icheckkids, SPOT, iscreen and Plusoptix performance in a high-risk, young pediatric eye practice Robert W. Arnold, MD, FAAP M.
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1 icheckkids, SPOT, iscreen and Plusoptix performance in a high-risk, young pediatric eye practice Robert W. Arnold, MD, FAAP M. Diane Armitage, certified orthoptist Alaska Blind Child Discovery
2 Disclosures ABCD has received discounted vision screen technology from several vendors and unrestricted grants from Walmart. Neither Dr. Arnold nor Miss Armitage has received direct compensation Dr. Arnold on board of Glacier Medical Software marketing ROP-Check icheckkids not yet FDA approved
3 Historic Battle Can Pediatric Ophthalmologists do a better job of battling AMBLYOPIA before it is too late?
4 Amblyopia still a GIANT problem Acuity-detected (age 3-4) average 20/32 best acuity Late detected microstrabismus and eccentric fixation Many never screened
5 Anti- Instrument Goliath Acuity-only proponents (not which but WHEN) Financial Disclosure advocates = anti-industry development Treat amblyopia Late (Wait until acuity is lost) Single Sensitive preschool vs AAP series of specific screens
6 Who will battle Amblyopia Goliath?
7 David Guyton Advanced the merits of Dynamic Retinoscopy and Brückner Test
8 Amblyopia GOLIATH Fighters David Coats David Wallace David Morrison David Stager Sr David Granet David Hunter
9 David Rogers MTI > Welch Allyn Suresight with David Plager
10 David Silbert With Noelle Matta, comparative validation by AAPOS guidelines of emerging photoscreen technology
11 Methods HIPAA - IRB compliant AAPOS 2003 Validation Guidelines Consecutive children in pediatric eye practice Did not exclude developmental delay
12 Photoscreeners PlusoptiX A-09 Pediavision SPOT (version 1.0.3, software ) iscreen 3000 icheckkids iphone 4s
13 five smooth stones 1Sa 17:40 icheckkids iscreen SPOT PlusoptiX A09 Photoscreeners
14
15 Validation Statistics Exam + Exam - Screen + A B Screen - C D sensitivity A/(A+C) specificity D/(B+D) PPV A/(A+B) NPV D/(C+D)
16 Validation Statistics Exam + Exam - Screen + A B Screen - C D Screen i E F sensitivity A/(A+C) specificity D/(B+D) PPV A/(A+B) NPV D/(C+D) ABCD sensitivity A/(A+C+E+F) ABCD specificity D/(B+D+E+F) ir sensitivity (A+E)/(A+C+E) ir specificity (D+F)/(B+D+F)
17 Delta-Center Crescent
18 icheckkids on iphone 4s
19 Results n=108 Age: mean 47 months (9-146 months) Pre-screen Probability 56% (normal 21%) Autism/Delays 10%
20 Risk Factors Refraction: average cyl spherical equivalent from -22 to +6 Anisometropia: n=10 over 2.0 diopters Strabismus: 11, Nystagmus: 1.
21 False negatives Intermittent strabismus (10-30 PD): n=9 small 1mm cataract: SPOT-, Plusoptix-?, iscreen and icheckkids-refer
22
23 Photoscreen Validation 100 Sensitivity Specificity inconclusive Plusoptix SPOT iscreen isc-dcc icheck
24 Inconclusives ABCD sens ABCD spec ir Sens ir Spec PlusoptiX SPOT iscreen icheckkids
25 preschool and Delays Sensitivity Specificity inconclusive Plusoptix-pre SPOT-pre iscreen-pre icheck-pre Plusoptix-delay SPOT-delay iscreen-delay icheck-delay
26 Discussion All 4 photoscreeners effective iscreen particularly useful in children with difficult fixation and attention icheckkids yielded useful photoscreen images Inconclusive images best considered as referrals Similar to Matta / Silbert validation studies
27 Limitations High prescreening probability (56% vs 21%) Special Needs Some older (autistic) Same examiner and interpret (DCC) Initial experience with icheckkids
28 Summary New photoscreeners can hit their target, even in high-risk young and special- needs children Combined with CPT and new AAP photoscreen endorsement, effective weapons against the Amblyopia Goliath
29 David Huang Adapted iphone technology to obtain valid photoscreen images. Developing interpretation software.
30 Davids vs Goliath Turning Point in the Photoscreener Battle: Practical Reimbursed Charitable Research 20 years Pediatric Tool
31 Goliath vs non-davids Howard Freedman still using objective technology that was spurred by his development of the MTI photoscreener
32 Goliath vs non-davids Jack Bellows founded iscreen and invested to obtain CPT
33 Goliath vs non-davids Sean Donahue: Vanderbilt Ophthalmic Image Center, MTI and many photoscreeners, AAPOS Uniform Guidelines
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