S04: Initial Alaskan Experience (6-07)
The Alaska Blind
Child Discovery (ABCD) program has had excellent validity
with central physician interpreted photoscreening devices including
MTI(1) and ADBC(2-6). The
physician central coordinating center has had disadvantages, however.
Screeners must assimilate photo data at the screening clinic without
notifying parents at that time of results. There has been a delay in
send-in, interpretation, and send-out notification, The worst was when
ABCD research students returned to school after 900+ State Fair screenings(3)-
All “positive” interpretations were rapidly notified, but
some of the “normals” had to wait more than two months for
notification. ABCD compares favorably with the statewide Lions-sponsored
program in Tennessee(7), Both programs had high predictive value but
relatively low community penetrance.
ABCD had initial experience with EyeDx,
an original computer interpreted system that had tremendous promise.
Compared to the current PlusOptix system, EyeDx was slower and with
lower specificity. Unfortunately, photoscreening
still fails to have uniform community reimbursement so EyeDx is
no longer financially solvent.
ABCD contacted Christian Schmidt at AAPOS in Colorado Spring 2006 and
received the first of
eight Lions Club sponsored photorefractor cameras shorty thereafter.
Research student Michelle Clausen and Lions coordinator Esther
West worked to procure and install software on eight computers with
label printers. ABCD adapted prior study-approved
paperwork for PlusOptix onsite screening and computer interpretation.
The PlusOptiX system was calibrated
head-to-head with previously validated(8) ADBC photoscreening in
Kindergarten and pre-school students. The PlusOptiX user can pre-define
age-based referral criteria so ABCD determined cost-effective,
valid levels published in Binocular Vision(9).
Each PlusOptix unit can function independently of a coordinating center
so there is a lag-time for ABCD to determine how state-wide screening
progresses. Screeners are happy and the apparent PPV (positive predictive
value) from referrals has been very good.
The PlusOptix system requires moderate experience with computers and
the three different cables (Firewire, USB and sound) required for efficient
screening. Once a PlusOptix is set up, screening infants and children
is quick and efficient. Efficiency is further enhanced if names and
birthdays are entered in advance of the clinic, for instance in a school
The reliability of the technology has been good and support from PlusOptix
in Germany has been immer Außgeseichnet (good).
ABCD has obtained additional, similar PlusOptiX S08 with one less cable, and the PlusOptix S09 running on LINUX rather than Windows operating system.
1. Lang DM, Arnold
AW, Leman RE, Arnold RW. Validated portable pediatric vision screening
in the Alaska Bush: A VIPS-like study in the Koyukon. Alaska Med. 2007;49(1):2-13.
2. Kovtoun TA, Arnold RW. Calibration of photoscreeners for threshold
contact- induced hyperopic anisometropia: Introduction of the JVC photoscreeners.
3. Arnold RW. Highly specific photoscreening at the Alaska State Fair:
Valid Alaska Blind Child Discovery photoscreening and interpretation.
Alaska Med. April/May/June 2003 2003;45(2):34-40.
4. Arnold RW, Armitage MD, Gionet EG, et al. The cost and yield of photoscreening:
Impact of photoscreening on overall pediatric ophthalmic costs. JPOS.
5. Arnold RW, Gionet E, Jastrzebski A, Kovtoun T, Armitage M, Coon L.
The Alaska Blind Child Discovery project: Rationale, Methods and Results
of 4000 screenings. Alaska Med. 2000;42:58-72.
6. Arnold RW, Stange CA, Ryan C. The compared predictive value of Bruckner,
acuity and strabismus from pediatric referrals. Am Orthopt J. 2006;56(1):15-21.
7. Arnold RW, Donahue SP. The yield and challenges of charitable state-wide
photoscreening. Binocul Vis Strabismus Q. 2006;21(2):93-100.
8. Arnold RW, Arnold AW, Stark L, Arnold KK, Leman RE, Armitage MD.
Amblyopia detection by camera (ADBC): Gateway to portable, inexpensive,
vision screening. Alaska Med. September/October 2004 2004;46(3):63-72.
9. Clausen MM, Arnold RW. Pediatric Eye/Vision Screening: Referral Criteria
for the PediaVision PlusOptix S04 Photoscreener Compared to Visual Acuity
Photoscreening: “Kindergarten Computer Photoscreening”.
Binoc Vis and Strabismus Quart. 207;22(2):in press.