Adherence to Red Reflex and Vision Screening Recommendations: A Deep Dive into Primary Care Implementation Gaps

Area of Science:

• Pediatric ophthalmology
• Primary care pediatrics
• Public health

Background:

• Early childhood vision screening is crucial for detecting amblyopia and other vision-threatening conditions.
• Despite recommendations, vision screening rates during well-child visits remain low.
• Red reflex assessment is recommended for ocular pathology but its primary care use is not well-described.

Purpose of the Study:

• To examine the rates and drivers of vision screening in pediatric primary care.
• To evaluate the documentation of red reflex and functional vision tests.
• To identify factors associated with screening variations.

Main Methods:

• Retrospective review of electronic health records for children aged 3-5 years.
• Analysis of well-child visits in 2022 across three primary care clinics.
• Multivariable logistic regression to assess associations with patient demographics and clinic site.

Main Results:

• Only 21.1% of visits had documented red reflex assessment; 60.8% had functional vision tests.
• Younger children (3-4 years) had higher odds of red reflex assessment but lower odds of functional vision tests.
• Screening rates varied by clinic site and were influenced by age, sex, and race/ethnicity.

Conclusions:

• Visual function and red reflex assessments are inconsistently performed in pediatric primary care.
• Low rates of red reflex documentation represent missed opportunities for early detection.
• Findings highlight targets for improving adherence to pediatric vision screening recommendations.