The effect of inconsistent guidelines on variability in pediatric vision screening referral outcomes.

Yearly vision screenings, often performed in a primary care setting, are an important part of child health for detection of ocular disorders, but there are discrepancies in referral guidelines. Whereas guidelines provide consistent failure and referral criteria for 3- and 4-year-olds, criteria for older children disagree. To investigate the effect of having discordant guidelines, we retrospectively applied each guideline threshold to a cohort of 5- to 6-year-olds who underwent visual acuity screening during a well-child encounter and compared the results to the real-life referral rates. We found a 2.7-fold difference in the proportion of 5- to 6-year-olds children failing a vision screening and a difference in referral rate of 18%. Our results demonstrate that the existence of even mildly conflicting pediatric vision screening guidelines can lead to uncertainty among primary care providers who perform vision screening in children. We hope that this study will shed light on the problem and stimulate efforts to harmonize referral criteria.