Study probes barriers to preschool eye exams

"We know that vision problems, including refractive error, strabismus, and amblyopia, are prevalent among preschool and school age children and that many vision disorders can be detected and treated early in life to hopefully prevent problems in school and with social and physical health," said Dr. Taub, assistant professor, SCO, Memphis, TN. "However, available data indicate that no more than one-fourth of preschool children receive any type of vision screening.

"Our findings confirm that only a small minority of preschool children receive an eye-care examination by an eye-care practitioner (ECP) and further indicate that parents and their views regarding pediatrician vision screenings represent two of the biggest barriers to helping identify vision disorders through comprehensive eye examinations. A solution to this problem will depend on better legislation that mandates vision examination and treatment," he noted. Dr. Taub became involved in these studies during his years as a community outreach director at SCO.

Breaking down the studies

The first study was based on data collected between August 2007, and March 2008, when personnel from the SCO screened 5,660 children aged 3 to 15 years at 38 private and public schools. The examination, which also served as training for SCO students, included distance and near cover tests, distance and near visual acuity (VA), stereoacuity, retinoscopy, and indirect ophthalmoscopy.

To gather epidemiological information on eye examinations, two questions were included in the consent form that had to be completed by a parent or guardian prior to the SCO exam:

"After adjusting the data for the 'no' responses to the first question, our study showed that only 1% of children were examined by age 1, and only about 14% by age 5. This latter number corresponds very well with previous information reported on the prevalence of eye care examination in preschool children," said Dr. Taub.

A second try

The second study was based on data collected in a second screening period in the fall of 2008, after a law was passed in Tennessee requiring vision screenings in kindergarten, 2nd, 4th, 6th, and 8th grade, and once during high school. In this screening effort, 3,931 children aged 4 to 12 years were examined at 18 schools, and the informed consent asked again about whether the child had an eye exam by an ECP. This time, however, the second question targeted parents/guardians answering "no" and asked them to identify the reason from these options: no insurance, passed pediatrician screening, passed school screening, child has no problem, financially unable, other.

Responses to the first question were obtained on only 2,903 (74%) of the questionnaires and showed that 1,426 (36%) of the 3,931 children had never been examined by an ECP. Considering 1,350 responses given for the second question (91.4%), passing the pediatrician's screening (36%), the child has no problem (29%), and passing the school screening (15%) were the leading reasons given for not having an exam by an ECP. These same three responses also predominated in a smaller subgroup of questionnaires where more than 1 reason was checked.

High CVS failure rate

As a disturbing finding, about 20% of children who never had a previous eye exam by an ECP failed the comprehensive vision screening (CVS) performed by the SCO personnel. This failure rate was consistent whether the child passed the pediatrician screening, the school screening, or had no problem.

Further analysis of the data from the subgroup of 96 children who failed the SCO exam and whose parent/guardian indicated the lack of an eye examination by an ECP was because the child had no problem showed 40 children failed the distance VA portion exam, 24 failed near VA testing, and 11 failed the near cover test. Considering the children whose parents indicated they did not have an exam by an ECP because the child passed the vision screening, failing the near VA portion was the most common cause of failure.

"This coincides with the fact that most vision screenings do not assess near demands, perhaps reflecting an erroneous premise that children who are able to see the board do not have a vision problem," he concluded.