Off-axis photorefractive eye screening in children

Purpose: To determine the utility of mass photoscreening for detecting visual anomalies in young, school-age children. Setting: Seventy elementary schools in Alabama, Florida, Georgia, North Carolina, and Virginia, USA. Methods: An off-axis photorefractive technique was used to screen 14,591 children in kindergarten, first, and fourth grades in 70 schools in 5 southeastern states in the United States. Results: A total of 14,075 (96.5%) of the screenings yielded analyzable photographs. Overall, 647 (4.6%) children had significant ocular findings; significant was defined as hyperopia 2.50 diopters (D) or more, myopia 1.00 D or more, anisometropia 1.00 D or more, astigmatism 2.00 D or more, media opacity 1.0 mm or more in diameter, or 5 degrees or more or 10.00 prism diopters or more of ocular misalignment. Another 950 (6.7%) had possibly significant findings, defined as the sign being present but in an amount less than that considered significant. The most common refractive error was myopia (4.5%), followed by anisometropia (3.1%), hyperopia (2.9%), and astigmatism (1.0%). Alignment problems were found in 1.7% and media opacities in 0.1%. Among the 1.0% with other ocular anomalies were cases of anisocoria greater than 2.0 mm or irregular pupils, ptosis greater than 2.0 mm, and subconjunctival hemorrhages. In all, 102 children had significant anomalies thought to predispose to amblyopia, including 196 with significant anisometropia and 6 with significant lens opacities. Pt a screening cost of $5 per child for the whole study, the cost of identifying these children with potentially blinding eye disease was $361 each. Conclusion: Mass photoscreening may be used to detect amblyogenic conditions in children early enough to prevent blindness with timely and appropriate treatment.