Abstract
Objective
In August 2018, Ontario introduced the Child Visual Health and Vision Screening Protocol
outlining school-based senior kindergarten (aged 4–6 years) vision screening. We determine
the prevalence of children at risk based on screening in an Ontario community and
follow up to determine resource utilization after screening.
Methods
Vision screening data (HOTV, Randot, Autorefractor) from 41 schools (1127 children)
were collected for the 2018–2019 and 2019–2020 school years. Phone follow-up was conducted
1–1.5 years after screening to determine whether an optometry visit occurred, if glasses
were prescribed, and potential barriers to accessing eye care. Independent t tests were used to compare time to follow-up between groups, and χ2 testing was used for associations between material and social deprivation.
Results
Overall screening resulted in a 32.2% referral rate within our region. Of the referred
children who responded, the rate of seeking out eye care was 69.9% (n = 64), and 65.2%
of these visits were prompted specifically by vision screening, and 34.4% of referred
children respondents were prescribed glasses. There was a significant relationship
between receiving a referral and living in a more materially deprived (p = 0.001) and a more socially deprived area (p = 0.006). The most frequently reported barriers were related to insufficient insurance
coverage for eye care or glasses, COVID-19-related difficulties, and scheduling conflicts.
Conclusion
Our vision screening program identified and referred more than one third of children
screened for follow-up eye examinations, with children in more deprived neighbourhoods
being more frequently referred. Around two thirds of referred children sought care,
and one third were prescribed glasses in the follow-up sample.
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References
- Psychosocial impact of amblyopia and its treatment: a multidisciplinary study.Clin Exp Ophthalmol. 2006; 34: 743-750
- Amblyopia and quality of life: a systematic review.Eye (Lond). 2011; 25: 403-413
- Effect of amblyopia on self-esteem in children.Optom Vis Sci. 2008; 85: 1074-1081
- The psychosocial effects of amblyopia study.J AAPOS. 1999; 3: 15-17
- Prehension deficits in amblyopia.Invest Ophthal Vis Sci. 2007; 48: 1139-1148
- Impact of visual acuity on developing literacy at age 4–5 years: a cohort-nested cross-sectional study.BMJ Open. 2016; 6e010434
- Whole-population vision screening in children aged 4–5 years to detect amblyopia.Lancet. 2015; 385: 2308-2319
- Prevalence of amblyopia and refractive errors in an unscreened population of children.Optom Vis Sci. 2012; 89: e44-e49
- Myopia prevalence in Canadian school children: a pilot study.Eye (Lond). 2018; 32: 1042
- Amblyopia treatment outcomes after screening before or at age 3 years: follow up from randomised trial.BMJ. 2002; 324: 1549
- Preschool vision screening: rationale, methodology and outcome.Surv Ophthalmol. 1996; 41: 3-30
- A cost-utility analysis of therapy for amblyopia.Ophthalmology. 2002; 109: 2265-2271
- Childhood vision screening in Canada: public health evidence and practice.Can J Public Health. 2012; 103: 40-45
- Preschool vision screening: rationale, methodology and outcome.Surv Ophthalmol. 1996; 41: 3-30
- Canadian Pediatric Society Committee. Vision screening in infants, children and youth.Paediatr Child Health. 2009; 14: 246-248
What OHIP covers. Ontario.ca [2017 Apr 21]. Accessed March 28, 2021. www.ontario.ca/page/what-ohip-covers.
Ontario budget fails to save eye care for patients. Ontario Association of Optometrists [2021 Mar 30]. Accessed October 28, 2021. optom.on.ca/ontario-budget-fails-to-save-eye-care-for-patients/.
Child visual health and vision screening protocol, 2018. Ontario Ministry of Health and Long-Term Care [August 2018]. Accessed March 23, 2021. www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Child_Visual_Health_and_Vision_Screening_Protocol_2018_en.pdf.
Oral health protocol, 2018. Ministry of Health and Long-Term Care [January 1, 2018]. Accessed April 12, 2021. www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Oral_Health_Protocol_2018_en.pdf.
- A deprivation index for health planning in Canada.Chron Dis Canada. 2009; 29: 178-191
- Material and social deprivation index: a summary.Institut National de sante Publique du Quebec, 2022 ([May, 2019]. Accessed January 6)
- Barriers to and suggestions on improving utilization of eye care in high-risk individuals: focus group results.Int Scholar Res Notices. 2014; 2014: 1-8
- The functional impact of amblyopia.Clin Exp Optom. 2018; 101: 443-450
- Interventions to improve school-based eye-care services in low- and middle-income countries: a systematic review.Bulle WHO. 2018; 96: 682
- A Canadian population–based study of vision problems: assessing the significance of socioeconomic status.Can J Ophthalmol. 2010; 45: 477-483
- Environmental factors explain socioeconomic prevalence differences in myopia in 6-year-old children.Br J Ophthalmol. 2018; 102: 243-247
- Evidence for the need for vision screening of school children in Turkey.BMC Ophthalmol. 2017; 17: 1-14
- Centers for Disease Control. Vision screening among children aged 6 years–Medical Expenditure Panel Survey, United States, 2009–2010.Morbid Mortal Weekly Rep. 2014; 63: 43-46
- Eye care utilization in Canada: disparity in the publicly funded health care system.Can J Ophthalmol. 2011; 46: 133-138
- Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers.Clin Exp Optom. 2020; 103: 347-352
- Testability of vision and refraction in preschoolers: the Strabismus, Amblyopia, and Refractive Error Study in Singaporean Children.Am J Ophthalmol. 2009; 148 (e6): 235-241
- Diagnostic reliability and normative values of stereoacuity tests in preschool-aged children.Br J Ophthalmol. 2013; 97: 308-313
- Testability of vision and refraction in preschoolers: the strabismus, amblyopia, and refractive error study in Singaporean children.Am J Ophthalmol. 2009; 148 (e6): 235-241
- Testability of refraction, stereopsis, and other ocular measures in preschool children: the Sydney Paediatric Eye Disease Study.J AAPOS. 2012; 16: 185-192
- Feasibility of a school-based vision screening program to detect undiagnosed visual problems in kindergarten children in Ontario.CMAJ. 2020; 192: E822-E831
- Vision screening in underserved and vulnerable populations in Kenya, Africa.J Health Care Poor Underserved. 2017; 28: 1050-1055
Article Info
Publication History
Published online: May 04, 2022
Accepted:
April 10,
2022
Received in revised form:
February 27,
2022
Received:
November 5,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
