Implementation of Instrument-Based Vision Screening in Primary Care Pediatric Offices: Enhancing Early Detection of Sight Threatening Disorders within a Children's Hospital System - The human visual system is not fully developed at birth and experiences a myriad of changes in the first few years of life along the entire visual pathway from the back of the eye to the connections in the brain. Abnormal neural development in the visual cortex of the brain can lead to amblyopia, yielding reduced visual acuity in one eye, relative to the other eye (monocular amblyopia); or in both eyes, relative to normal vision (bilateral amblyopia). If left untreated, amblyopia can lead to lifelong visual impairment. Vision screening during repeated Well Child Checks is an integral part of identifying a child at risk for amblyopia and other vision disorders. From newborn through 30 months of age, evaluation of the visual system is based on a risk assessment that includes: 1) family history of eye disorders and parents’ observations; 2) external inspection of the eyes; 3) red reflex testing to detect opacity in the visual axis or different reflex intensities between the eyes; 4) pupil examination; 5) ocular alignment and motility; 6) visual function, i.e. the ability to fixate and follow an object. The American Academy of Pediatrics advocates assessment of visual function (risk factor #6) by measuring monocular visual acuity once a child can identify or match symbols displayed on a chart, ideally beginning at 3-years of age. However, only about one half of 3-year-olds and one third of 4-year-olds can complete the necessary visual acuity assessments. We implemented instrument-based vision screening for 3-, 4- and 5-year Well Child Checks at 44 general pediatric offices affiliated with Akron Children’s Hospital beginning in April 2021. Since then, we have demonstrated a significant increase in the rate of vision screening for these ages from a low of 6% for 3-year-olds to approximately 85% across all three ages. We have maintained a database of the results from the vision screenings, including patients who were screened and completed a follow-up visit to the Vision Center. We have access to the results from comprehensive eye examination for the patients seen within Akron Children’s Hospital system as well as the results from the vision screenings. The purpose of this proposal is to leverage these data sets to better understand the accuracy of our current vision screening protocol and referral criteria. The impact of any screening program cannot be fully evaluated without follow-up information: We are able to do just that with our extensive tracking of both screening and eye examination outcomes. The analysis of our real-world data will provide a model for effective implementation of instrument-based vision screening for other Children’s Hospital Systems, impacting earlier detection of vision problems in childhood.
