Utilization and barriers to eye care following school-wide pediatric vision screening

Area of Science:

• Public Health
• Ophthalmology
• Pediatrics

Background:

• Ontario's Child Visual Health and Vision Screening Protocol (August 2018) mandates school-based vision screening for senior kindergarten children (aged 4-6 years).
• Understanding the prevalence of children at risk and their subsequent resource utilization is crucial for program evaluation.
• This study assesses the effectiveness of the protocol in a specific Ontario community.

Purpose of the Study:

• To determine the prevalence of children identified as at-risk for vision issues through school-based screening.
• To evaluate resource utilization, including optometry visits and prescription of glasses, following screening.
• To identify barriers to accessing eye care services for children in the community.

Main Methods:

• Vision screening data (HOTV, Randot, Autorefractor) were collected from 41 schools (1127 children) over two academic years (2018-2019, 2019-2020).
• A phone follow-up was conducted 1-1.5 years post-screening to ascertain optometry visits, glasses prescriptions, and barriers.
• Statistical analyses included independent t tests and chi-squared testing to assess relationships between deprivation and outcomes.

Main Results:

• The screening protocol resulted in a 32.2% referral rate in the studied region.
• Among referred children who responded, 69.9% sought eye care, with 34.4% being prescribed glasses.
• Children residing in materially and socially deprived areas showed a significantly higher referral rate (p<0.01).
• Key barriers to care included insufficient insurance, COVID-19 disruptions, and scheduling issues.

Conclusions:

• The vision screening protocol successfully identified over one-third of children requiring follow-up examinations.
• Children in deprived neighborhoods were disproportionately referred, highlighting potential health inequities.
• Approximately two-thirds of referred children accessed eye care, and one-third received glasses, indicating program impact but also room for improvement in access and follow-through.