Implications of community-based repeat annual vision screening using the Spot photoscreener

Abstract

Introduction: The implications of repeat annual visual screening have not been reported. This study compares photoscreening characteristics of children who fail repeat annual preschool vision screening. Methods: Children screened with the SPOT photoscreener from 2015-2018 were categorized based on the results of repeat screening: fail-fail, fail-pass, pass-fail. The medians of the spherical and cylindrical powers for the first fail, and the medians of the change in spherical and cylindrical powers between the first and second screening were compared among the groups using Kruskal-Wallis ANOVA and Mann-Whitney tests. Results: Of 20,375 children screened, 1,299 received repeat annual screening and 262 children failed at least once, with 93 in the fail-fail, 56 in the fail-pass, and 43 in the pass-fail group. 70 were excluded due to incomplete data. The fail-fail group had greater cylindrical error (P < 0.001) and smaller change in cylindrical power than the other groups (P < 0.001). Follow-up rate after initial referral was 71% (fail-fail group) and 84% (fail-pass group). Discussion: Children who failed repeat annual vision screening (fail-fail group) were more likely to show higher levels of astigmatism and stable levels of astigmatism between screenings with the SPOT photoscreener. This may be due to the lower rate of follow-up in this group. High cylindrical power and stable cylindrical power over time have been associated with higher rates of amblyopia. Conclusions: Astigmatism readings prompting referral with the SPOT photoscreener are stable between annual screenings. Compliance with follow-up should be emphasized in children with cylindrical error who fail repeat vision screening.