Current Methods

Recently, photoscreening (photographing the eye’s red reflex) has been proposed as an alternative way of evaluating for vision problems in children. In theory, photoscreening allows testing of very young or developmentally impaired children who could not otherwise cooperate with manual screening techniques. Unfortunately, photoscreening does not check the child’s vision. Photoscreening can only check for certain eye conditions which might impair vision. In addition, photoscreening requires expensive, specialized equipment and large numbers of trained personnel both to perform and interpret the testing. These limitations make photoscreening less desirable for use with children old enough to read an eye chart. Furthermore, on the spot interpretation of results is often not accurate. Offsite, professional interpretation improves accuracy but delays results, adds expense, and makes coordinating medical referrals difficult.

The third method to check a child’s vision and screen for amblyopia is a professional examination in an eye doctor’s office. Although a full examination has the potential to be the most thorough method of screening for eye problems, it is not performed in the schools. Many children are unable to visit an eye doctor’s office. Even if it were logistically possible for every child to visit an eye doctor’s office, the costs would be overwhelming. Furthermore, not all eye doctors are trained the same. The lack of a standardized child’s eye examination makes even this most expensive proposition subject to accuracy and reliability concerns. It also opens up a Pandora’s box for the possible over-prescription of eye services.

For comparison purposes, these calculations assume the use of a nationwide volunteer network to screen 20 million children attending 100,000 schools.

The manual screening method requires the use of volunteers to both organize and perform the screenings. Including training and materials, the estimated costs are $2.50 per child. The cost per child is fixed as additional children are screened. Therefore, nationwide manual screening would cost $50 million per year. Unfortunately, even if this money was available today, there are not enough volunteers available to perform 20 million screenings annually.

Like manual screening, photoscreening requires volunteers to organize and perform the screenings. When photoscreening interpretation is performed offsite, results are not known immediately. Volunteers, then, must also coordinate a recall system to notify parents of results received days or even weeks later. In addition to trained volunteers, photoscreening requires a camera apparatus. This apparatus adds substantial upfront and maintenance costs. In addition, on-going costs include film and interpretation of the photographs. Assuming one screening apparatus per school, we estimate the amortized costs to be $200 million annually to photoscreen all of our nation’s schoolchildren.

Professional eye exams would also require a volunteer network to coordinate, schedule, and in some cases, transport children to an eye doctor’s office. The American Optometric Association has recently sponsored legislation in some states to mandate that all children receive a professional eye examination prior to entering school. Many experts question whether there are enough eye doctors trained in children’s vision examinations to perform 20 million screenings annually. This is by far the most expensive method to perform national vision screenings. At a conservative estimate of $50 per child, the cost of such a program would exceed $1 billion annually. Surprisingly, some states that have already passed this legislation have not fully addressed the issue of “who is to pay”.