The Use of the RETeval Portable Electroretinography Device for Low-Cost Screening: A Mini-Review.

Electroretinography (ERG) provides crucial insights into retinal function and the integrity of the visual pathways. However, ERG assessments classically require a complicated technical background with costly equipment. In addition, the placement of corneal or conjunctival electrodes is not always tolerated by the patients, which restricts the measurement for pediatric evaluations. In this short review, we give an overview of the use of the RETeval portable ERG device (LKC Technologies, Inc., Gaithersburg, MD, USA), a modern portable ERG device that can facilitate screening for diseases involving the retina and the optic nerve. We also review its potential to provide ocular biomarkers in systemic pathologies, such as Alzheimer's disease and central nervous system alterations, within the framework of oculomics.

Reducing the Costs of an Eye Care Adherence Program for Underserved Children Referred Through Inner-City Vision Screenings.

PURPOSE: We previously reported costs and outcomes of the Children's Eye Care Adherence Program (CECAP1), a social worker intervention designed to improve adherence to eye care for underserved children in urban Philadelphia. Using cost findings from CECAP1, we revised the intervention to reduce costs. The aim of this study was to evaluate costs and effectiveness of the revised intervention (CECAP2). DESIGN: Retrospective cohort study. METHODS: Records of children needing ophthalmic follow-up after 2 community-based vision screening programs were reviewed. We modified CECAP1 to prioritize children more likely to visit, decreased phone calls and scheduling attempts, better documented children already followed by other doctors, and constricted our geographic catchment area for better accessibility. Cost was calculated using time spent executing CECAP2 by our salaried social worker. Effectiveness was defined as the percentage of patients completing at least 1 follow-up visit within the recommended time frame. RESULTS: Of 462 children referred to CECAP2 from our in-school and on-campus screening programs, 242 (52.4%) completed subsequent recommended eye examinations, a proportion identical to our prior report (52.3%). Social worker time per patient was 0.8 hours; a significant reduction from the previous 2.6 hours (P < .01). Cost per patient was $32.73; a significant reduction compared to the previous $77.20 (P < .01). CONCLUSIONS: Programmatic changes to reduce social worker intervention time and target potential patients by likelihood to attend along with constriction of the catchment area led to reduced costs by more than 50%, without impairing CECAP effectiveness.

Cost Analysis of Teleophthalmology Screening for Diabetic Retinopathy Using Teleophthalmology Billing Codes.

BACKGROUND AND OBJECTIVE: To evaluate the financial sustainability of teleophthalmology screening for diabetic retinopathy (DR) using telehealth billing codes. PATIENTS AND METHODS: The authors performed an Institutional Review Board-approved retrospective review of medical records, billing data, and quality metrics at the University of California Davis Health System from patients screened for DR through an internal medicine-based telemedicine program using CPT codes 92227 or 92228. RESULTS: A total of 290 patients received teleophthalmology screening over a 12-month period, resulting in an increase in the DR screening rate from 49% to 63% (P < .0001). The average payment per patient was $19.86, with an estimated cost of $41.02 per patient. The projected per-patient incentive bonus was $43.06 with a downstream referral revenue of $39.38 per patient. One hundred seventy-eight clinic visits were eliminated, providing an estimated cost savings of $42.53 per patient. CONCLUSION: Sustainable teleophthalmology screening may be achieved by billing telehealth codes but only with health care incentive bonuses, patient referrals, and by accounting for the projected cost-savings of eliminating office visits. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S26-S34.].

Cost-Minimization Analysis of Ranibizumab Versus Aflibercept for Treating Saudi Patients With Visual Impairment Owing to Age-Related Macular Degeneration or Diabetic Macular Edema.

OBJECTIVE: The standard-of-care treatment for age-related macular degeneration (AMD) and diabetic macular edema (DME) includes inhibiting blood vessel proliferation and reducing macular edema or swelling using anti-vascular endothelial growth factor therapies, such as ranibizumab and aflibercept. To conduct a cost-minimization analysis of ranibizumab and aflibercept for treating Saudi patients with visual impairment owing to AMD or DME. METHODS: Cost minimization was analyzed assuming that ranibizumab and aflibercept have equivalent clinical effectiveness. The third-party payer's perspective was used in several clinical scenarios. The base-case scenario was DME cases followed monthly using a protocol-specific follow-up. In scenario 1, AMD cases followed a treat-and-extend protocol over 2 years. In scenario 2, AMD cases followed the PRN (pro re nata) regimen over 2 years. In scenario 3, DME cases followed the PRN regimen for 1 year only. RESULTS: Aflibercept yielded cost savings of 25.75%, 31.54%, 51.30%, and 9.28% compared with ranibizumab for the base case, scenario 1, scenario 2, and scenario 3, respectively, which supports the premise that aflibercept is more cost saving than ranibizumab. CONCLUSIONS: From the third-party payer perspective, aflibercept is a cost-containment option that provides substantial savings over ranibizumab for treating Saudi patients with AMD or DME.

