ImportanceAmblyopia can result in permanent vision loss if not properly treated before age 7 years. In 2017, the US Preventive Services Task Force recommended that vision screening should occur at least once in all children aged 3 to 5 years to detect amblyopia.ObjectiveTo understand trends and factors associated with screening, referral, or diagnosis of amblyopia before and after photoscreening expansion across a relatively large health care system in late 2017.Design, Setting, and ParticipantsThis is a retrospective cohort study of electronic health record data from patients with a well child care visit at approximately age 3 years (ages 2.75-3.25 years) in a relatively large, multispecialty group practice in Northern California and linked census data between 2015 and 2022. Data were extracted and analyzed from October 2022 through August 2023.ExposuresPatient sex, race and ethnicity, immunization records, previous well child care visits, and census-level median household income.Main Outcomes and MeasuresVision screening, pediatric ophthalmology referral, or amblyopia diagnosis, compared using adjusted odds ratios (AORs).ResultsThe study included 2015-2017 data from 23 246 patients aged 3 years with at least 1 well child care visit (11 206 [48.2%] female) compared with 2018-2022 postexpansion data from 34 281 patients (16 517 [48.2%] female). The screening rate increased from 5.7% (424 of 7505) in 2015 to 72.1% (4578 of 6354) in 2022. The referral rate increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018. The diagnosis rate was 2.7% (200 of 7505) in 2015, peaked at 3.4% (263 of 7792) in 2018, and decreased to 1.4% (88 of 6354) in 2022. Compared with White patients, patients who were Asian, Black, or Hispanic were less likely to be screened (Asian: AOR, 0.80; 95% CI, 0.72-0.88; Black: AOR, 0.71; 95% CI, 0.53-0.96; Hispanic: AOR, 0.88; 95% CI, 0.80-0.97). Compared with White patients, patients who were Asian or Hispanic were more likely to be referred (Asian: AOR, 1.49; 95% CI, 1.36-1.62; Hispanic: AOR, 1.32; 95% CI, 1.18-1.48) and were more likely to be diagnosed (Asian: AOR, 1.29; 95% CI, 1.07-1.56; Hispanic: AOR, 1.67; 95% CI, 1.33-2.11).Conclusions and RelevanceIn this study, increased availability of photoscreeners was associated with an increase in overall rates of vision screening for children aged 3 years in a relatively large health care system. Given that US rates of visual impairment are predicted to increase, additional targeted interventions would be needed to address remaining disparities in amblyopia care along patient- and clinician-level factors.

中文翻译：

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广泛采用光筛查仪后的弱视护理趋势

重要性如果在 7 岁之前未得到适当治疗，弱视可能会导致永久性视力丧失。2017 年，美国预防服务工作组建议对所有 3 至 5 岁儿童至少进行一次视力筛查，以发现弱视。 目的了解扩大照片筛查前后与弱视筛查、转诊或诊断相关的趋势和因素2017 年底，在一个相对较大的医疗保健系统中进行了一项研究。 设计、设置和参与者这是一项回顾性队列研究，研究对象为 3 岁左右（2.75-3.25 岁）接受过良好儿童保育的患者的电子健康记录数据。北加州的大型多专业团体实践以及 2015 年至 2022 年期间关联的人口普查数据。数据是从 2022 年 10 月到 2023 年 8 月提取和分析的。暴露患者性别、种族和族裔、免疫记录、既往儿童看护就诊以及人口普查水平中位数主要结果和措施使用调整后的比值比 (AOR) 进行比较，对视力筛查、儿科眼科转诊或弱视诊断进行比较。结果该研究包括 2015-2017 年 23 246 名 3 岁患者的数据，这些患者至少接受过 1 次儿童看护服务（11 206 [48.2%] 女性）与 2018-2022 年 34 281 名患者（16 517 [48.2%] 女性）扩张后数据进行比较。筛查率从2015年的5.7%（7505人中的424人）增加到2022年的72.1%（6354人中的4578人）。转诊率从2015年的17.0%（7505人中的1279人）增加到2018年的23.6%（7792人中的1836人）。 2015年诊断率为2.7%（7505人中的200人），2018年达到峰值3.4%（7792人中的263人），2022年下降至1.4%（6354人中的88人）。与白人患者相比，亚裔、黑人患者或西班牙裔美国人接受筛查的可能性较小（亚洲人：AOR，0.80；95% CI，0.72-0.88；黑人：AOR，0.71；95% CI，0.53-0.96；西班牙裔：AOR，0.88；95% CI，0.80- 0.97）。与白人患者相比，亚裔或西班牙裔患者更可能被转诊（亚洲人：AOR，1.49；95% CI，1.36-1.62；西班牙裔：AOR，1.32；95% CI，1.18-1.48），并且更有可能转诊待诊断（亚洲：AOR，1.29；95% CI，1.07-1.56；西班牙裔：AOR，1.67；95% CI，1.33-2.11）。结论和相关性在这项研究中，光筛查仪可用性的增加与总体在相对较大的医疗保健系统中，3 岁儿童的视力筛查率。鉴于美国视力障碍率预计将增加，因此需要采取额外的有针对性的干预措施，以解决弱视护理中因患者和临床医生层面因素而存在的差异。