Conclusion

Establishing proper referral criteria may prove to be the biggest challenge facing these new autorefractors.  Various referral criteria may be appropriate, depending on the screening situation specifically for the suspected prevalence of the disease in the population, the availability and cost of subspecialty providers for referred patients, and the net direct and indirect cots of over-referrals.  Areas of the country that have low access to providers and referral subspecialists and high direct and indirect costs of obtaining care need to balance a low sensitivity with extremely high specificity and low referral rates.  Conversely, areas with high population density and adequate primary pediatric eye care capacity may seek a high specificity with less regard for over-referrals.  Further evaluation of autorefraction and adjustment of referral criteria in the future in order to maximize both sensitivity and specificity will likely continue to increase acceptance of this technology.