Reduce referrals: Skip eye chart with automated vision checker for kids

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.