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  • Pediatric Ophth/Strabismus

    Review of: Amblyopia care trends following widespread photoscreener adoption

    Stults C, Liang S-Y, Wilcox J, et al. JAMA Ophthalmology, in press 2024

    Disparities in rates of regular vision screening in young children continues to be an ongoing concern in the United States. Newer photoscreener devices provide automated estimates of refractive error in a user-friendly format, and their widespread use could help reduce screening disparities.

    Study Design

    Investigators conducted a retrospective cohort review of 7 years of electronic health record data from more than 57,000 ~3-year-old patients who had well child visits at a multispecialty group practice in Northern California. Their primary goal was to identify the trends and factors associated with screening, referral patterns to pediatric ophthalmologists, and diagnosis of amblyopia before and after the practice began using a vision photoscreener.


    The vision screening rates ranged from 5.7%–18.7% in the “pre-implementation” period (2015–2017) and 61.6%–72.1% in the “post-implementation” period (2018–2022), a significant increase. At the same time, the authors report an increase and then a decrease in the referral rates to pediatric ophthalmologists in the group practice, from 17.0% in 2015 to 23.6% in 2018 and 15.7% in 2022. Similar patterns were noted for amblyopia diagnoses. Multivariate regressions found that in the post-implementation period, Asian, Black, or Hispanic patients were less likely to be screened than White or Asian patients. However, Asian and Hispanic patients were more likely to be referred to a pediatric ophthalmologist, and in turn were more likely to be diagnosed with amblyopia.


    Limitations of the study include its retrospective nature and the fact that the findings have limited generalizability regarding race and diagnosis of amblyopia from vision screenings over the 8-year time period. In addition, the COVID-19 pandemic occurred during the last 3 years of the study, and in the beginning of the pandemic, all non-emergent care, such as vision screening prevention, was delayed. This likely impacted patient care evaluation and referral rates.

    Clinical Significance

    For all pediatric ophthalmologists evaluating young children who have had a failed vision screening or who have never had a vision screening test, mindfulness regarding disparities among our patient populations is important. A child’s access to vision screening may be associated not only with age of presentation, but also with general health care access. As clinicians, we can partner and work with our pediatrician colleagues to ensure that factors such as gender, ethnicity, and neighborhood setting are not barriers for referrals and amblyopia evaluations and diagnoses.

    Financial Disclosures: Dr. Jennifer Galvin discloses no financial relationships.