GoCheck Featured in Modern Healthcare

App screens kids for eye problems before they can talk

When a patient goes to Children’s Hospital of Orange County (CHOC) for an annual well-child visit, there’s the standard exam: a nurse measures the child’s vital signs, weight, and height before the patient checks in with the doctor. But for the youngest children, there’s another step—and it involves a smartphone.

Early last year, CHOC integrated an app called GoCheck Kids as part of routine care in well-child visits for patients ages 1 to 3 within its primary-care network. The app screens for vision disorders in young children—many of whom are too young to describe their own vision—to help providers determine whether a referral to an eye specialist is needed.

When a child visits a pediatrician, a nurse uses an iPhone preloaded with the vision-screening app and asks the child to look forward. After taking a photo, the app analyzes how light refracts off the patient’s eyes to assess the risk of vision abnormalities such as amblyopia, a common vision development disorder in young children. If the app detects a risk factor, an off-site team at GoCheck reviews the photos to confirm the finding.

Existing methods to screen young children for amblyopia—better known as lazy eye—weren’t cutting it, according to Dr. Charles Golden, a pediatrician and executive medical director of the CHOC primary-care network. “There was a presumption that we were missing subtle cases,” he said. Vision problems are among the most prevalent disabling conditions in children, according to the CDC, though some—like amblyopia—can be successfully treated if detected early.

The U.S. Preventive Services Task Force in 2017 said there’s insufficient evidence to recommend vision screening for children younger than 3, but pediatrics groups such as the American Academy of Pediatrics (AAP) have endorsed instrument-based screening—like photoscreening, the technique used by GoCheck Kids—for children ages 1 to 3. Without treatment, amblyopia can lead to permanent vision loss. “Once the brain is fully mature, you cannot go back in time and reverse that amblyopia,” said Dr. Geoffrey Bradford, AAP’s section chair for ophthalmology and a pediatric ophthalmologist at West Virginia University Medicine.

Traditional screening methods for nonverbal children, such as the cover-uncover test, require significant clinician skill and can easily miss subtle abnormalities. “There are subtleties of abnormalities that may be missed,” Golden said. GoCheck Kids is part of a growing market of photoscreening tools, including those from iScreen Vision, Plusoptix, and Rebion. That growth has been fueled by AAP’s 2016 policy recommending photoscreening at annual visits through age 5 or until a child can reliably use an eye chart.

Well-child visits are an ideal opportunity for vision screening, Bradford said, though he acknowledged photoscreening can be expensive. “It’s a big capital investment for a pediatrician to purchase one of these,” he said. GoCheck charges healthcare organizations about $149 per month per phone, providing an iPhone with a specialized case that concentrates the camera’s flash. Pricing may vary for additional services or volume discounts.

On top of those costs, not all health plans cover photoscreening. CHOC has applied for grants to offset expenses, but at least half of its patients are not covered for the exam, Golden said. “We code for it, submit the claim form—if we get reimbursed, great. If we don’t, we just chalk that up as, unfortunately, a loss.”

Still, Golden emphasized that not screening pediatric patients could be more costly in the long run. Untreated vision disorders can lead to expensive interventions later, such as glasses, ongoing specialist care, and even surgeries.

Source: Modern Healthcare