Preschool Vision Screening by Parental Risk Factor Questionnaire

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Vision disorders such as significant refractive errors, amblyopia, and strabismus impact the developing visual system of 2 to 5% of preschool children. The long-term sequelae of these conditions that degrade visual acuity (VA) and/or binocular vision can be minimized by early detection and treatment. While early detection through a comprehensive eye examination of every infant is the ideal, the vast majority of infants and young children are without significant vision problems. Directing the limited health care resources towards those with problems or who are at risk for developing future vision problems through vision screening is a more reasoned and attainable approach. Currently, the primary responsibility for screening preschoolers for vision anomalies falls to pediatricians and family practitioners who rely on the direct measurement of one or more aspects of vision. Screening guidelines suggest inspection of eye health and red reflex at birth and 6 months to 1 year of age with VA and alignment added to the screening at age 3 to 3.5 years. Despite its common use, the efficacy of the red reflex test in screening has not been evaluated and concern over high false positive rates when used by non-ophthalmologist or in infants < 8 months suggest significant limitations. The lack of evidence to support routine vision screening in children less than 3 is reflected in the 2011 recommendations of the US Preventive Services Task Force (USPSTF) that excludes children less than 3 previously included in the 2004 recommendations. The long-term objective of this research is to provide sufficient evidence to restructure the current vision screening recommendations for children less than 3 years. The first step towards this goal and the aim of this application is to develop and validate a risk factors screening questionnaire that can be easily completed by a parent. The questionnaire will triage children into one of 3 categories that will direct the parent to: 1) schedule an eye examination as soon as possible, 2) schedule additional screening by trained personnel using existing/evolving technologies or 3) defer examination at age 3 to 5 years. A parent completed questionnaire will ease the time burden vision screening currently places on pediatricians and family practitioners and will reduce one of the often cited barriers to implementing vision screening by busy physicians. This targeted and tiered approach to vision screening will improve the efficiency and accuracy of our current, often cursory and fragmented, screening efforts. Early identification of those in need of additional assessment and/or care, through a low or no cost, widely accessible, valid and reliable questionnaire, will more effectively utilize the limited manpower and financial resources of the strained health care system.