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Children with autism have low rates of vision screening; photoscreening could help

March 21, 2023

Children with autism spectrum disorder (ASD) have a higher risk for vision problems yet are much less likely than typically developing children to have their vision screened at well visits — especially if they are younger or Black.

Instrument-based vision screening devices such as photoscreeners might help reduce disparities and increase these rates, according to a new retrospective cross-sectional study "Disparities in Vision Screening in Primary Care for Young Children with Autism Spectrum Disorder" (Hoover K, et al. Pediatrics. March 21, 2023).

Photoscreening is an alternative to visual acuity screening in children with ASD. It has high sensitivity in detecting ocular conditions in these children, and the average screening time is 90 seconds.

Researchers analyzed rates of vision screening in patients with and without ASD, the rate of photoscreening compared with visual acuity screening, and the effects of demographic characteristics on screening.

Data were collected from 63,829 well visits of 3- to 5-year-olds in a large primary care network between 2016 and 2019, tapping medical record data from 40 practices in Delaware, Pennsylvania (Delaware Valley) and Florida. Vision screening was completed in 59% of those visits.

Children were classified as having autism with developmental delay, autism without developmental delay or no autism (control group). Most of the children in the autism groups were male. Researchers excluded patients with a known eye condition or who had been to an ophthalmologist or optometrist before age 3.

Of 1,209 well visits for children with ASD, there were 441 completed vision screenings (207 using visual acuity screens, 234 photoscreens). Because there was no significant difference in screening rate between in the two ASD groups, the subgroups were combined for the analysis.

Overall, children with ASD were significantly less likely than those without that condition to have a vision screening (36.5% vs. 59.9%). The lowest rates were noted at the 3-year-old visit. Black children with ASD had a lower rate (27.6%) than White children (39.7%) and other/multiracial children (39.8%).

Use of photoscreening was higher in Hispanic children, which boosted their overall vision screening rate above that of non-Hispanic children. This demonstrates how photoscreening can be a useful tool to improve vision screening rates, the authors noted.

Rates also varied by region, with higher rates of overall vision screening in Florida, where photoscreening was utilized more frequently among children who completed vision screening.

The AAP recommends annual instrument-based vision screening, if available, at well visits from 12 months to 3 years, with direct visual acuity testing beginning at the 4-year-old visit. For children with developmental delays, however, instrument-based screening such as photoscreening can be considered for any age.

The authors added that there must be reimbursement by insurance payers for effective use of photoscreeners in primary care practices.

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