Referral patterns for common amblyogenic conditions

Abstract

The early detection and management of common pediatric ophthalmic problems is crucial to assure successful visual maturation and best potential for development of binocular vision. The referring physician plays a pivotal role in this process. This study was designed to investigate the prevailing referral patterns for common amblyogenic conditions in a defined geographic region. We sent a short questionnaire to 300 pediatricians and 1500 family practitioners (FPs) in Minnesota, asking them to use a multiple choice system to indicate how long after diagnosis they would wait before referring a child to an ophthalmologist for exotropia, esotropia, ptosis, nystagmus, and abnormal red reflex. The response rate was 46.9% ( n = 117) for pediatricians and 17.9% ( n = 240) for FPs. Of respondents, 64.6% of pediatricians and 50.2% of FPs would refer patients with exotropia within 2 months of diagnosis ( P < 0.001). For esotropia, 58.8% of pediatricians would refer within 2 months, while 38.6% would wait up to 12 months. In comparison, 48.7% of FPs would refer sooner, while 47.9% would refer later. These differences in referral patterns for pediatricians and FPs were statistically significant ( P = 0.037). There was less variation for referral of ptosis, nystagmus, and abnormal red reflex. These referral patterns were unaffected by years in practice. Pediatricians referred patients with strabismus significantly more promptly than FPs. The majority of primary care providers (PCPs) appropriately timed their referrals for these amblyogenic conditions. However, many children continue to be referred late, underscoring the need for continued education of PCPs.