are in heaven with these devices, so besides the billing that you can do, you can save staff time and easily justify the cost of the device. My office now has 4 or 5 of these devices because it just saves so much time to have them readily available.”
Professional societies endorse automated vision screening
Amblyopia is seen in 2 or 3 children per 100 in the United States, reported Dr. Vernacchio. Chart-based vision screening is notoriously difficult to accomplish in young children and there is both a risk of missing amblyopia in those who do not cooperate and a risk of overreferral because of poor performance on the test.
Recently, the American Academy of Pediatrics, the U.S. Preventive Services Task Force, and others have endorsed the use of instrument-based vision screening in place of chart-based screening for children aged 3-5 years based on evidence of improved testability and acceptable sensitivity and specificity.
The Spot Vision Screener has a retail cost between $6000 and $7000, according to Dr. Vernacchio. “Many” insurance companies will pay a separate fee for vision screening using an instrument, but others bundle the screening into a well visit, he noted.
“So, you can actually calculate the time to recover the cost of the device based on your payer practices,” he said. Another option is a smart phone app that uses a subscription model, in which the test results are interpreted by the company within a few minutes with a per test charge of about .99 cents.
“The Holy Grail is whether this process will reduce the incidence of amblyopia,” said Dr. Vernacchio. That study is next on his to-do list, he said, but “it’s going to take longer to answer that question.”
The authors reported no conflicts of interest. There was no external funding.
TORONTO – Using an automated photorefractor-based vision screening in preschool-age children reduced referrals to ophthalmologists and optometrists by one-third, compared with standard chart-based screening, according to a nonrandomized trial conducted in Boston. The handheld device that was used requires minimal cooperation from the child and also checks ocular alignment.
“This device requires almost zero cooperation from the child. The nurse or assistant holds the device and the child has to look at it for about two seconds, as opposed to several minutes to do a chart-based test,” reported Louis Vernacchio, MD, at the 2018 Pediatric Academic Societies meeting.
They found a 33.7% decline in initial ophthalmology and optometry visits after practices switched from chart-based vision screening to the hand-held screening device.
“Optometry and ophthalmology is the No. 1 specialist to whom our patients of all ages are referred to in our pediatric network, and the No. 1 diagnosis was normal vision, so in most cases, there’s nothing wrong, and they’re clogging up the system.”
Instrument-based vision screening has been shown to have high sensitivity and specificity, compared with ophthalmic vision screening, and has much better testability in young children than traditional eye chart–based screening.
In previously reported data, Dr. Vernacchio’s group showed that, with instrument-based vision screening, completed screening rates among children aged 3-5 years improved. The most marked improvement was in the 3-year-olds, among whom completed screening rates increased from 39% with chart-based screening to 87% with instrument screening. (Modest JR et al. Pediatrics. 2017 Jul;140[1]. pii: e20163745.) Family satisfaction is also improved with the automated method.
The automated vision screening device used in the study was the Spot Vision Screener produced by Welch Allyn.
“Our nurses are in heaven with these devices, so besides the billing that you can do, you can save staff time and easily justify the cost of the device. My office now has 4 or 5 of these devices because it just saves so much time to have them readily available.”
Professional societies endorse automated vision screening
Amblyopia is seen in 2 or 3 children per 100 in the United States, reported Dr. Vernacchio. Chart-based vision screening is notoriously difficult to accomplish in young children and there is both a risk of missing amblyopia in those who do not cooperate and a risk of overreferral because of poor performance on the test.
Recently, the American Academy of Pediatrics, the U.S. Preventive Services Task Force, and others have endorsed the use of instrument-based vision screening in place of chart-based screening for children aged 3-5 years based on evidence of improved testability and acceptable sensitivity and specificity.
The Spot Vision Screener has a retail cost between $6000 and $7000, according to Dr. Vernacchio. “Many” insurance companies will pay a separate fee for vision screening using an instrument, but others bundle the screening into a well visit, he noted.
“So, you can actually calculate the time to recover the cost of the device based on your payer practices,” he said. Another option is a smart phone app that uses a subscription model, in which the test results are interpreted by the company within a few minutes with a per test charge of about .99 cents.
“The Holy Grail is whether this process will reduce the incidence of amblyopia,” said Dr. Vernacchio. That study is next on his to-do list, he said, but “it’s going to take longer to answer that question.”
The authors reported no conflicts of interest. There was no external funding.
Key clinical point: Switching from a chart-based to an instrument-based vision screening reduced unnecessary pediatric eye care referrals.
Major finding: Use of an automated vision screening system reduced referrals for pediatric eye care by 33.7%.
Study details: A nonrandomized analysis of referral patterns from January 2015 to June 2015 from 12 pediatric primary care practices, with findings compared with a prior time period before the vision screening device was used.
Disclosures: The authors reported no conflicts of interest. There was no external funding