Abstract
Purpose :
We demonstrated in an earlier report that implementation of instrument-based vision screening at 3-, 4- and 5-year well-child-checks in pediatric offices increased rates of successful screening at these visits to approximately 90% for all age groups. The purpose of this report is to evaluate rate of follow-up to a comprehensive eye exam after a failed vision screening during these visits.
Methods :
From May through August 2021 two pediatric clinics affiliated with Akron Children’s Hospital conducted instrument-based vision screenings for patients attending 3-,4- and 5-year well-child-checks. Referral rates for a comprehensive eye examination and completion of the referral any time before the next well-child-check were compiled. In addition, we conducted a review of the referrals who did not show an eye examination, in order to more fully understand the impact of these incomplete follow-ups.
Results :
There was a total of 176 ophthalmology referrals generated from the two clinic sites during the 4-month time period. Of those referred, 109 had a comprehensive eye exam within 12 months of referral and 67 did not, resulting in 62% follow-up rate. When data between clinics were compared, one clinic had a 66% follow-up rate for comprehensive eye exam and the other had a 48% follow-up.
Detailed inspection of the patients with no follow-up eye examination yielded two explanations for the majority of these patients. Approximately 50% of these patients had no further well-child-checks in these clinics; and approximately 30% were screened at a subsequent well-child-check and evaluated as needing no further follow-up.
Conclusions :
Screening for risk factors. or the presence of any disease, has little to no benefit when gold standard follow-up assessments are not completed after a screening that is categorized as warranting a referral. However, all screening tests have both a correct positive and a false positive rate. Our follow-up rate was only 62% and varied across ages as well as clinics. The fact that close to 30% of the patients who did not complete the initial referral were evaluated at their next annual visit and “passed” the screening, raises questions about the referral criteria being used as well as the degree of urgency for a comprehensive eye examination, particularly with the youngest age group.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.