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G.E. Bradford, P. Nottingham Chaplin, J.V. Odom; Preschool Vision Screening Practices by Primary Care Physicians in West VIrgina . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4844.
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Purpose: Early detection and treatment of ophthalmic conditions causing amblyopia is essential to optimize normal visual acuity and binocular development in preschool children. Practice guidelines established by the American Academy of Pediatrics and American Academy of Family Physicians recommend preschool vision screening be a part of routine health care. However, only 21% of preschoolers have their vision screened.1 We conducted a survey to solicit vision screening practice patterns for 3- and 4-year-old children by primary care physicians (PCPs) in West Virginia (WV). Methods: With institutional review board approval, 226 pediatricians and 633 family physicians (FPs) in WV were anonymously sent a questionnaire soliciting their current practice patterns for preschool vision screening. Results: 30 pediatricians (13%) and 46 family physicians (7%) responded. These respondents represent 55% of the counties in WV. 77% (23/30) of responding pediatricians and 67% (30/45) of responding FPs screen preschoolers for vision and eye disorders. Overall, PCPs who test visual acuity estimate that they can comfortably test 36% of 3-year-old children and 64% of 4-year old children. Most respondents (93% or 39/42) list poor patient cooperation as the most common reason they are uncomfortable screening this age group. Lack of office time (17% or 7/42) and insufficient training (12% or 5/42) were also cited as reasons for discomfort when screening. The "Sailboat" kindergarten symbol chart was used most commonly by PCPs (52% or 31/60). More than half of the respondents (59% or 29/49)use a 20' testing distance. Licensed practical nurses (56% or 34/61) typically perform preschool vision screening. Less than half of respondents (37% or 20/54) bill for the service. When billing does occur, many (55% or 12/22) use ICD-9 Code 99173. Reimbursement from third party payers ranges from $6 to $20 per patient. Conclusions: Although specialty practice guidelines recommend preschool vision screening, many PCPs in WV are uncomfortable providing this service. Poor patient cooperation, especially with 3-year-old children, is the most frequently cited reason for this discomfort. Many PCPs appear to be unaware of current methods for preschool vision screening and would like better training in this area. Improving education, training, and access to appropriate vision screening methods, as well as enhancing reimbursement, may increase preschool vision screening among PCPs. 1Ehrlich, M I, Reinecke, R D, Simons, K: Preschool vision screening for amblyopia and strabismus. Programs, methods, guidelines, 1983. Survey of Ophthalmology, 28:145-163, 1983.
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