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Amblyopia Care Trends Following Widespread Photoscreener Adoption
Cheryl D Stults1, Su-Ying Liang1, Joseph Wilcox2
1Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, California.
Insights
Increased photoscreening significantly boosted vision screening rates for 3-year-olds, but disparities in amblyopia (lazy eye) detection and diagnosis persist among racial and ethnic groups, necessitating targeted interventions.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Amblyopia, or lazy eye, can lead to permanent vision loss if untreated before age 7.
- The US Preventive Services Task Force recommends vision screening for children aged 3-5 years to detect amblyopia.
Purpose of the Study:
- To evaluate trends in amblyopia (lazy eye) screening, referral, and diagnosis before and after the expansion of photoscreening in a large healthcare system.
- To identify factors associated with these outcomes, including patient demographics.
Main Methods:
- Retrospective cohort study using electronic health records from a multispecialty group practice (2015-2022).
- Analysis included over 57,000 children aged 3 years, comparing pre- and post-photoscreening expansion periods.
- Statistical analysis used adjusted odds ratios (AORs) to compare outcomes based on patient characteristics.
Main Results:
- Vision screening rates for 3-year-olds increased from 5.7% to 72.1% after photoscreening expansion.
- Referral rates increased, and diagnosis rates initially peaked then decreased.
- Asian, Black, and Hispanic children were less likely to be screened compared to White children.
- Asian and Hispanic children were more likely to be referred and diagnosed with amblyopia.
Conclusions:
- Photoscreener availability significantly increased vision screening rates for young children.
- Despite increased screening, disparities in amblyopia care persist, particularly for minority populations.
- Targeted interventions are crucial to address remaining inequities in amblyopia screening, referral, and diagnosis.
Importance:
Amblyopia can result in permanent vision loss if not properly treated before age 7 years. In 2017, the US Preventive Services Task Force recommended that vision screening should occur at least once in all children aged 3 to 5 years to detect amblyopia.
Objective:
To understand trends and factors associated with screening, referral, or diagnosis of amblyopia before and after photoscreening expansion across a relatively large health care system in late 2017.
Design, Setting, And Participants:
This is a retrospective cohort study of electronic health record data from patients with a well child care visit at approximately age 3 years (ages 2.75-3.25 years) in a relatively large, multispecialty group practice in Northern California and linked census data between 2015 and 2022. Data were extracted and analyzed from October 2022 through August 2023.
Exposures:
Patient sex, race and ethnicity, immunization records, previous well child care visits, and census-level median household income.
Main Outcomes And Measures:
Vision screening, pediatric ophthalmology referral, or amblyopia diagnosis, compared using adjusted odds ratios (AORs).
Results:
The study included 2015-2017 data from 23 246 patients aged 3 years with at least 1 well child care visit (11 206 [48.2%] female) compared with 2018-2022 postexpansion data from 34 281 patients (16 517 [48.2%] female). The screening rate increased from 5.7% (424 of 7505) in 2015 to 72.1% (4578 of 6354) in 2022. The referral rate increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018. The diagnosis rate was 2.7% (200 of 7505) in 2015, peaked at 3.4% (263 of 7792) in 2018, and decreased to 1.4% (88 of 6354) in 2022. Compared with White patients, patients who were Asian, Black, or Hispanic were less likely to be screened (Asian: AOR, 0.80; 95% CI, 0.72-0.88; Black: AOR, 0.71; 95% CI, 0.53-0.96; Hispanic: AOR, 0.88; 95% CI, 0.80-0.97). Compared with White patients, patients who were Asian or Hispanic were more likely to be referred (Asian: AOR, 1.49; 95% CI, 1.36-1.62; Hispanic: AOR, 1.32; 95% CI, 1.18-1.48) and were more likely to be diagnosed (Asian: AOR, 1.29; 95% CI, 1.07-1.56; Hispanic: AOR, 1.67; 95% CI, 1.33-2.11).
Conclusions And Relevance:
In this study, increased availability of photoscreeners was associated with an increase in overall rates of vision screening for children aged 3 years in a relatively large health care system. Given that US rates of visual impairment are predicted to increase, additional targeted interventions would be needed to address remaining disparities in amblyopia care along patient- and clinician-level factors.
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