5 MINUTES
Photo screening devices objectively measure refractive errors and alignment between the eyes, which helps identify risk factors of amblyopia without much cooperation from the patient.1 Select photo screening devices can examine both eyes at once and can take only a few seconds to perform the screening.
Visual acuity subjectively measures how well a child can see using a wall chart. The child needs to cooperate to look at the correct line and verbally relay what they see.2 Visual acuity testing may detect refractive errors but does not detect eye misalignment and may miss differences between eyes.2 Visual acuity screening may also detect non-refractive vision problems that may be caused by problems with the retina, eye structure or neurological connection between the eye and the brain.
The American Academy of Pediatrics (AAP) and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) recommend the use of photo screening instruments in young children before they can successfully complete a chart-based visual acuity test.3,4 Once children can successfully perform a visual acuity test, usually around age 5, the policy recommends subjectively testing visual acuity with a chart-based screener.4 Policy statements have not endorsed the use of photo screeners in children older than age 5, largely because photo screener performance has not been thoroughly studied in this age group.5
A study performed by researchers at Virginia Commonwealth University demonstrated the effectiveness of photo screening in school-age children6. The study included 1,593 third-grade children across 16 elementary schools in a single county in Virginia. Students received both instrument-based screening and traditional visual acuity screening tests.
Children referred through either method were provided with a comprehensive eye exam with cycloplegic refraction to assess the accuracy of the referral. Time to screen was also measured for both instrument-based screening and visual acuity measurement.
A total of 516 (32.4%) students were referred for a comprehensive eye exam based on either method. Of the children referred by instrument-based vision screening alone, 78% required an intervention, compared to only 50% of students referred by visual acuity testing alone. Instrument-based vision screening detected a higher number of children who needed refractive correction.6
Referral from both screening methods was a strong predictor of children requiring intervention, with 94% of those referred by both confirmed to require glasses or a more in-depth follow-up examination.6
Results of the study proved that instrument-based screening is time efficient and can be performed in ¼ the time of visual acuity screening. Specifically, instrument-based screening took on average 30 seconds to screen each child compared with visual acuity testing, which took on average 120 seconds to screen each child.6
According to the U.S. Preventative Services Task Force, children between the ages of 3 and 5 years should receive vision screening at least once to help promote healthy vision.7 Vision screening can help reveal vision problems that may lead to blindness without early treatment. Visual acuity testing can detect refractive errors2 while photo screening can identify six risk factors of amblyopia in a time-efficient manner.6 Using instrument-based screening alone correctly identified more students in need of a comprehensive eye exam than using chart-based visual acuity screening alone6, helping to prevent vision loss.
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References
1. Mudie, Lucy I., Kaci Pickett, Kaylene Ross, Emily McCourt, and Robert Enzenauer. “Performance of the Spot Vision Screener in Children with Down Syndrome and Other Special Needs.” Journal of American Association for Pediatric Ophthalmology and Strabismus, September 17, 2023. https://doi.org/10.1016/j.jaapos.2023.07.011
2. Comprehensive eye exams. (n.d.). AOA. https://www.aoa.org/healthy-eyes/caring-for-your-eyes/eye-exams?sso=y. Accesed June 15, 2024.
3. Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. American Academy of Pediatrics. www.pediatrics.org/cgi/doi/10.1542/peds.2015-3596
4. American Academy of Pediatrics. http://www.aappublications.org/news/2015/12/07/Vision120715 Accessed January 19, 2023
5. Prevent Blindness. National Center for Children's Vision and Eye Health. Vision Screening Guidelines by Age. https://nationalcenter.preventblindness.org/vision-screening-guidelines-by-age/ Accessed July 8, 2024.
6. Silverstein, Evan, and Elaine R. McElhinny. “Traditional and Instrument-Based Vision Screening in Third-Grade Students.” Journal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS} 24, no. 4 (August 1, 2020): 232.e1-232.e6. https://doi.org/10.1016/j.jaapos.2020.04.013.
7. "Vision Screening in Children Aged 6 Months to 5 Years: Recommendation Statement" U.S Preventive Services Task Force. American Family Physician. Volume 96, Number 12, December 15, 2017.
Baxter, Hillrom, Spot and Welch Allyn are trademarks of Baxter International Inc. or its subsidiaries. US-FLC158-240086 (v1.0) 10/2024
