Cost-Effectiveness of photoscreeners in screening at-risk amblyopia in Indian children.

Objectives: Amblyopia is the most common cause of preventable vision impairment in children. This study tried to evaluate the cost-effectiveness of photoscreeners in identifying refractive errors making children at risk of amblyopia.

Materials And Methods: This was designed as a prospective, open-label, randomized controlled study to compare the cost-effectiveness of photoscreeners (2WIN Adaptica and Plusoptix) versus autorefractor and Mohindra retinoscopy to identify the at-risk amblyopia. This study was conducted from October 2018 to December 2018 in coordination with Nanna Kannu school screening project and children in the age group of 5-11 years were included in the study. The photoscreening was done by lay screeners. A supervising ophthalmologist collated all data. Cost-effectiveness was calculated for the individual instruments and compared. The average time is taken for each instrument to record the refractive error was calculated and compared with the Mohindra retinoscopy.

Results: Number of children included in this study was 2910. The mean age of the children was 7.82 + 0.65 years. The mean time taken for 2WIN Adaptica was 6 sec, Topcon -10 s, and Plusoptix -4 s. Plusoptix showed the minimal time for screening a child when compared to all other methods. The Plusoptix and 2WIN Adaptica were shown to be cost-effective when compared to Mohindra retinoscopy (P < 0.05).

Conclusion: Photoscreening using Plusoptix and 2WIN Adaptica with lay screeners was < seven times the cost incurred and five times faster than the trained optometrists using either autorefractor or Mohindra retinoscopy and thus more cost-effective in screening a large number of young children with at-risk amblyopia at the community level.