Pediatric teleophthalmology screening: a scoping review of global evidence and implications for Canada.

BACKGROUND

In Canada, nearly 90% of children under 6 have never received a comprehensive eye exam, despite national guidelines recommending at least 1 before age 5. Missed diagnoses of amblyopia, strabismus, and retinopathy of prematurity (ROP) contribute to preventable vision loss and inequities.

OBJECTIVE

To synthesize evidence on pediatric teleophthalmology screening, evaluating performance, feasibility, and economic considerations, with attention to relevance in the Canadian context.

METHODS

A scoping review was conducted in Ovid MEDLINE, EMBASE, CINAHL, and Scopus (2005-2025) for studies assessing teleophthalmology screening in children. Screening was performed in duplicate, with data extracted on modalities, conditions, settings, and costs.

RESULTS

Of 3 752 identified studies, 30 met inclusion criteria, involving >15,000 children. Digital retinal imaging (n = 18), video (n = 7), and smartphone-based tools (n = 5) demonstrated diagnostic performance comparable to gold-standard in-person exams in most reports. Cost-analysis studies consistently found teleophthalmology to be more cost-effective than in-person screening. Barriers included equipment costs, staff training, and poor connectivity in rural areas; facilitators included reduced costs and expanded screening capacity. Evidence gaps remain for non-ROP conditions (e.g., amblyopia, strabismus, retinoblastoma) and for rural, low-resource, and Indigenous populations.

CONCLUSIONS

Teleophthalmology shows promise for expanding pediatric vision screening capacity and accessibility in Canada. However, Canadian validation studies are limited. Implementation research focusing on rural and Indigenous communities, non-ROP conditions, and patient-centered outcomes is urgently needed to guide equitable integration into pediatric eye care.