Related Experiment Video
Updated: Jun 23, 2026
Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
Published on: March 24, 2020
Overcoming barriers to pediatric visual acuity screening through education plus provision of materials
Michelle M Clausen1, M Diane Armitage, Robert W Arnold
1Pediatric Ophthalmology and Strabismus Ophthalmic Associates, Anchorage, Alaska 99501-2242, USA.
Purpose:
The American Academy of Pediatrics (AAP) recommends that LEA and HOTV optotypes be used for vision screening and that adhesive tape be used to occlude one eye during testing. We have developed an educational program designed to improve the quality and efficiency of vision screening. The purpose of this study was to ascertain the effectiveness of this program.
Methods:
All 672 pediatric doctors and nurses in the state of Alaska were surveyed by mail to assess their screening protocol and the number of patients cared for annually. Respondents received educational material, including an instructional video, eye patches for visual acuity testing, and a critical line HOTV test box. Subjects were resurveyed 3 months later to determine whether the instructional intervention altered their established protocol.
Results:
Of the 672 practitioners contacted for the survey, 239 (35.6%) responded, representing 31,000 patients, or 62% of all preschool children in Alaska. Use of recommended optotypes was rare (Lea, 3%, HOTV, 7%) compared with the use of nonrecommended optotypes (including use of the E test by 40% of respondents). The postintervention survey was answered by 107 (16%) practitioners. Of these, 24 (23%) reported that they had begun using an adhesive patch for visual acuity testing, whereas 19 (18%) had begun using AAP-recommended testing optotypes.
Conclusions:
In-office video education and provided adhesive eye patches increased the use of patches in primary care preschool vision screening. Mail delivery was less effective than anticipated.
