Vision Screening Referrals Are Often Disregarded By Parents

Parents frequently do not adhere to referral recommendations following vision screenings for their child.

Parents often do not comply with requests to have their children evaluated with a comprehensive eye examination following vision screening referrals, according to research published in Clinical and Experimental Optometry. This non adherence was not influenced by ethnicity or socioeconomic status, according to the report.  

Researchers invited 1283 children (mean [SD] age, 4.5[0.6] years; 52.2% boys) to receive a free vision screening in the Jerusalem district, Israel. Children with abnormal findings received a referral for an ophthalmological examination and parents were contacted 3 to 6 months following the referral to assess adherence and barriers. The team organized barriers into a conceptual framework consisting of parental predisposing and health system factors and evaluated adherence and barriers according to sex, age, ethnic group and socio-economic status.

According to the report, a majority of the children screened were members of the ultra-Orthodox Jewish community (51.4%; n=660), while the remainder identified as secular or religious (33.2%; n=426) or were of Arabic ethnicity (15.4%; n=197). Most of the children included in the analysis lived in economically disadvantaged neighborhoods (87.6%).

Since most barriers were associated with predisposing factors of parents, interventions to improve adherence should include parental education.

The overall referral rate was 23.0% (n=295). Among those receiving referrals, 54.3% (n=160) of parents reported complying with recommendations to take their child for a full eye examination. Adherence did not differ with sex, ethnicity or socio-economic status. Parents of children who were aged between 5 and 6 years were significantly more likely to adhere to referral recommendations compared with parents of children younger than 5 years. Among parents who did not comply with referral recommendations, 79.3% cited predisposing factors including a lack of time or cooperation from their child, 16.3% reported system factors including not having insurance and 4.4% cited other reasons.

“Since most barriers were associated with predisposing factors of parents, interventions to improve adherence should include parental education,” according to the researchers. “Interventions aimed at increasing adherence should involve the importance of vision for learning and the importance of identification of amblyogenic factors at a young age.”

Study limitations include the use of telephone calls instead of medical records to determine adherence, the use of open-ended questions to determine patient barriers to care, and the possibility of skewed results due to the dataset not being corrected for sibling pairs. 


Gordon-Shaag A, Ben-Eli H, Cohen OS, Toledano M, Benyamin A, Stein-Zamir C. Adherence to referrals from preschool vision screening and identification of barriers for non-adherence in Israel. Clin Exp Optom. Published online August 15, 2022. doi:10.1080/08164622.2022.2107891