How a smartphone app can find kids' vision problems

Inside a dark exam room, Dr. Karen Judy is preparing to take a photograph of her 3-year-old patient when he starts to hear the sound of birds chirping.

Edwin Barr is an easily distracted toddler on this afternoon, but the chirps from her smartphone have his attention while Judy focuses on his blue eyes and snaps a picture. A vision screening app studies the image and delivers almost immediate results: Edwin's eyes check out just fine.

"Look at those handsome eyes!" his mom, Nicki Barr, says.

Pediatricians are increasingly testing children for potential vision problems through so-called photoscreening even before they need a state-mandated, comprehensive eye exam heading into kindergarten.

Judy tested the kid-friendly screening at her Glen Ellyn practice three years ago, and now other suburban pediatric offices in the Northwestern Medicine Regional Medical Group are offering it for patients as young as 12 months.

"It's an exciting advancement, and we were glad to be able to take advantage of it," Judy said.

"It just took a month or so for all of us to be true believers. We feel more confident that we're not missing something that we probably were before."

The case of a Wheaton boy illustrates how difficult it is to detect eye disorders in kids with no obvious symptoms. But his screening in the Glen Ellyn office led to a diagnosis of a serious condition: amblyopia, or lazy eye.

When to test

Judy and her Northwestern colleagues introduced photoscreening in February 2015. The app, "GoCheck Kids," flags risk factors for lazy eye - one of the most common causes of visual impairment among children. In patients with the disorder, neural pathways from the weak eye to the brain are not fully developed.

"If one of your eyes drifts off, your brain can't handle input from eyes not moving together in equilibrium," Judy said. "It can't take all that input, so it basically will shut down one of the eyes, so you will only be using one eye."

Vision can progressively worsen in the weaker eye while the dominant eye compensates for that loss. The sooner patients start treatment, the better their chances for correcting the problem.

And that's why Judy is urging parents not to wait to have their children tested until the required kindergarten eye exam by an ophthalmologist.

The Itasca-based American Academy of Pediatrics also recommends that instrument-based screening should be first attempted between 12 months and 3 years of age and at annual well-child checkups.

"Vision affects learning and behavior and later success in school, so I think it's imperative to identify any abnormality that benefits from correction," Judy said.

Her medical group - with offices in Batavia, St. Charles, Sugar Grove and Wheaton - screens kids using leased smartphones. A patient care technician opens the app and frames a child's eyes within circles that show up on the screen. Software assesses the image for abnormalities in the red reflex.

"There are a lot of kids that have such subtle, subtle asymmetries that their parents don't pick it up, and we can't pick it up on exam, and those are the ones that we're really happy to pick up with this," Judy said.

If the app picks up risk factors, Judy refers the patient to an ophthalmologist. In the first 10 months of the pilot program, pediatricians screened 870 children, 11 of whom were later diagnosed with severe amblyopia. They now find about one new patient each month with a vision concern, Judy said.

At most, parents can pay roughly $60 for out-of-pocket costs, but most insurance companies cover the screening, she said.

"And more and more I think will, because it's becoming the standard," she said. "And it can save a lot of money down the line if you can keep them from needing surgery."

'Spreading the word'

Jill Baer's son, Ethan, wasn't complaining of vision problems when he was screened at age 3. So when the results indicated an issue and a follow-up visit to the ophthalmologist confirmed lazy eye, the Wheaton mom was stunned.

"I don't know that we would have found this problem until his kindergarten eye exam, which would be this coming fall," she said. "So he would have gone two full years with using his own coping mechanisms to see, and who knows what it would have done to the weakness of his muscles in his left eye.

"Thankfully, the problem was discovered, and we've been able to work on it and do the eye therapy."

She now thinks her son's occasionally squinting in the back seat of her car may have been a warning sign of a vision deficit.

But his eye doctor is seeing some improvement from Ethan's treatment: covering his dominant, right eye with a patch, first for four hours a day and eventually down to one. The 4-year-old also started wearing glasses with strong prescription lenses.

"His jaw kind of dropped, and he did the 'Wow, this is what it looks like,'" Baer said of her son's reaction to seeing his world through glasses.

Her son's progress has the mom encouraging other parents to have their children screened.

"It's kind of sad to think my kid has a really bad vision deficit, but I always think it's helping other people by spreading the word that if you have the opportunity, you get this testing done," she said.