O4309: Ophthalmic Needs of Children in Foster Care

Background: While prevalent health care needs and access barriers have been well documented among children in foster care, detailed data about ophthalmic needs is sparse. Unaddressed ophthalmic issues can lead to permanent visual deficits and impaired academic performance. Additional information about the ophthalmic needs of children in foster care in the context of academic needs could inform clinical care, advocacy, and policy. We aimed to describe a) ophthalmic health care needs and access among children in foster care b) characteristics of children with unmet ophthalmic needs including academic development assessment.

Methods: Retrospective review conducted at a specialty clinic for children in foster care where vision screens (eye chart, spot vision screener) were performed per Bright Futures guidelines, and standardized developmental testing was completed by occupational therapy (OT). Children evaluated after reunification were excluded. We extracted history of ophthalmic needs, ophthalmology appointments and access to glasses from available records. Threshold to pass eye chart screen was 20/30 if ≥ 5 years and 20/40 if 4 - < 5 years. When visual acuity differed between eyes, the lower result was used for analysis. The following were extracted from OT notes: presence of visual motor integration delay based on Beery-Buktenica test and Wide Range Achievement Test percentile for reading, math, and spelling. We used descriptive statistics.

Results: Table 1 details characteristics of the 141 patients included. Out of 89 eye chart and 12 spot vision screens 56 (55%) were abnormal, and 3/56 (5%) children with abnormal vision screens had access to glasses. Reasons for unavailability of glasses were documented for 32 patients; most common reasons were glasses lost (10), never went to optometrist (7), glasses broke (6), and glasses left at a prior home (4). Among children with abnormal eye chart screen and no glasses, median result was 20/50, and vision was ≥20/200 for 7 (Table 2). Table 2 details academic development assessments for children with uncorrected vision deficits. Ophthalmology referrals were noted in past medical records of 8/141 (6%) patients, while previously completed ophthalmology visits were noted for 4. Most common reason for prior ophthalmology referrals was strabismus (3). Median number of months children with prior ophthalmology visits were overdue for follow-up was 19.5 (range 0, 121). 17/141 (12%) of children received ophthalmology referrals from our specialty clinic, and median time until they were subsequently seen by ophthalmology was 1 month (range 0, 5 months).

Conclusion: Unmet ophthalmic needs including severe uncorrected visual deficits were frequent. Access to corrective lenses is important to developing academic skills such as reading and math. Frequency of academic concerns among children with uncorrected visual deficits underscores the importance of policies and practice changes to ensure children in foster care have access to vision screens, glasses, and ophthalmology / optometry care.