Children with Additional Support Needs Risk Missing Out on Effective Vision Screening: Audit and Survey Considering Attendance Rates and Parent Reported Barriers to Service Access, including Recommendations for Improvement.

Objective: Vision screening programs in children aged 4-5 years aim to address visual issues before they start school, supporting children's educational, developmental, emotional, and social well-being. This study evaluates attendance rates and barriers to attendance for children requiring follow-up in an urban hospital eye service after their initial screening visit. Methods and Analysis: Retrospective data on attendance, visual acuity, refractive errors, and presence of additional support needs (ASN) were collected from the National Database for preschool screening and the hospital electronic record system. Caregivers of children with missed appointments were invited for a telephone survey. Results: First-time hospital attendance rate was 61%. Children with ASN were 1.8× more likely to miss two hospital appointments and had more incomplete tests compared to children without ASN. In children receiving a spectacle prescription, vision improved by 0.07 LogMAR in the better eye and 0.16 LogMAR in the worse eye. Barriers for attendance included being unaware of the appointment, ASN, hospital environment, scheduling and transport issues. Parents recommended information with the appointment letter in an accessible language for the child and caregiver, an appointment reminder text message and options for vision tests in the community or at school. Conclusion: Whilst the initial uptake of vision screening is high, there is a significant proportion of children with incomplete screening tests or missed follow-up appointments. Greater attention should be placed on improving accessibility of the service for children with ASN, as they may be at greater risk of missing out on appropriate eye care.