On the use of photoscreening

By Anna Horwood

Data being collected in Sheffield is showing that photoscreening is used widely in the EUSCREEN partner countries and around the world, but that it is rarely introduced as a stand-alone test and in many countries it has been introduced as an add-on to existing healthcare provision.
Anna Horwood’s and the University of Reading’s role in the project is advisory, and specifically in relation to how photoscreening is used. There is a large literature on photoscreening or autorefraction used in a screening context, but the vast majority of papers describe equipment development or referral threshold validation, mainly in the US healthcare setting. While short term costs are low (in terms of cost per child screened), long term cost-effectiveness of introducing photoscreening, where many more children can enter health services much earlier, is rarely published. Local, national and cultural factors may mean that what is appropriate, or possible, for one country may be very different in another. In time we hope the model will help decision-makers decide what is best.
Photocreening detects “amblyopia risk factors”, which are more common than amblyopia itself, and photoscreening may lead to much higher costs of following and treating children with risk factors, but no actual low vision. There is not even a consensus about what constitutes “the target” – is screening looking for amblyopia, risk factors for amblyopia, refractive error itself, or low vision of any cause?
At present, photoscreening is not the primary focus of the EUSCREEN model development, but Anna Horwood is currently undertaking a systematic literature review to establish the scope of use of photoscreening or autorefraction used in primary care and screening contexts, and to evaluate in detail any evidence for relative cost effectiveness of photoscreening compared to other methods. She has also been involved in advising and training screeners in the new Romanian programme in Cluj-Napoca.

Anna Horwood PhD DBO(T) is Professor of Orthoptics & Visual Development, University of Reading and Research Director, British & Irish Orthoptic Society.

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