Results of a primary care–based quality improvement project to optimize chart-based vision screening for preschool age children

Implementation of Instrument-Based Vision Screening for Preschool-Age Children in Primary Care

“…1 -4 Based on our experience with this project, the improvement seen with instrument screening relates to the success of this technique in addressing the major barriers to chart-based vision screening, primarily: limitations of preschool-aged children's ability to focus and complete the testing; limitations of adequate distractionfree space to complete chart-based screening; and the need for staff training and expertise with chartbased screening techniques. 12 Additionally, staff reported that the time to complete instrumentbased screening in young children (typically <1 minute) was substantially shorter than that for chart-based screening (typically several minutes), an important consideration for busy primary care practices.…”

“…The Pediatric Physicians' Organization at Children's (PPOC) is an independent practice association of >80 privately-owned pediatric practices affiliated with Boston Children's Hospital that provides primary care to an estimated 400 000 children throughout eastern Massachusetts. We invited applications from all 56 practices that had participated in our previous QI project to optimize chartbased vision screening 12 to apply to participate in the project. We received applications from 22 eligible practices and randomly selected 12 practices to participate by using random number generation.…”

“…7 -11 Our previous work found that even an extensive training program for primary care practices led to only small increases in successful screening rates among 4-and 5-year-old children and no improvement among 3-year-old children. 12 With the current status quo, the rate of amblyopia in the United States has been stable at 2% to 3%, well above what it could be if efficient and effective primary care-based screening and referral techniques were in place. 13 Given the limitations of chartbased vision screening, several professional groups have recently recommended replacing its use in young children with instrumentbased screening using portable photoscreeners or autorefractors.…”

Effect of Instrument-Based Vision Screening for 3- to 5-Year-Old Children on Referrals to Eye Care Specialists

“…Practices had to have previously participated in a QI project to optimize chart-based vision screening for preschool-age children in order to be eligible for the intervention. 13…”

Primary Care Implementation of Instrument-Based Vision Screening for Young Children

“…However, the difficulties of accomplishing such screening in preschool-aged children has been made apparent in multiple studies. 6-11 A potential solution to this problem has come in the form of portable photoscreener and/or autorefractor devices designed to detect vision problems quickly and with minimal patient cooperation. The current generation of these devices demonstrates high sensitivity and specificity relative to a gold standard comprehensive eye exam.…”