Alaska Blind Child Discovery

PlusOptiX Experience

PlusOptix 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 setting.
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. JPOS. 2004;41(3):150-158.
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. 2005;42(2):103-111.
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 & Digital Photoscreening: “Kindergarten Computer Photoscreening”. Binoc Vis and Strabismus Quart. 207;22(2):in press.