Photoscreening efforts for preschoolers need guidance

Orlando-A review of 17 volunteer-led preschool photoscreening programs indicates that such programs can be highly successful but that strong, preferably paid, administrative leadership is crucial in ensuring adequate rates of follow-up and referral, according to Sean P. Donahue, MD, PhD, associate professor of ophthalmology and visual sciences, pediatrics, and neurology at Vanderbilt University Medical Center, Nashville, TN, and chief of ophthalmology, Monroe Carell Jr. Children's Hospital at Vanderbilt.

Dr. Donahue presented the findings on behalf of a group of colleagues from numerous other centers throughout the country at the annual meeting of the American Academy of Pediatric Ophthalmology and Strabismus. The group analyzed screening efforts conducted through the Lions Club International Foundation's Core Four Sight Preservation Grant Program. In this program, Lions organizations at the state or multi-district level receive grants to establish preschool vision screening programs in which volunteers visit local childcare centers to conduct the screenings.

Photos are sent to a partnering institution such as an academic ophthalmology department or local private practice, and results are returned to the volunteer organization for distribution to the children and their families through the preschool or childcare center. Children referred for further screening receive examinations from ophthalmologists or optometrists in their communities, and the results are again submitted to the partnering institution.

Screening program analyses

For the study, Donahue and his colleagues reviewed 17 screening programs, 16 in the United States and one in Taiwan, analyzing data through the end of 2004.

They concluded that preschool photoscreening is feasible on a large scale but that the Lions Club International Foundation model has several drawbacks, including low follow-up rates, large variability in referral rates, high volunteer turnover, and, in many programs, too few children who receive screening.

"The net bottom line is whether the child who needs it gets to an eye doctor who performs an adequate exam and confirms whether there is a problem. If the screening gets done, that is not a success unless the child gets further exam," he said.

"Unfortunately, too many screening programs across the country have as their only measure of success how many children were screened. To me that is not a reasonable measure of success," he continued. "The best measure of success is getting the children to doctors who can diagnose a problem and take care of it. Once these children get into the medical system, we hope they'll be able to be treated appropriately and be able to have good results."

In his study, children were not followed past the point of referral to a doctor's office to determine results of treatment.

Overview of programs

Sixteen of the 17 programs in the study used the MTI photoscreening device. Seven partnered with an academic ophthalmology group and two with a local private practice. In the various programs, professionals such as pediatric ophthalmologists, general ophthalmologists, optometrists, and PhDs provided program oversight. Technicians or orthoptists, ophthalmologists, optometrists, imaging centers, and others provided central interpretation of photos.

A total of 409,830 children were screened, and the outcomes of the various screening programs were "all over the place," Dr. Donahue said.

"There were some programs that screened a lot of children and had no follow-up," he said. "There were some programs that screened very few children, a couple of thousand, despite receiving $200,000 in a grant from the International Foundation, and of those referred 10% or 15% only had follow-up on a handful of kids. Clearly that was not money that was well spent.

"On the other hand there were several programs that for $200,000 screened tens of thousands of children and were able to get several thousand in for follow-up exams. And those programs were eminently successful," he added.

Tennessee screened the highest number of children, 145,214, while seven programs screened fewer than 5,000 children and three screened fewer than 1,500.