Results of a primary care-based quality improvement project to optimize chart-based vision screening for preschool age children.

PURPOSE: To design chart-based vision screening for preschool-aged children. METHODS: Our program consisted of educational sessions for providers as well as hands-on training for practice staff. We evaluated the intervention through pre- and post-intervention review of medical records. RESULTS: Completion of full vision screening (distance visual acuity in each eye plus stereovision beginning at 3 years of age, as recommended at the time of the project) at well-child visits improved for 5-year-olds (45.0% to 58.2%; risk difference +13.2% [95% CI, 1.7-24.7]) and 4-year-olds (39.3% to 51.4%; risk difference +12.0% [95% CI, 0.7-23.4]) but declined somewhat among 3-year-olds (23.1% to 14.3%; risk difference, -8.8% [95% CI, -17.7 to 0.0]). Risk factors for not being fully screened included being 3 years old (risk ratio of 4.1 compared to 5-year-olds) and being a patient of a small practice (risk ratio of 1.9 compared to large practices). CONCLUSIONS: This quality improvement project showed that screening for visual acuity and stereovision among preschool-aged children using chart-based techniques is difficult to accomplish and unlikely to be consistently successful, especially among 3-year-olds.

Tortuosity of arterioles and venules in quantifying plus disease.

BACKGROUND: Plus disease is the major criterion for laser treatment of retinopathy of prematurity. ROPtool is a computer program that traces retinal blood vessels and measures their tortuosity. Our objectives were to determine (1) whether examiners could accurately discriminate between arterioles and venules and (2) whether tortuosity sufficient for plus disease and pre-plus disease was assessed most accurately by considering arterioles, venules, or both. METHODS: One hundred retinal vessels were identified in 25 images randomly selected from 184 total images. Three pediatric ophthalmologists independently designated vessels as arteriole or venule. Seventy-seven images that had at least 1 traceable arteriole and venule in each quadrant were analyzed by ROPtool, and the results were compared with the consensus of 3 expert examiners. Receiver operating characteristics (ROC) curves were generated and areas under the curves calculated to quantify the diagnostic utility of ROPtool's assessment of tortuosity of arterioles, venules, and both. RESULTS: Three pediatric ophthalmologists agreed on the designation of arteriole or venule for 83 of 100 blood vessels. With the use of expert consensus as the reference standard, areas under the ROC curves for identification of tortuosity sufficient for plus disease were 0.91, 0.70, and 0.93 for arterioles, venules, and both, respectively. Areas under the ROC curves for identification of tortuosity sufficient for pre-plus disease were 0.91, 0.63, and 0.90 for arterioles, venules, and both, respectively. CONCLUSIONS: When considering whether tortuosity is sufficient for plus or pre-plus disease, the assessment of either arterioles alone or of arterioles and venules together resulted in high diagnostic accuracy.