Development of a system based on artificial intelligence to identify visual problems in children: study protocol of the TrackAI project.

INTRODUCTION: Around 70% to 80% of the 19 million visually disabled children in the world are due to a preventable or curable disease, if detected early enough. Vision screening in childhood is an evidence-based and cost-effective way to detect visual disorders. However, current screening programmes face several limitations: training required to perform them efficiently, lack of accurate screening tools and poor collaboration from young children.Some of these limitations can be overcome by new digital tools. Implementing a system based on artificial intelligence systems avoid the challenge of interpreting visual outcomes.The objective of the TrackAI Project is to develop a system to identify children with visual disorders. The system will have two main components: a novel visual test implemented in a digital device, DIVE (Device for an Integral Visual Examination); and artificial intelligence algorithms that will run on a smartphone to analyse automatically the visual data gathered by DIVE. METHODS AND ANALYSIS: This is a multicentre study, with at least five centres located in five geographically diverse study sites participating in the recruitment, covering Europe, USA and Asia.The study will include children aged between 6 months and 14 years, both with normal or abnormal visual development.The project will be divided in two consecutive phases: design and training of an artificial intelligence (AI) algorithm to identify visual problems, and system development and validation. The study protocol will consist of a comprehensive ophthalmological examination, performed by an experienced paediatric ophthalmologist, and an exam of the visual function using a DIVE.For the first part of the study, diagnostic labels will be given to each DIVE exam to train the neural network. For the validation, diagnosis provided by ophthalmologists will be compared with AI system outcomes. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the principles of Good Clinical Practice. This protocol was approved by the Clinical Research Ethics Committee of Aragón, CEICA, on January 2019 (Code PI18/346).Results will be published in peer-reviewed journals and disseminated in scientific meetings. TRIAL REGISTRATION NUMBER: ISRCTN17316993.

Effect of Instrument-Based Vision Screening for 3- to 5-Year-Old Children on Referrals to Eye Care Specialists.

Recently, several professional groups have recommended a change from chart-based to instrument-based screening for preschool-age children, but the effect of this change on health care utilization is unknown. We performed a secondary analysis of a site-randomized quality improvement project on transitioning from chart-based to instrument-based vision screening for 3- to 5-year-old children in primary care. We analyzed visit rates to ophthalmologists and optometrists and costs of such care before and after implementation of instrument-based vision screening with comparison to nonparticipating practices. The implementation of instrument-based vision screening resulted in a decrease in visits to eye care specialists from 83.1 visits per 1000 children per year to 55.0, a reduction of 33.8%; no comparable reduction was seen in nonparticipating practices. The cost of services by eye care specialists fell from $65 715 per 1000 children per year prior to $55 740, a decline of 15.2%; similar costs among control practices rose 13.4%.

The cost-effectiveness of alternative vision screening models among preschool children in rural China.

PURPOSE: To explore the accuracy and cost-effectiveness of three vision screening models among preschool children in rural China. METHODS: Vision screening was carried out among children aged 4-5 years in 65 preschools in two counties in Northwest China, using Crowded Single Lea Symbols to test visual acuity. Children were assigned randomly by school to one of three screening models: screening by teachers (15 schools, 1835 children), local optometrists (30 schools, 1718 children) or volunteers (20 schools, 2183 children). Children identifying ≥2 symbols incorrectly in either eye failed screening. Accuracy of screening was compared with screenings executed by experienced optometrists among 141 children selected randomly from the three screening models. Direct and indirect costs for each model were assessed. Costs to detect a true case failed screening were estimated. RESULTS: The sensitivity for three models ranged from 76.9% to 87.5%, specificity from 84.9% to 86.7% and standardized positive predictive value from 83.7% to 85.7%. None differed significantly between models. The costs per case detected were $37.53, $59.14 and $52.19 for the teachers, local optometrists and volunteers. In producing the cost estimates for teacher screening and local optometrist screening models, we used a salary payment that was identical for both models (with the salary being equal to that of the optometrist). The teacher screening model was the most cost-effective. CONCLUSION: Accuracy of screening by teachers, local optometrists and volunteers was the same in this setting, but the use of teachers was most cost-effective, reducing the cost per case detected by almost 40%.

Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial.

OBJECTIVE: Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. METHODS AND ANALYSIS: A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. RESULTS: 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. CONCLUSION: Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates.

Cost-effectiveness and cost utility of community screening for glaucoma in urban India.

OBJECTIVES: Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. STUDY DESIGN: A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. METHODS: Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. RESULTS: The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. CONCLUSIONS: In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40-69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India.

Custo-efetividade no glaucoma. Conceitos, resultados e perspectiva atual / Cost-effectiveness in glaucoma. Concepts, results and current perspective

RESUMO O glaucoma é a principal causa de cegueira irreversível no Brasil. Sua prevalência e incidência tendem a aumentar significativamente no futuro, principalmente devido ao aumento da população e ao seu envelhecimento. A escassez de recursos para a saúde associada ao aumento da disponibilidade e dos custos das tecnologias em saúde exige uma análise parametrizada destas tecnologias e uma alocação eficiente dos recursos. Os estudos de custo-efetividade e custo-utilidade são importantes, pois permitem uma comparação entre diferentes alternativas tanto em termos de seus custos quanto de seus resultados. Para isto, modelos matemáticos (como modelagem de Markov) são comumente utilizados como método de análise. Existem na literatura muitas evidências de custoefetividade e custo-utilidade no glaucoma, inclusive no Brasil. Este artigo se propõe a revisar de maneira prática os conceitos de avaliação econômica em saúde, os tipos de estudos econômicos em saúde, bem como os resultados dos estudos de custo-efetividade e custo-utilidade na área de glaucoma na literatura.

ABSTRACT Glaucoma is the leading cause of irreversible blindness in Brazil. Its prevalence and incidence tend to increase significantly in the future, mainly due to the population increase and aging. The scarcity of health care resources and the increasing costs in health require a balanced analysis of health interventions and an efficient allocation of resources. The cost-effectiveness and cost-utility studies are important because they allow a comparison between different alternatives in terms of both their costs and their results. For this purpose, mathematical modeling (such as Markov modeling) is commonly used as the analytical method. The literature, including in Brazil, has plenty of evidence of cost-effectiveness and cost-utility in glaucoma. This article aims to review in a practical way the concepts of economic evaluation in health, describe the different types of health economic studies, as well as the results of cost-effectiveness and cost-utility studies in glaucoma in the literature.

Cost-effectiveness of School-Based Eye Examinations in Preschoolers Referred for Follow-up From Visual Screening.

IMPORTANCE: Many preschool visual screening programs incorporate school-based comprehensive examinations, but the follow-up rates and cost-effectiveness of this approach are not well studied. OBJECTIVE: To determine the follow-up rates and cost-effectiveness of referral to community-based eye care professionals vs to a mobile eye examination unit (mobile follow-up) among preschool children with failed visual screening results. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort cost-effectiveness study with decision analytic modeling and probabilistic sensitivity analysis included 3429 children in 37 public preschools in San Francisco, California, who underwent visual chart screening during the 2009-2012 academic years and 1524 children in the same schools who underwent autorefraction screening during the 2012-2013 academic year. One hundred seventy-five children who underwent visual chart screening were referred for community-based comprehensive eye examinations; 204 who underwent autorefractive screening were referred for preschool-based mobile follow-up. Data were collected from October 1, 2009, to May 29, 2013, and analyzed from June 30, 2013, to January 16, 2016. MAIN OUTCOMES AND MEASURES: Cost-effectiveness of community-based vs mobile follow-up standardized for referral method. RESULTS: Of the 175 children referred for community-based follow-up (91 boys [52.0%]; 84 girls [48.0%]; mean [SD] age, 3.8 [0.7] years), 104 attended (59.4%). Of 204 children referred for mobile follow-up (89 boys [43.6%]; 115 girls [56.4%]; mean [SD] age, 4.1 [0.6] years), 112 attended (54.9%). Costs per case detected were $664 and $776, respectively. In univariate analysis, mobile follow-up was equally cost-effective if it increased the follow-up rate to 73% or if its costs were reduced by at least 27%. In multivariate analysis with Monte Carlo simulation, community-based follow-up was more cost-effective than mobile follow-up in 88% of simulated cases and had typical savings of $112 (95% CI, -$77 to $368) per case detected. CONCLUSIONS AND RELEVANCE: Community-based eye care professionals may provide more cost-effective care than a mobile eye examination unit visiting the preschool among children with failed preschool-based visual screening.

