title: Predictive value from pediatrician plusoptix screening: impact of refraction and binocular alignment.
abstract: BACKGROUND
  The positive predictive value (PPV) of conventional preschool acuity screening is about 50% whereas previous Polaroid photoscreening with experienced interpretation can achieve PPV greater than 85%. The Plusoptix photoscreener has immediate computer interpretation and a CPT code available to pediatricians.
  
  
  METHODS
  Two Plusoptix SO9 were used in two pediatric group practices with previously validated refractive criteria and new manufacturer's binocular alignment criteria. CPT billing was monitored. Referred patients had prior gold-standard AAPOS examinations.
  
  
  RESULTS
  12% of 675 photoscreened preschoolers were referred. Of the 39 with AAPOS gold-standard exams, the PPV from strabismus referrals was 17%, while 26 of 27 refractive referrals had true amblyopia risk factors (PPV 96%). Screening CPT code 99174 reimbursement rose from zero to half of insurers in 15 months.
  
  
  CONCLUSIONS
  Plusoptix photoscreening is valid after adjusting the binocular alignment criteria. Such photoscreening should be employed by pediatric practices to detect and ultimately to reduce amblyopia vision impairment in children.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Arnold
authors.forename: Daniel
authors.initials: D
authors.lastname: Tulip
authors.forename: Erin
authors.initials: E
authors.lastname: McArthur
authors.forename: Janet
authors.initials: J
authors.lastname: Shen
authors.forename: John
authors.initials: J
authors.lastname: Tappel
authors.forename: Laura E
authors.initials: LE
authors.lastname: Arnold
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Winkle
authors.forename: M Diane
authors.initials: MD
authors.lastname: Armitage
mesh_terms: D000550:Amblyopia / Q000175:diagnosis; D006801:Humans; D007223:Infant; D012030:Refractive Errors / Q000175:diagnosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015351:Vision Screening