The following findings are from Periodic Survey #22 which explored the vision screening practices of pediatricians. PS#22 was an eight-page self-administered questionnaire sent to a random sample of 1600 active US FAAPs. A total of five mailings were conducted from June through September 1993 for a response of 1137 surveys or 71.1%.

These questions were initiated by the Pediatric Research in Office Settings (PROS) Network as a follow-up to questions on the vision screening practices of pediatricians originally fielded on Periodic Survey #3 in spring 1988. The findings from that survey were used as comparison data for the PROS Network study on vision screening of young children. These findings compare data from PS#3 (1988) and PS#22 (1993) to determine any changes in the reported vision screening practices of pediatricians.

Pediatricians Reporting Vision Screening Procedures:

In 1993, approximately the same proportion of pediatricians reported routinely performing vision screening tests during health supervision visits as reported in 1988:

• Ninety-one percent of pediatricians reported routinely performing visual acuity tests during health supervision visits in both 1993 and 1988.

• Fifty-eight and 54% of pediatricians reported routinely performing tests for binocularity during routine health supervision visits in 1993 and 1988, respectively.

Overall, there was little change from 1988 to 1993 in the percentage of pediatricians who reported routinely performing specific eye examination procedures (red reflex test, Hirschberg test, funduscopic, and cover/uncover test); however, significantly more pediatricians reported performing the red reflex test in 1993 than in 1988.

• In 1993, 98% of pediatricians routinely performed the red reflex test; in 1988, 94% reported they performed this test (p<.01).

• 79% performed the Hirschberg test in both 1993 and 1988.

• 80% in 1993 compared to 77% in 1988 performed the funduscopic test.

• 71% in 1993 compared to 69% in 1988 performed the cover-uncover test.

Vision Screening by Patient Age:

In 1993 as in 1988, the majority of pediatricians routinely test for visual acuity among patients 4 to 6 years of age. Only one-third of pediatricians reported testing patients for visual acuity at 3 years of age and very few (6%, 5% in 1993 and 1988, respectively) tested patients at 2 years of age.

In both survey years, the most commonly used method of testing visual acuity is the wall chart, followed by the illiterate E.

In 1993 as in 1988, most pediatricians routinely test binocularity of patients 4 and 5 years of age. About one-half of pediatricians test for binocularity at age 6 (46% in 1993, 53% in 1988). Only about one-fourth test for binocularity at 3 years of age (26% in both years) and about 10% said they test for binocularity among 2 year olds.

In 1993, the preferred method of testing binocularity is a screening machine (50% in 1993 v. 23% in 1988, p<.01), whereas in 1988 the preferred method was the titmus stereo fly (33% in 1993 v. 65% in 1988, p<.01).

Although, among patients in general, the proportion of pediatricians who reported performing specific eye examination procedures (red reflex, Hirschberg test, funduscopic, cover-uncover) has not changed since 1988, when specific procedures are examined by patient age, in 1993 significantly more pediatricians report routinely performing the red reflex and the Hirschberg tests on patients in each age group than so reported in 1988. Significantly more pediatricians report performing the funduschopic test among 5 and 6 year old patients in 1993 than in 1988, while more pediatricians in 1993 report performing the cover-uncover test on very young patients than did pediatricians in 1988.

Source of Vision Screening Information:

In 1993, about one-half of pediatricians (49%) said they have read an article or participated in a continuing education program on vision screening within the past two years. Among those who so reported, nearly two-thirds (64%) said they read the vision screening articles published in Pediatrics in Review in January 1992; 39% said they read the vision screening articles in the May 1992 issue of Pediatrics and another 16% said they read other vision screening articles in Pediatrics. Twenty percent said they participated in an AAP or other CME program on vision screening.