Incentives in Diabetic Eye Assessment by Screening (IDEAS): study protocol of a three-arm randomized controlled trial using financial incentives to increase screening uptake in London.

BACKGROUND: Diabetes is an increasing public health problem in the UK and globally. Diabetic retinopathy is a microvascular complication of diabetes, and is one of the leading causes of blindness in the UK working age population. The diabetic eye screening programme in England aims to invite all people with diabetes aged 12 or over for retinal photography to screen for the presence of diabetic retinopathy. However, attendance rates are only 81 %, leaving many people at risk of preventable sight loss. METHODS: This is a three arm randomized controlled trial to investigate the impact of different types of financial incentives (based on principles from behavioral economics) on increasing attendance at diabetic eye screening appointments in London. Eligible participants will be aged 16 or over, and are those who have been invited to screening appointments annually, but who have not attended, or telephoned to rearrange an appointment, within the last 24 months. Eligible participants will be randomized to one of three conditions: 1. Control condition (usual invitation letter) 2. Fixed incentive condition (usual invitation letter, including a voucher for £10 if they attend their appointment) 3. Probabilistic incentive condition (invitation letter, including a voucher for a 1 in 100 chance of winning £1000 if they attend their appointment). Participants will be sent invitation letters, and the primary outcome will be whether or not they attend their appointment. One thousand participants will be included in total, randomized with a ratio of 1.4:1:1. In order to test whether the incentive scheme has a differential impact on patients from different demographic or socio-economic groups, information will be recorded on age, gender, distance from screening center, socio-economic status and length of time since they were last screened. A cost-effectiveness analysis will also be performed. DISCUSSION: This study will be the first trial of financial incentives for improving uptake of diabetic eye screening. If effective, the intervention may suggest a cost-effective way to increase screening rates, thus reducing unnecessary blindness. TRIAL REGISTRATION: ISRCTN14896403, 25 February 2016.

The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits.

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p<0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p<0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p<0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p<0.01) less likely to have a functional limitation due to vision.

Results of a pediatric vision screening program in western South Dakota.

BACKGROUND: South Dakota is one of eight states that do not require any vision screening for children. This study describes the results of the first children's vision screening program in the state. METHODS: Children ages 6 months to 12 years were screened using the SPOT photoscreener by lay volunteers as part of the Northern Plains Eye Foundation's Western South Dakota Children's Vision Screening Initiative (CVSI). Referral criteria were based on the recommendations of the manufacturer. Data was stratified by age group, sex, and percentage of children referred for hyperopia, myopia, astigmatism, anisocoria, anisometropia, and ocular misalignment. The cost benefit of amblyopia treatment in South Dakota was also calculated. RESULTS: Screenings were completed on 4,784 children from August 2012 to May 2014 with 62 excluded due to age. Mean age of the 4,722 (2,373 females) subjects was 6 years 7 months. Overall, the SPOT device referred 563 (11.9 percent) children. There was no significant difference in referral rate based on sex (p = 0.598). Children aged 73-144 months had the highest referral rate (12.2 percent) and children aged 12-30 months had the lowest referral rate (7.9 percent). The suspected reasons for referral based upon the screenings were as follows: 371 (7.9 percent) astigmatism, 24 (0.5 percent) ocular misalignment, 101 (2.1 percent) anisometropia, 135 (2.9 percent) myopia, 36 (0.8 percent) hyperopia, and 16 (0.3 percent) anisocoria. CONCLUSIONS: The SPOT photoscreener yielded an acceptable referral rate of 11.9 percent. This study represents an effective model for pediatric vision screening in South Dakota.

Efficient referral thresholds in autorefraction-based preschool screening.

PURPOSE: To determine economically efficient referral criteria for a preschool vision-screening program using autorefraction. DESIGN: Retrospective economic evaluation of a screening protocol. METHODS: 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. RESULTS: 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 population of Oakland, the cost per case detected was $258. When compared in Oakland, the original referral criteria and criteria based on Vision in Preschoolers study cost, respectively, $424 and $371 per additional case detected. The modeled referral criteria had a lower cost per case detected across sensitivity analysis. CONCLUSIONS: More stringent referral criteria may reduce the cost per case detected in vision screening and allow more at-risk children to be detected with the same financial resources.

