This article is more than 5 years old. Information may no longer be current.
All children deserve comprehensive exams
Click Here to Manage Email Alerts
To the Editor:
I read Dr. Suh’s article in the October 2018 issue of PCON (“Results with photoscreener shown comparable to comprehensive exam”). I applaud him on his efforts to help the underserved children in his Omaha community. The article was very interesting, but I have a few questions.
Which photoscreener was used? Did Dr. Suh consider the 2.74% of false negatives? That meant that six children who had significant vision issues would have been missed by the screening. Even one child who is falsely identified as normal is too many. Where was retinal or anterior segment health in this study? Some photoscreeners can pick up media opacities, but none can identify retinal lesions.
Try as we might, there is no substitute for a comprehensive, dilated eye exam for children by an OD or MD. In my private practice, I utilize the Spot (WelchAllyn) and a Marco autorefractor. However, I can’t even count the times over my 26 years of practice when I was shocked at the +6.00 D OU cycloplegic refraction on a 20/30 child. Data from states like Kentucky will prove over time that all children deserve the gold standard. Our professions just need to do a better job locally and nationally to make this point clear.
Cathy P. Doty, OD
SpecialEyes Pediatric Vision Clinic
New Bern, N.C.
Dr. Suh responds:
We used the Plusoptix Vision Screener.
Agreed, in an ideal setting, we would like to have close to 100% sensitivity and 0% negative predictive value. In a real setting, even with comprehensive eye exams, this may not be possible. With these devices, settings can be adjusted for a higher sensitivity or specificity depending on the population.
Please keep in mind, we were interested in screening tens of thousands of children who have multiple barriers to traditional care. Given the numbers of children and limited resources, we utilized a public health approach and identified a screening mechanism that was reliable and could be replicated easily with the resources available. All children with any vision concerns were encouraged to seek a comprehensive exam, and each is given a list of providers accepting Medicaid and/or able to provide a sliding fee scale based on need.
If the patient has any significant anterior or retinal lesions that are vision threatening, the photoscreener will detect it by failing the exam. Also, retinal dystrophy with any strabismus or nystagmus would have been detected by the device. We are in the process of developing a device that can take photos of the anterior and posterior segment (retinal) abnormalities and be interpreted by our specialists via telehealth.
Regarding the issue of children with significant hyperopia and potential development of amblyopia or strabismus, we have submitted our most recent research, the Hyperopia Treatment Study, by the Pediatric Eye Disease Investigator Group, for publication. After it is published, I would be happy to discuss the paper more in detail.
Donny W. Suh, MD, FAAP