Purpose:
A significant number of children who fail vision screening do not receive follow-up care. Our aim is to identify barriers to care in order to attain higher rates of successful follow-up and treatment of eye disease.
Methods:
Consented children ages 36 to 59 months in the Oregon Head Start program received visual acuity screening with the Lea chart and stereo-acuity testing using Random Dot E. Criteria for failing the vision screening included: inability to identify 20/40 on the Lea chart or incorrect response on stereo-acuity testing on more than 1 of 5 presentations. If a child failed the vision screening, parents were sent a copy of their IRB consent form containing the results of their child’s screening and an information packet explaining the risks of amblyopia. For those children who received follow-up care, chart notes from the ophthalmic exam were obtained and used for analysis. For those children who did not receive follow-up care, parents were asked to report the reason for not taking their child to the eye doctor. An independent interviewer conducted 200 telephone interviews with both parents of children who received care following the vision screening and those who did not.
Results:
A total of 3,438 children consented for vision screening. Of these, 2,698 passed (78.5%) and 740 were referred (21.5%) for a comprehensive eye exam. Of the 740 children referred, 243 (32.8%) did not obtain follow-up care. The most common reason reported by parents for not seeking follow-up care after a failed vision screening was skepticism of the screening results. In-depth telephone interviews seeking information such as demographic data, knowledge of screening failure, health status of other family members, and knowledge of eye conditions have led to a better understanding of this skepticism.
Conclusions:
Amblyopia is an eye disease that lacks broad awareness beyond pediatric eye care medical professionals. Public education is needed regarding the seriousness of amblyopia. Even a child’s pediatrician, who is not adequately informed, can be a barrier to receiving a comprehensive dilated eye exam.
Keywords: screening for ambylopia and strabismus • amblyopia