Summary
Goals:
To determine the rate of vision screening among children with and without autism spectrum disorder (ASD), the rate of screening compared to visual acuity testing, and the effect of demographic factors on vision screening. for children with ASD.
Methods:
Wellness visit data for children ages 3 to 5 years between January 2016 and December 2019 were collected through PEDSnet. Eye exam billing codes were an indicator of vision exam completion.
χ2 analysis examined the relationship of age, sex, race, ethnicity, region, and socioeconomic status with vision detection rate and photo detection rate versus acuity detection visual. Multivariate logistic regression assessed factors that affected the odds of having an eye exam.
Results:
63,829 well-child visits were analyzed. Children with ASD were less likely to have an eye exam (36.5%) compared to children without ASD (59.9%). The lowest detection rates occurred during the 3-year visit.
Of those with ASD, Black children had a lower detection rate (27.6%) than White children (39.7%) and other multiracial children (39.8%). Use of photographic screenings was highest in Hispanic children, increasing the overall rate of vision screenings more than non-Hispanic children.
Region of practice influenced vision screening rates for children with ASD due to the greater number of photographic screenings.
Conclusions:
Children with ASD are less likely to receive a vision screening at follow-up visits compared to typically developing children. This disparity was greatest between younger children and black children.
One practice region used more photodetection and had higher detection rates. Photodetection is a useful tool to decrease disparity, especially among high-risk patient groups.
Comments
Disparities exist within this population, with Black children having the lowest screening rate
Young children with autism spectrum disorder (ASD) are much less likely to receive an eye exam than their peers, despite the high risk of serious eye disorders, according to a Nemours Children’s Health study published in Pediatrics .
“I noticed that many of our patients with autism had never had an eye exam, even though it is recommended for all young children,” said the study’s lead author, Brittany Perry, DO, a pediatrician at the Autism Center. Nemours Swank. “So, I wanted to study whether this could be a broader disparity, if children with autism receive vision screenings less frequently than other children.”
The study found that only 36.5% of children with ASD had completed vision screenings at follow-up visits, a substantially lower rate than the 59.5% of children without ASD. Additionally, among children with ASD, the detection rate for Black children (27.6%) was significantly lower than that for White children (39.7%) and children classified as multiracial (39.8%). %).
Early childhood is crucial for vision development, and early detection and treatment of eye problems can prevent long-term vision loss. The research team examined data from 63,829 well visits for children ages 3 to 5 from 2016 to 2019, in a primary care network spanning Delaware, Pennsylvania, and Florida.
The researchers said Florida facilities had much higher rates of vision screenings for children with ASD (45.7%) than those in Delaware and Pennsylvania (28.1%). They noted that 80% of Florida doctor’s offices used the photoscreening vision screening method, compared to only 13% in Delaware and Pennsylvania.
Photodetection, which uses a specialized camera or video system to capture detailed images of a child’s eyes, is particularly useful for children with ASD because they cannot always understand and respond verbally to instructions or questions on acuity tests. conventional visuals.
The American Academy of Pediatrics (AAP) recommends an annual instrument-based vision exam, especially for children with developmental delays. The researchers said reimbursement is necessary for greater use of screening tests in primary care, a concern also noted by the AAP.
“Increasing the use of photo screening can be a great tool to reduce disparities and increase vision screening in the most vulnerable populations with autism,” Perry said.
“The key takeaway from this study for providers is to be aware that these disparities exist for all children with autism, so we can work to provide better care,” he added. “And for parents, it can help you better advocate for your child with autism and request an eye exam at a routine visit, or a referral to an ophthalmologist, if your child is behind.”
Perry’s team is currently studying the effect of the COVID-19 pandemic on pediatric eye screening and plans to examine national data on this topic, in collaboration with other children’s hospitals.
