P2.O283: Improving successful vision screening rates at well visits for 3–5-year-old children in a pediatric primary care setting

Purpose/Objectives: The American Academy of Pediatrics recommends vision screening beginning at 3 years of age in a cooperative patient. The purpose of our intervention was to improve the rate of vision screening for children 3-5 years of age with the implementation of an instrument-based screener to 90% in 1 year.

Design/Methods: We obtained baseline data for the months of May, June, and July 2022 to determine our successful screening rates using only the LEA symbols eye charts. We later obtained a Spot Vision screener through a hospital grant for our primary care practice. We worked with IT to modify our EMR to add Spot Screener as a method of screening with options to select whether the result was in range or out of range. The nursing staff received an in-service on how to use the device. Standing orders were already in place to do vision screening for the appropriate well visits as per the AAP periodicity schedule. First attempts to screen were done with a conventional LEA symbols eye chart. The patients that could not participate with eye chart screening were then screened with the Spot Vision screener. The printout was given to the physician for review.

Results: Our baseline screening rates using eye charts only for the months of May, June and July 2022 was 46, 49, and 46% respectively. The percent of abnormal screens for that same period was 8, 29, and 14%.

The screening rates using eye charts for the months of May, June and July 2023 were substantially lower. They were 18, 25, and 25% respectively. The percent of abnormal screens was 10, 8, 8% for those same months.

The screening rates for the Spot Vision screener were 100, 95, 89% for May, June and July 2023 respectively. When combining completed screening for eye charts with Spot Vision screening, the screening rates rose to 100, 96, 91% for the months of May, June, and July 2023. The percent of abnormal screens for combined eye charts and screener was 26, 23, and 19% for May, June, July 2023.

Conclusion/Discussion: It is our conclusion that instrument-based screening should be implemented in primary care practices that care for young children to improve the screening rates for potential vision problems. Six risks factors that could lead to amblyopia, a leading cause of blindness were screened for with this device: myopia, hyperopia, astigmatism, anisometropia, strabismus, and anisocoria. It should be noted that we still had a few patients that could not be screened. It is important to have a system for referring patients with abnormal screens for further evaluation and early intervention.