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Geoffrey E. Bradford, P. K. Nottingham Chaplin; The Quality Of Examinations Performed On Preschoolers By Licensed Eye Care Providers After Referrals For Failed Vision Screenings. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1599.
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In order to identify children with amblyopia and other abnormalities of vision, the AAP recommends visual acuity screening beginning at age three, with referral to a licensed eye care provider for children who either fail the screening or are unable to complete the screening because of behavioral or developmental impediments. This study seeks to assess the quality of pediatric eye examinations performed by optometrists and ophthalmologists on children referred after screening as part of the Children’s Eye Foundation’s See By Three preschool vision screening project in West Virginia.
Primary care providers and their staff were trained and equipped in a standardized manner using AAP guidelines to perform visual acuity screening on preschool-aged children presenting for well-child checks. Children who either failed the screening or who were un-testable were referred to local eye care providers for examination. Eye care providers submitted a standard summary of their exams and findings. The exam elements performed were compared to the AAO Preferred Practice Patterns for Pediatric Eye Evaluations and to the AAP Vision Screening Guidelines to assess adherence to these recommendations. Spectacle prescribing practices were compared to the AAPOS guidelines for determining significant refractive errors.
292 children were referred by primary care providers for eye examinations. 178 of these children were examined. 114 reports from optometrists (ODs) and 64 reports from ophthalmologists were reviewed. Compared to ophthalmologists, ODs were more likely to avoid the use of topical cycloplegic agents as part of their evaluations (55.3% vs 4.7%). ODs were less likely to test acuity at the recommended distance of 10 feet (13.4% vs 53.1%). ODs were less likely to perform acuity testing with a chart recommended by the AAP (94.7% vs 5.3%). ODs were more likely to prescribe spectacles that did not fall within the guidelines published by AAPOS (25.0% vs 10.0%). All of these differences were significant at p<0.05.
This study demonstrates that more uniform adherence by licensed eye care providers to published standards for pediatric eye evaluations and for treatment of refractive errors is necessary when children are referred after a preschool vision screening.
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