Challenges of Eye Health Care in Children and Strategies to Improve Treatment Uptake: A Qualitative Study from the Perspective of Eye Care Professionals in the UK

Abstract

Follow up from universal vision screening at four to five years has been shown to be low in England, potentially increasing the risk of vision disorders not being treated. This study explores vision specialists' views on the perceived barriers and facilitators encountered when engaging with parents and young children, and the strategies adopted to improve child/parent centred care. Fifteen semi-structured qualitative interviews were conducted with eye care professionals to explore perspectives on the challenges of treating children. Thematic analysis was performed to identify key barriers and the strategies eye care professionals adopt to enhance person-centred eye care when working with young children and their families. Two overarching themes were identified related to the professional-patient relationship. The first reflects the challenges which vision specialists experience when treating children, considering lack of eye health education and negative attitudes to diagnosis and treatment as major barriers. The second discusses the strategies adopted to tackle those barriers. Three strategies are proposed to enhance child-centred eye care: more eye health education, more personalised communication to enhance referral uptake and the development of better coordinated pathways of care between schools, communities and hospital services.

How accessible is primary eye care for children in England?

“…Our findings suggest that age influences the accessibility of primary eye care for young children. One possible explanation for this might be the perceived barriers in community practices, such as children having a short attention span, leading to the possibility of an incomplete assessment; hence, a need for multiple visits 21 . It is reassuring that our findings regarding the child with autism showed that practices were willing to be adaptable by offering additional time and advising the parent that the child should be seen when the practice is quiet.…”

“…For parents, visiting a community optometrist is likely to be a preferred option due to the convenience and flexibility of appointment times available. However, it is noted that factors such as ethnicity, parental income, parents’ level of education and attitude toward diagnosis and treatment may influence attendance at appointments 21,22 . Despite the fact that community optometrists are well placed to play an important part in children's eye care, a telephone survey conducted in 2007 reported that 2% of practices would not carry out an eye examination on a child until the age of 7 years and that 54% of practices would exclude young children (aged 1 year) from a General Ophthalmic Services (GOS) eye examination 23 …”

“You’re too young to have an eye problem”: Reasons for nonadherence to referrals for follow-up eye care for schoolchildren in Nigeria -- a descriptive qualitative study

“…[36] This may help explain why parents do not understand the need for a follow-up eye examination for their children or additional care after failing a vision screening test. [37] Other parental barriers include a lack of cooperation or interference from family members who hold differing beliefs about when and where to seek care for a child. In Africa, decisions about when and where to seek care outside the household is usually made by a "therapy management group" [38] consisting of key persons in the immediate family or household plus others who are part of the extended family or seen as particular wise or influential.…”

Evaluation of Visual Acuity Measurement Based on the Mobile Virtual Reality Device

“…ese include that (1) the optotypes should have approximately equal legibility; (2) each line on a chart should have an equal number of optotypes; (3) the horizontal spacing between optotypes should be equal to the width of the optotypes on that line; (4) the vertical spacing between each row should be equal to the height of the optotypes in the smallest row; (5) the optotype sizes should progress geometrically up or down the chart in uniform steps of 0.1 log units; and (6) the optotypes should be black on a white background and viewed under good lighting conditions [31]. Moreover, Cassetti et al [32] note that current challenges in the effective administration of eye chart procedures include that parents have to take time off work for children's eye exams, which can lead to unnecessary healthcare expenses and overlooked financial burdens. erefore, a well-designed eye chart that conforms to recommended standards is needed.…”