title: Nine-year results of a volunteer lay network photoscreening program of 147 809 children using a photoscreener in Iowa.
abstract: OBJECTIVE
  To present the largest cohort of preschool children screened by the MTI PhotoScreener over a 9-year period from a single, statewide vision screening effort.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  We included 147,809 children screened between May 1, 2000, and April 30, 2009 by a photoscreening program.
  
  
  METHODS
  Retrospective review of results from the Iowa photoscreening program using the MTI PhotoScreener. The photographs were taken by volunteers from local Lions clubs and sent to the University of Iowa for interpretation. Children who failed the photoscreening were referred to local eye care professionals, who preformed a comprehensive eye evaluation and forwarded the results to the Iowa KidSight program.
  
  
  METHODS
  Number of screenings, referral rate, positive predictive value (PPV), follow-up rate, and associated costs per year are described.
  
  
  RESULTS
  Over the 9 years of the continuously operating program, 147,809 children underwent photoscreens to detect amblyopic risk factors at 9746 sites. Because of abnormal photoscreen results, 6247 children (4.2%) were referred. Of the children, 24.3% were evaluated by local ophthalmologists and 76.7% were seen by local optometrists. Between 2000 and 2009, the follow-up rate ranged from a low of 36.1% to a high of 89.5%, with an overall program follow-up rate after the addition of the follow-up coordinator of 81.3%. The overall PPV of the MTI PhotoScreener was 94.2%. Taking into account overall operating budget including salaries and associated costs, the cost of screening 1 child has been reduced to $US9 per child.
  
  
  CONCLUSIONS
  The addition of a part-time follow-up coordinator to the photoscreening program produced 89.5% follow-up rate when screening 147,809 children for amblyopia risk factors over a 9-year period.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. susannahlongmuir@uiowa.edu
authors.forename: Susannah Q
authors.initials: SQ
authors.lastname: Longmuir
authors.forename: Wanda
authors.initials: W
authors.lastname: Pfeifer
authors.forename: Alejandro
authors.initials: A
authors.lastname: Leon
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Olson
authors.forename: Lori
authors.initials: L
authors.lastname: Short
authors.forename: William E
authors.initials: WE
authors.lastname: Scott
mesh_terms: D000550:Amblyopia / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007223:Infant; D007484:Iowa; D008297:Male; D010781:Photography / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D015397:Program Evaluation; D015203:Reproducibility of Results; D042262:Retinoscopy; D012189:Retrospective Studies; D012307:Risk Factors; D015351:Vision Screening / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D014838:Volunteers