Best Practices and Research
Children's Vision and Eye Health
Performance Measures Guidelines

Vision and Eye Health in Children 36 to <72 Months: Proposed Performance Measures

Currently, providers of vision screening and eye examinations lack a system to provide national or state level estimates of the proportion of children who receive either a vision screening or an eye examination. Recommendations have been developed by the National Expert Panel to the National Center for Children’s Vision and Eye Health at Prevent Blindness and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, U.S. Department of Health and Human Services to establish performance measures for children’s vision health. The panel developed numerator and denominator definitions to measure rates of children “who completed a vision screening in a medical or community setting using a recommended method, or received an eye examination by an optometrist or ophthalmologist at least once between the ages of 36 to <72 months.” Separate measures for vision care provided to children with neurodevelopmental disorders, measures for receipt of an eye examination, and receipt of follow-up care were also developed. The panel recommends that these measures be implemented at national, state and local levels.

This webpage provides a synopsis of the article content. Read the complete journal article.

Recommendation Summaries

Recommendation Summary

The expert panel recommends a child-based performance measure for vision care of children aged 36 to <72 months, defined as:

Numerator: Number of children from the denominator who completed a valid* vision screening in a medical or community setting, or received an eye examination by an optometrist or ophthalmologist at least once between the ages of 36 to <72 months.

Denominator: All children who turn 72 months of age by December 31st of the reporting year in the entire population, or a representative sample.

*For all performance measures, “valid vision screening” is defined as: vision screening attempted using a recommended quantitative method (See Vision Screening Recommendations) with an outcome of “pass” OR another outcome (fail or untestable) AND evidence that the child was referred or re-screened. Thus, a non-passing result without evidence of a referral or rescreen is considered an invalid screening and is not counted in the numerator. Acceptable evidence of referral would be the date of the appointment, and name of consulting ophthalmologist or optometrist reported by the screening agency.


Additional Recommendations

  • Entities establishing this performance measure are encouraged to identify their baseline performance and to set annual targets increasing towards their specific goal.
  • Entities that require a population based goal, (such as the Healthy People 2020 goal of 44% of children screened by 2020), will need to be equipped to report all community-based and office-based screening.
  • Age-specific reporting, for purposes of identifying settings that successfully test younger children, could be a secondary goal.
  • Reporting age specific screening rates would require adjustments to the numerator and denominator to reflect the cohort being addressed.

Recommendation Summary

The panel recommends a separate performance measure for children with diagnosed neurodevelopmental disorders (e.g., hearing impairment, motor abnormalities such as cerebral palsy, Down syndrome, cognitive impairment, autism spectrum disorders and speech / language delay), who should be referred directly.

Implementation will require integration of vision and developmental diagnostic data.

Numerator: Number of children from the denominator who completed an eye examination by an ophthalmologist or optometrist within 6 months of diagnosis of the neurodevelopmental disorder.

Denominator: All children who turn 72 months of age by December 31st of the reporting year in the state, or a representative sample, diagnosed with a neurodevelopmental disorder.

Recommendation Summary

The panel recommends a performance measure addressing the proportion of children receiving follow-up eye examinations after a screening referral defined as:

Numerator: Number of children from the denominator who completed an eye examination by an optometrist or ophthalmologist within 6 months of a referral from quantitative vision screening.

Denominator: All children who turn 72 months of age by December 31st of the reporting year in the state, a region, or a representative sample, who were referred after quantitative screening (see Table 2) in a medical or community setting between the ages of 36 to <72 months.

In case of multiple services, data should reference the earliest examination by an optometrist or ophthalmologist, which was preceded by a referral from a screening (this performance measure does not include eye examinations not preceded by a referral, or triggered by another reason such as positive family history, neurodevelopmental disorder, or observation of an abnormality).

This measure should be calculated 6 months after the end of the reporting year, in order to account for those children that failed a vision screening between the ages of 67 to <72 months who required time to receive a follow up eye examination.

Treatment Measure

The following treatment measure addresses the proportion of children with an eye examination found to have visually-significant eye conditions, who receive treatment or additional visits to an ophthalmologist or optometrist.

Numerator: Number of children from the denominator who obtained glasses and/or attended at least one follow-up appointment with an optometrist or ophthalmologist* within 6 months of an eye examination.

Denominator: All children who turn 72 months of age by December 31st of the reporting year in the population, or a representative sample, who were prescribed treatment including glasses and/or instructed by an optometrist or ophthalmologist to return within six months (e.g. for treatment of amblyopia, strabismus, or amblyogenic refractive error21).

* This numerator would be reported by the prescribing ophthalmologist or optometrist.

This measure would provide surveillance of treatment adherence in children with diagnosed vision conditions or amblyogenic refractive error.

Recommendation Summary

  • Utilizing existing data infrastructure, while working towards a more interchangeable data system that will readily support the implementation and reporting of valid measures, is recommended.
  • The panel urges implementation of performance measures into emerging data systems to assure the necessary infrastructure and data elements to allow reporting of the vision measures.
  • Implementation of the vision performance measures will require technical assistance, and integration with other data collection and performance measure initiatives.
  • A technical manual, developed with input from experts in epidemiology, performance measurement, statistics, information technology, and vision, should be adopted so that basic measures are standardized, and the estimates are valid, reliable and comparable to other locations.
  • Linkage of child-based measures with child demographic information will enable monitoring of possible disparities in health care provision (27,28) e.g. racial/ethnic differences in screening and/or follow-up rates, which are especially important for children.
  • The panel supports the use of national parent survey data, e.g. the National Survey of Children’s Health (NSCH), as an interim step to allow states to estimate their performance on the recommended measures, however a web-based data system should supersede the survey approach as quickly as possible.
  • Vision care performance measure results should be publicly available. Such data can be used to determine progress toward goals and drive quality improvement efforts.
  • Improvements in vision screening and eye examination rates can also be enhanced by concurrent public health and health behavior campaigns aimed at parents and providers.

Marsh-Tootle, WL, Russ SA, Repka MX for the National Expert Panel to the National Center for Children’s Vision and Eye Health. Vision Screening for Children 36 to <72 Months: Proposed Performance Measures.  Optom Vis Sci 2015;92(1):17-23.

Corresponding Author:

Wendy L. Marsh-Tootle, OD, MS
University of Alabama at Birmingham
School of Optometry
1716 University Blvd.
Birmingham, AL, 35294
[email protected]

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