Abstract
Purpose :
Preschool vision screening to detect amblyopia or its risk factors (RF) is recommended by the US Preventive Services Task Force. The General Pediatrics Clinic at Vanderbilt currently performs automated screening on all patients at 1.5, 3, and 4 years. Referral to Vanderbilt specialists occurs based on prespecified screening criteria. We performed a retrospective chart review exploring reason for referral, attendance at follow up appointment, and final diagnosis.
Methods :
All screenings were done using the plusoptiX S12C photoscreener and the ROC 5 referral criteria between 4/1/19 and 9/30/19. Referred patients have a formal examination with cycloplegic retinoscopy scheduled at Vanderbilt. Amblyopia RF were determined using American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee Guidelines. Patients followed by ophthalmology or had prior amblyopia intervention were excluded (n=13).
Results :
319 patients had screening results available for review. In all age groups, astigmatism was the primary reason for referral - 85% of patients were referred for suspected astigmatism, of whom 80% had astigmatism as the exclusive referral reason. Other reasons for referral were anisometropia (overall 16%, exclusive 5%), hyperopia (8%,3%), myopia (12.5%,4%), gaze asymmetry (2%,1%), and anisocoria (1%,1%). There was no significant relationship found between suspected reason for referral and age group (p=0.64), or ethnicity (Hispanic versus not) (p=0.62).
Of the 359 referred patients who were treatment naïve, scheduling was attempted in 92%. Of these patients, 79% had an appointment scheduled. Thus far, 67% (n=120) of scheduled patients have been followed up and 33% (n=58) have been no shows. There was no significant relationship between reason for referral and attendance (p=0.30), or age group (p=0.23). Formal examination determined an overall positive predictive value (PPV) of 42% for detecting amblyopia or amblyopia RF.
Conclusions :
Early vision screening is important and this vision screening program refers primarily for astigmatism and has an overall PPV of 42%. Treatment is rare in children prior to age 3 and common after age 4. The preliminary data makes a case for modifying the astigmatism referral criteria to optimize patient and provider time, while reducing costs. However, clear referral criteria adjustments remain to be found.
This is a 2020 ARVO Annual Meeting abstract.