title: Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.
abstract: BACKGROUND
  Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here.
  
  
  METHODS
  Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria.
  
  
  RESULTS
  All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children.
  
  
  CONCLUSIONS
  Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.
authors.affiliation: Tennessee Lions' Eye Center at Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, USA. sean.donahue@vanderbilt.edu
authors.forename: Sean P
authors.initials: SP
authors.lastname: Donahue
authors.forename: John D
authors.initials: JD
authors.lastname: Baker
authors.forename: William E
authors.initials: WE
authors.lastname: Scott
authors.forename: Paul
authors.initials: P
authors.lastname: Rychwalski
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Neely
authors.forename: Patrick
authors.initials: P
authors.lastname: Tong
authors.forename: Donald
authors.initials: D
authors.lastname: Bergsma
authors.forename: Deborah
authors.initials: D
authors.lastname: Lenahan
authors.forename: Dawn
authors.initials: D
authors.lastname: Rush
authors.forename: Ken
authors.initials: K
authors.lastname: Heinlein
authors.forename: Ron
authors.initials: R
authors.lastname: Walkenbach
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Johnson
mesh_terms: D000550:Amblyopia / Q000175:diagnosis*; D002675:Child, Preschool; D005500:Follow-Up Studies; D005582:Foundations / Q000458:organization & administration*; D006801:Humans; D007390:International Agencies; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015351:Vision Screening / Q000458:organization & administration*; D014792:Visual Acuity