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Exploring Pre-school Vision Screening in Primary Care Offices in Alabama

Marsh-Tootle, Wendy L.; Frazier, Marcela G.; Kohler, Connie L.; Dillard, Carey M.; Davis, Kathryn; Schoenberger, Yu-Mei; Wall, Terry C.

doi: 10.1097/OPX.0b013e318269ca9f
Original Articles

Purpose. To investigate practices, barriers, and facilitators of universal pre-school vision screening (PVS) at pediatric primary care offices.

Methods. Focus group sessions (FGS) were moderated on-site at nine pediatric practices. A semi-structured topic guide was used to standardize and facilitate FGS. Discussions were audiotaped, and transcriptions were used to develop themes. All authors reviewed and agreed on the resultant themes.

Results. FGS included 13 physicians and 32 nurses/certified medical assistants (CMAs), of whom 82% personally conducted some facet of PVS. In all practices, nurses/CMAs tested visual acuity (most using a non-recommended test), and physicians completed vision screening with external observation, fix/follow, red reflex, and cover test. Facilitators included (1) accepting that PVS is a routine part of the well-child visit, and (2) using an electronic medical record with prompts to record acuity (eight of nine practices). Barriers were related to difficulty testing pre-schoolers, distractions in the office setting, time constraints, and limited reimbursement.

Conclusions. Responsibility for PVS is shared by physicians and nurses/CMAs; thus, interventions to improve PVS should target both. Few practices are aware of new evidence-based PVS tests; thus, active translational efforts are needed to change current primary care practices.








School of Optometry (WLM-T, MGF, CMD), School of Medicine (CLK, Y-MS, TCW), Department of Health Behavior (CLK), Division of Preventive Medicine, (Y-MS), and Department of Pediatrics (TCW), University of Alabama at Birmingham, Birmingham, Alabama; and Northwestern University Health Literacy and Learning Program (KD), Northwestern University, Chicago, Illinois.

Received October 20, 2011; accepted June 13, 2012.

Wendy Marsh-Tootle University of Alabama at Birmingham School of Optometry 1716 University Boulevard Birmingham, AL 35294 e-mail:

© 2012 American Academy of Optometry