Damian McNamara

May 01, 2013

BOSTON, Massachusetts — What most assume is common practice — screening 3-, 4-, and 5-year-old children for vision problems — is not universal, a new study reveals.

To get an accurate snapshot of preschool vision screening, Suzanne Johnston, MD, from Boston Children's Hospital in Massachusetts, and her team randomly selected the charts of 450 children from an electronic medical record system used by 72 private pediatrician practices in Massachusetts.

Overall, 63% of children had undergone visual acuity screening and 38% had undergone stereovision testing, Dr. Johnston told Medscape Medical News here at the American Association for Pediatric Ophthalmology and Strabismus 39th Annual Meeting.

Pediatrician practices are not equally adept at vision screening. "We found a statistically significant difference; larger practices tend to do a better job than smaller practices," she reported.

The researchers also found that patient age plays a significant role. When they compared 3 age groups (n = 150 each), older children were more likely to undergo amblyopia screening. "Older children are generally more cooperative than younger children. A 3-year-old, for example, might have a harder time sitting still for testing," Dr. Johnston explained.

Table. Visual Acuity Screening by Practice Size and Age Group

Variable Proportion Screened, %
Practice size*  
   Small (1 or 2 physicians) 41.4
   Medium (3 to 5 physicians) 60.5
   Large (6 or more physicians) 76.8
Age group*  
   3 years 42.2
   4 years 70.5
   5 years 77.2
*P < .0001

Once a potential visual problem is identified, is that child getting referred? "My general impression is that referrals are low," said Dr. Johnston.

The researchers found that for children who failed any portion of the vision test or for whom there was no documentation of a completely normal visual acuity and stereovision test, only 11.3% had evidence of a referral to an ophthalmologist or optometrist.

"It is not surprising that a higher percentage of the older preschoolers were screened because it is much easier to test these children. The percentage of children receiving a screening was decent, considering that repeat screenings are offered throughout childhood," said Katherine Lee, MD, a pediatric ophthalmologist at St. Luke's Children's Hospital in Boise, Idaho, who was asked by Medscape Medical News to comment on the findings.

Dr. Lee, who took interested attendees on a guided poster tour during the meeting, added that "the percentage of children who had evidence of referral following failed or missed screening was poor. This is certainly an area in need of attention in screening programs."

Dr. Johnston agrees, and noted that future research should examine the rate of follow-through with referrals.

She added that although this study was retrospective — all participants were screened during well-child visits in 2010 — one of its strengths is the large number of patients and practices. The private practices participating in the study are all members of the Pediatric Physicians' Organization, which is affiliated with Boston Children's Hospital.

The ramifications of this research likely go beyond providing a snapshot of current screening prevalence, Dr. Johnston noted. "The practices involved have shown an interest in using these data to improve their vision screening, and data can provide an impetus to change practice.... It is satisfying that [the results] will have a practical effect."

This study was funded by a Prevention of Blindness Grant sponsored by the Maternal & Child Health Bureau, the US Department of Health and Human Services. Dr. Johnston and Dr. Lee have disclosed no relevant financial relationships.

American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 39th Annual Meeting: Abstract 81. Presented April 6, 2013.