CAPOS AWARD WINNER - Utilization and barriers to eye care services following school-wide implementation of pediatric vision screening

Authors: Patrick Wang, Sonya Bianchet, Megan Carter, Christine Law.

Author Disclosure Block: P. Wang: None. S. Bianchet: None. M. Carter: None. C. Law: None.

Abstract Body:

Purpose: To examine screening results/trends and identify barriers to accessing optometry care from various schools and communities within our region in the 2018/19 and 2019/20 school years.
Study Design: Retrospective collection of vision screening data and follow-up cross-sectional phone survey.
Methods: Vision screening data (HOTV, Randot, Autorefractor) was collected for the 2018-2019 and 2019-2020 school years; data for 2019-2020 was incomplete due to COVID. Data was linked to demographic data recorded prior by public health. Schools were categorized according to pre-defined dental screening risk. A stratified random sample of children with a “refer” screening result and an equivalent sample of those receiving a “pass” were followed-up by phone call. Phone follow-up was conducted to determine whether an optometry visit occurred, glasses were prescribed, and potential barriers to accessing eye-care. Quantitative data was analyzed using descriptive statistics along with Chi-squared and t-tests for comparison.
Results: Out of the 1127 screened children in the sample, 363 children (32.2%) were identified as “refer” and 764 (67.8%) were identified as “pass” and the average age of children screened was 6.11 years. Overall, the referral rate varied across school risk with 26.2%, 32.8% and 50.8% of low, medium, and high-risk schools, respectively, X² (2, N = 1127) = 29.94, p < .005. A total of 501 families screened (252 refers and 249 passes) were followed-up by phone call, of which 158 responded (93 refers and 65 passes). Of the referred children, 69.9% (n=65/93) sought follow-up with an eye-care specialist and of these, 33.8% were prescribed glasses (n=22/65). Of children referred and who sought follow-up care (n=65), 43.1%, 46.1, and 10.8%, were from low, medium, and high-risk schools, respectively. The most frequently reported barriers were related to insufficient insurance coverage for eye-care/glasses (n=12), COVID-19 related (n=14), and scheduling conflicts (n=9).
Conclusions: Overall screening resulted in a 32.2% referral rate within our region. Follow-up phone calls revealed a high proportion of children sought out follow-up care after being referred. Despite universal, province-wide, yearly pediatric eye exam coverage, children at high-risk schools are more frequently referred and less often seek care once informed. While implementation of a school-wide vision screening program is a step in the right direction, considerations into implementing follow-up for refers from higher risk schools and underserved communities may be warranted.