Cost-utility analysis of screening for diabetic retinopathy in Japan: a probabilistic Markov modeling study.

PURPOSE: To evaluate the cost-effectiveness for a screening interval longer than 1 year detecting diabetic retinopathy (DR) through the estimation of incremental costs per quality-adjusted life year (QALY) based on the best available clinical data in Japan. METHODS: A Markov model with a probabilistic cohort analysis was framed to calculate incremental costs per QALY gained by implementing a screening program detecting DR in Japan. A 1-year cycle length and population size of 50,000 with a 50-year time horizon (age 40-90 years) was used. Best available clinical data from publications and national surveillance data was used, and a model was designed including current diagnosis and management of DR with corresponding visual outcomes. One-way and probabilistic sensitivity analyses were performed considering uncertainties in the parameters. RESULTS: In the base-case analysis, the strategy with a screening program resulted in an incremental cost of 5,147 Japanese yen (¥; US$64.6) and incremental effectiveness of 0.0054 QALYs per person screened. The incremental cost-effectiveness ratio was ¥944,981 (US$11,857) per QALY. The simulation suggested that screening would result in a significant reduction in blindness in people aged 40 years or over (-16%). Sensitivity analyses suggested that in order to achieve both reductions in blindness and cost-effectiveness in Japan, the screening program should screen those aged 53-84 years, at intervals of 3 years or less. CONCLUSIONS: An eye screening program in Japan would be cost-effective in detecting DR and preventing blindness from DR, even allowing for the uncertainties in estimates of costs, utility, and current management of DR.

Vision screening by teachers in southern Indian schools: testing a new "all class teacher" model.

AIM: To study the effectiveness and cost of a new school vision screening program involving all class teachers (ACTs) compared with the standard program involving a limited number of selected teachers (STs) in Southern India. METHODS: A total of 12 schools were selected for intervention and 12 schools were matched as controls, from in and around Pondicherry, India. Teachers in both the intervention arm (ACTs) and the standard arm (STs) were trained to identify students between the ages of 6 and 17 years with visual acuity ≤20/30 in either eye or obvious ocular abnormalities and refer them to an ophthalmic team. The ophthalmic team, including an ophthalmologist, visited the schools to examine all children referred by teachers, provided medical treatment or a prescription for glasses, or referred them to the base hospital if required. RESULTS: ACTs (761 teachers) screened 39,357 children (97.7%) and STs (156 teachers) screened 38,469 children (95.7%). ACTs found significantly fewer screen-positive children (n = 3806, 9.7%) than the STs (n = 6387, 16.6%; p < 0.001), but had a significantly larger number of children with actual vision loss and other ocular pathology (2231, 5.7% and 1554, 4.0%, respectively, p < 0.001). More children from ACTs than STs reached the base hospital for further investigation within 3 months (p < 0.001). The cost of screening per child with actual ocular pathology was estimated to be US$1.91 for ACTs and US$4.83 for STs. CONCLUSIONS: A school vision screening program involving ACTs resulted in more efficient screening than a program involving STs at about a third of the cost and also improved compliance with hospital referral.

School-entry vision screening in the United Kingdom: practical aspects and outcomes.

PURPOSE: To describe and assess an orthoptist-led vision screening service for school-entry (reception class) children, and report outcomes from one healthcare trust in the UK. METHODS: A total of 3721 children (aged 4-5 years) in reception class primary school (155 state, 3 private) underwent orthoptist-conducted vision screening. Children who failed to meet the screening criteria were referred to hospital-based eye services for re-testing and final diagnosis. RESULTS: The screening take-up rate was 96.41%; the remaining 3.59% refused/failed to consent to screening. The screening capture rate of participating children was 99.7%. A total of 11.14% of screened children failed to meet the screening criteria and were referred elsewhere; no abnormalities were found in 14% (false referral rate) of these children. Of the referred children, 53% had refractive errors requiring glasses and 42% had squints. The estimated percentages of common visual problems in screened children were 9.15% for refractive error and 3.81% for squint. CONCLUSION: An orthoptist-led, time-of-school-entry vision screening service is ideal for successful childhood vision screening and is, thus, a valuable source of information regarding the prevalence of common visual problems among children.