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D. P. Saltarelli, S. L. Lopper; The Prevalence of Eye Findings Identified as a Result of Mandatory Pre-School Eye Examinations. Invest. Ophthalmol. Vis. Sci. 2008;49(13):634. doi: https://doi.org/.
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In 2000, Kentucky became the first state to implement legislation requiring all children entering the public school system to have a mandatory eye examination (Kentucky House Bill 706). This law has been met with resistance by both health policy and healthcare providers, citing an increased likelihood of unnecessary treatment plans for otherwise minor eye problems in children, and the potential for unnecessary private and state funded health care costs. Determining the presence or absence of amblyogenic risk factors in children is typically the primary goal of the pediatric eye care provider when performing a pre-school eye evaluation. The purpose of this study was to determine the prevalence of serious eye problems identified as a result of this law by reporting on the number of Kentucky children with one or more amblyogenic risk factors.
A retrospective chart review of 1590 Kentucky children between the ages of 4 and 6 was conducted to determine the primary purpose for eye examination. The number of amblyogenic factors, as defined by the American Academy of Pediatric Ophthalmology and Strabismus (AAPOS, Vision Screening Committee), was recorded for each child who presented specifically to satisfy the requirement of a pre-school eye exam.Only children that were new patients at the time of their appointment were included in this study.
Over a 2 ½ year span, 150 children were specifically examined for no other reason than to satisfy the pre-school eye exam requirement. The majority of these patients were hyperopes (n=81 or 54%), followed by emmetropes (n=38 or 25%) and then hyperopic astigmats (n=13 or 9%). The remainder included myopes (n=8 or 5%), myopic astigmats (n=6 or 4%), and mixed astigmats (n=2 or 1%). Two subjects (1%) were identified with strabismus. Thirteen of the 150 subjects (8.7%) were identified as having met the criteria for having ≥ 1 amblyogenic risk factor as defined by the AAPOS criteria. Eight of 13 subjects were identified as having one amblyogenic risk factor while the remaining 5 subjects had two amblyogenic risk factors. Six of 13 had a primary diagnosis of hyperopia, 3 of 13 astigmatism, 2 of 13 strabismus, and 2 of 13 anisometropia.
The prevalence of eye findings (defined as amblyogenic risk factors) was found to be 8.7% in the pre-school population that we identified through the use of comprehensive eye exams. This capture rate is not necessarily greater than what is normally observed in current vision screening programs.
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