Efficient referral thresholds in autorefraction-based preschool screening

American Journal of Ophthalmology
Eugene A Lowry, Alejandra G de Alba Campomanes

Abstract

To determine economically efficient referral criteria for a preschool vision-screening program using autorefraction. Retrospective economic evaluation of a screening protocol. Preschoolers in 2 cities received preschool-based Retinomax screening with a standard referral protocol and as-needed comprehensive eye examinations in 2012-2013. Positive predictive values and referral criteria that minimized cost per case detected were derived using data from San Francisco. These modeled referral criteria were then retrospectively tested for cost-effectiveness against other common criteria in Oakland with sensitivity analysis. Cases were defined by American Association for Pediatric Ophthalmology and Strabismus (AAPOS) criteria for amblyopia risk factors. The perspective was a third-party payer. Costs were obtained from a regional insurance provider. In San Francisco, 3974 children were screened, 631 referred, and 412 examined. Forty-eight percent of referrals, 301 children, met more than 1 of the referral criteria. Positive predictive values ranged from 7% for myopia to 56% for astigmatism. In Oakland, 2359 children were screened and 269 were examined. When applying the modeled referral criteria derived from San Francisco to the popula...Continue Reading

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Citations

Aug 31, 2018·Journal of Pediatric Ophthalmology and Strabismus·Robert W ArnoldR Kevin Winkle
Sep 24, 2019·Journal of Pediatric Ophthalmology and Strabismus·Sandra GuimarãesEduardo Silva
Dec 18, 2019·Journal of Current Ophthalmology·Ai-Hong ChenPatricia Arthur
Sep 8, 2020·European Journal of Public Health·Catharina P B Van der PloegPaul H Verkerk

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