PURPOSE: To evaluate vision screening practices during well-child visits for 3- to 5-year-old children at two large academic health systems and identify potential care gaps in primary care vision screenings.
METHODS: This study was performed through a retrospective cross-sectional chart review of primary care clinics at two major academic health systems. Outcome measures included vision screening attempt and success rates, testing modalities, referral outcomes, and completion of various screening requirements. Results were stratified by physician specialty and patient age.
RESULTS: Among 800 well-child visits at Health System 1 (HS1) (mean age, 3.9 ± 0.8 years), screening attempt rates ranged from 4% to 90% across clinics, with an overall average of 49.5%. In the highest-performing clinic at HS1, photoscreeners were used as the primary screening method. Of 390 well-child visits at Health System 2 (HS2) (mean age, 4.0 ± 0.8 years), attempt rates ranged from 64% to 98%, with a total average of 91%. At both institutions, vision screening was attempted more frequently in pediatric clinics than in family medicine clinics (P < 0.01). Among 218 vision screening exams analyzed at HS2, none documented all screening requirements, with cover testing documented in only 38% of visits and red reflex recorded in less than 1%.
CONCLUSIONS: Vision screening deficits were noted at both health systems, whether in attempt rate or adherence to guideline components. Variability across sites and incomplete documentation of examination requirements highlight the need for revised guidelines, electronic medical record optimization, and support of semiautomated tools such as photoscreeners.