Enhanced Housing Photoscreeners 2WIN and GoCheckKids Compared in Burma and Alaska
Condition: Amblyopia; Anisometropia
MeSH terms: Amblyopia; Anisometropia
Study type: Observational

Summary: 
      "Adaptica" (Padova, Italy) designed a fixed-distance, dark portable tube with power and
      remote control for the "2WIN: photoscreener. GoChecksKids designed a flash-concentrating case
      for the iPhone 7+ to more quickly achieve two-axis photoscreen. These devices were compared
      to confirmatory exams in children and young adults in a remote Burma clinic and in an Alaskan
      pediatric ophthalmology practice.
    

Detailed description: 
      Photoscreening with follow up confirmatory exams for referred and passed interpretations were
      offered to children and young adults at a remote clinic in the Karen State of eastern Burma
      (Myanmar). The clinic had intermittent 220 Volt power generator, but no internet or cell
      phone coverage.

      Consecutive patients in a "WiFi-equipped" pediatric ophthalmology practice in Anchorage,
      Alaska had photoscreening before confirmatory examination.

      Each patient had photoscreening with the "2WIN" photoscreener installed in the "Kaleidos"
      housing. In Anchorage, the devise was controled by the wireless tablet computer. In Burma,
      however, despite a "WiFi router" not connected to internet, the tablet computer would not
      connect to the 2WIN and therefore the "Kaleidos" read-trap door was opened so the 2WIN could
      be activated and controlled manually. The" 2WIN" stored results on an "micro-SD" memory card
      which was eventually downloaded to computer.

      Each patient also had photoscreening with GoCheckKids (GCK) on an "iPhone 7 Plus" using the
      enhanced, flash-concentrating cell-phone case. In Anchorage, in addition to on-site
      smart-phone interpretation, images were uploaded to the central reading center for secondary
      interpretation. In Burma, all images were retained on the smart phone and eventually uploaded
      for GoCheckKids central secondary analysis after return to urban internet availability. In
      Burma, a portable, light-wieght tent was used to provide a dim screening environment with
      less distraction.

      Confirmatory exams were performed consistent with 2003 and 2013 American Association for
      Pediatric Ophthalmology and Strabismus (AAPOS) uniform guidelines. Cycloplegic refractions
      were performed 20-40 minutes after cyclopentolate 1% instillation. Visual acuity was checked
      with patched, surround "HOTV" at 3 meters threshold with at least 3 of 4 optotypes correct.
      Validation was performed with conventional 2 x 2 screen-exam matrix, and also with Alaska
      Blind Child Discovery (ABCD) 3 x 3 matrix including inconclusive results (no instrument
      interpretation or unable to gain a reading) with inconclusive interpretations considered a
      referral.
    

Intervention name(s): photoscreen
Intervention type(s): Device
Intervention description(s): Determine amblyopia risk factors
Other intervention name(s): refraction
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children and young adults attending eye clinics in Burma and Alaska