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W.L. Marsh-Tootle, T.C. Wall, J.M. Hardin, H.H. Evans; Do Referral Practices in Pediatric Primary Care Settings Depend Upon Age and / or the Technique Used to Screen Vision? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4849.
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Purpose: To determine whether vision screening referral practices in pediatric primary care settings vary by age and / or technique. Methods: Children aged 3 to 18 years attending well-child visits in one of nine practices in Birmingham, AL were enrolled in the study following training sessions for nurses, research assistants and pediatricians on AAP vision screening guidelines or photo-screening. Nursing staff or medical students screened 2040 patients: 874 by visual acuity and 1166 by MTI photorefraction. Decisions to pass, re-check or refer were made by the primary care physician. Logistic regression was performed using the decision to refer as the dependent variable with co-variates including method type, patient demographics (age, gender, race, and insurance type), and academic affiliation of the practice. Results: The decision to refer was not influenced by any factor above except academic affiliation (more likely to refer, p=0.024). Less than half of preschool children obtained examinations after failing either screening technique (2/5, 40 % VA versus 26/71, 36.6% MTI). Conclusions: Primary care practices in academic settings are more likely to refer according to established protocols for visual acuity and photorefraction screening. Practices using photorefraction showed good agreement between screening results, referral decisions, and the estimated prevalence of abnormal refractive errors and strabismus at preschool ages. Practices using visual acuity showed large discrepancies, with fewer preschool children screened and referred than expected. Perhaps most surprising, primary care providers decided NOT to refer the vast majority of older children who did not pass visual acuity. View OriginalDownload SlideView OriginalDownload Slide
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