Nine-year Results of a Volunteer Lay Network Photoscreening Program of 147 809 Children Using a PhotoScreener in Iowa

Purpose: To present the largest cohort of preschool children screened by the MTI PhotoScreener over a 9-year period from a single, statewide vision screening effort. Design: Cross-sectional study. Participants: We included 147 809 children screened between May 1, 2000, and April 30, 2009 by a photoscreening program. Methods: Retrospective review of results from the Iowa photoscreening program using the MTI PhotoScreener. The photographs were taken by volunteers from local Lions clubs and sent to the University of Iowa for interpretation. Children who failed the photoscreening were referred to local eye care professionals, who preformed a comprehensive eye evaluation and forwarded the results to the Iowa KidSight program. Main Outcome Measures: Number of screenings, referral rate, positive predictive value (PPV), follow-up rate, and associated costs per year are described. Results: Over the 9 years of the continuously operating program, 147 809 children underwent photoscreens to detect amblyopic risk factors at 9746 sites. Because of abnormal photoscreen results, 6247 children (4.2%) were referred. Of the children, 24.3% were evaluated by local ophthalmologists and 76.7% were seen by local optometrists. Between 2000 and 2009, the follow-up rate ranged from a low of 36.1% to a high of 89.5%, with an overall program follow-up rate after the addition of the follow-up coordinator of 81.3%. The overall PPV of the MTI PhotoScreener was 94.2%. Taking into account overall operating budget including salaries and associated costs, the cost of screening 1 child has been reduced to $US9 per child. Conclusions: The addition of a part-time follow-up coordinator to the photoscreening program produced 89.5% follow-up rate when screening 147 809 children for amblyopia risk factors over a 9-year period.