Keywords: vision screening, children, myopia

Background:

Childhood refractive disorders are increasingly prevalent yet underdetected in primary care. GPs, as first-line providers, are well positioned to contribute to early detection and prevention of vision problems. However, their role in pediatric vision protection remains undefined in many healthcare systems.

Research questions:

What is the current role of GPs in early detection and prevention of refractive disorders in children, based on longitudinal cohort outcomes and GP screening practices?

Method:

A prospective longitudinal study was conducted from 2017 to 2023 in multiple municipalities of Stara Zagora, Bulgaria. A cohort of 588 children aged 7–14 years at baseline was examined annually. Examinations were conducted by two ophthalmologists using the Plusoptix S12с Mobile autorefractor. Three consecutive non-mydriatic refraction readings were averaged for each eye. Spherical equivalent (SE) and cylindrical power were measured and categorized (myopia, hyperopia, astigmatism) using standard definitions. Participants completed structured questionnaires annually, reporting on visual complaints and behavioral factors. Inclusion criteria ensured exclusion of pre-existing ocular pathology.
Parallel to child follow-up, 78 GPs completed structured questionnaires assessing current vision care practices, referral patterns, and familiarity with preventive guidelines.
Data were analyzed using independent t-tests, ANOVA with Bonferroni correction, chi-squared tests, and prevalence calculations with 95% confidence intervals. Attrition and maturation variability were recognized as study limitations.

Results:

Over seven years, a statistically significant myopic shift (mean SE change −0.20D, p<0.05) was observed. Nearly half of participants reported visual complaints by study end. Despite all surveyed GPs performing basic vision checks, only 17% referred children for specialist evaluation. Familiarity with structured guidelines was inconsistent, and standardized screening protocols were absent.

Conclusions:

This longitudinal cohort study highlights the critical but underutilized role of GPs in vision protection. Structured vision screening and early referral protocols, embedded within primary care, are urgently needed to empower GPs in safeguarding children’s visual health.

Points for discussion:

The gap between screening and referral?

Lack of Standardized Guidelines?

Knowledge, Attitudes, and Barriers Among GPs?