Visual Acuity Screening in a Pediatric Primary Care Clinic

Abstract

Problem: Accurate and timely vision screening for visual acuity is imperative for cognitive and social development. Visual acuity screening can be assessed in the pediatric primary care office using chart-based screening, and evidence supports such screening. Children who fail vision screening should be referred to a pediatric eye specialist. Purpose: The purpose of this quality improvement (QI) project is to implement and evaluate systematic vision screening for patients seen for an initial medical exam upon entering foster care. Methods: A QI project was designed to implement vision screening in a pediatric primary care clinic for new patients between the ages of 3-18 years old who attend their initial medical exam upon entering foster care. Screening was performed using SNELLEN letter or LEA symbol charts. The project’s goals were to achieve 100% education of staff on vision screening procedures, 100% compliance with vision screening tool, and referral of all patients with a failed vision screening. Results: Vision screening was successfully implemented with high rates of screening completion and referrals. At completion of the Q/I project, 90.4% (75/83) of eligible patients were screened. Thirty-nine patients had failed vision screenings and 92.3% (36/39) were referred to an eye specialist. Conclusions: An overwhelming majority of patients were screened for visual acuity; nearly all children with a failed screening result were referred to an eye care specialist. This QI project was successful in implementing a visual acuity screening process and referral for vision concerns in an outpatient pediatric primary care setting. The visual acuity screening could easily be replicated in other pediatric practices.