Barriers to Vision Screening
Although guidelines for vision screening are widely available, actual screening rates remain relatively low. The rate of PVS in children under age 4 has not significantly increased over the last 18 years. The Department of Health and Human Services found that 60% of children on Medicaid did not receive any vision screenings in nine selected states. An analysis of PVS at well child checks in Alabama found that only 12% of 3-year olds were screened. Screening rates in this analysis were not higher than 50% for any age. Other studies report similar low screening rates among children in the 3–5-year-old range. Of 3-year olds, rates of screening are often reported around 40%. A small percentage of pediatric primary care providers report not to perform vision screening at all.
Primary care providers perceive several barriers to performing vision screening, including inadequate training, inadequate reimbursement, problems with child cooperation, and time constraints. Even when appropriate screening is performed, a high percentage of children are not being referred for a complete eye examination. One study found a referral rate of less than 50%. Often, primary care physicians will not initiate a referral for a failed screening if there are no other abnormalities, because of lack of confidence in the reliability of the test. If a child is found to be untestable secondary to lack of cooperation or inability to perform the test, there are no evidence-based guidelines for timing of rescreening. Also, rescreening is frequently not reimbursable. Therefore, children who are untestable frequently are not referred until a future screening is performed at a later well child exam, leading to delay in the diagnosis and treatment of amblyopia.