1. In a large survey-based database, the percentage of children receiving vision screening decreased significantly from 69.6% to 60.1% between 2016 and 2020.
2. The prevalence of reported unmet needs for vision care increased significantly between 2019 and 2020.
Evidence Rating Level: 2 (Good)
Study Rundown: Vision screening is a vital part of pediatric care both because of the impact of visual function on day-to-day life and the high potential for intervention for many causes of decreased vision, such as refractive error and amblyopia. This study aimed to use the National Survey of Children’s Health (NSCH) to assess trends in childhood vision screening and vision care. Based on about 175,000 survey responses, the prevalence of vision screening decreased significantly, from 69.6% in 2016 to 60.1% in 2020. The percentage of screenings performed by a vision specialist also decreased significantly, from 55.6% to 50.4%. There was no statistically significant change in rates of reported blindness or trouble seeing while wearing glasses. Between 2019 and 2020, reported unmet needs for vision care increased significantly from 0.5% to 1.1%, indicating a likely impact of the COVID-19 pandemic. Trends within age, geographic, racial, and other subpopulations were not reported, and further information about referral patterns and other details of clinical practice could illuminate drivers of the decrease in screenings. Nonetheless, this recent, distinct, and significant decrease in vision screenings is alarming and necessitates interventions focused on increasing specialist and non-specialist screening alike.
Relevant Reading: A review of paediatric vision screening protocols and guidelines
In-Depth [cross-sectional study]: Data were drawn from annual cross-sectional NSCH surveys, which included children from birth to age 17, between 2016 and 2020 and were used to calculate 5-year trends. Vision screening was defined as testing with pictures, shapes, or letters in the previous year. Vision screening by specialists included ophthalmologist and optometrist screenings, while non-specialists included pediatricians and school nurses. Logistic regression models were used to analyze trends by year while controlling for age group (ages 0-5, 6-11, and 12-17), sex, race, ethnicity, and socioeconomic bracket based on percentage of federal poverty level. The 95% confidence interval (CI) for the 2016 screening rate was 68.6-70.5% and for 2020 was 69.1-61.1% (p<0.001). Between 2016 and 2019, before the onset of the COVID-19 pandemic, the absolute rate of vision screening decreased by 5.6% (p<0.001); between 2019 and 2020, the rate decreased a further 4% (p<0.001).
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