Diagnostic Yield of Pediatric Ophthalmology Consultations in Children Aged 6–24 Months According to Referral Context

PURPOSE: To evaluate the diagnostic yield of specialist pediatric ophthalmologic examinations in children aged 6-24 months according to referral context, and to assess implications for screening pathway design and specialist resource allocation. METHODS: This retrospective study included 1,991 children aged 6-24 months who underwent comprehensive ophthalmologic examinations between 2012 and 2022 at a tertiary center. Every examination, including visual behavior assessment, cycloplegic refraction, and strabismus evaluation, was performed by a pediatric ophthalmologist. Children were categorized as routinely examined without prior concern or referred because of clinical or parental suspicion. Primary outcomes were the prevalence of clinically significant ocular findings requiring treatment or close follow-up. RESULTS: Among the 914 children examined routinely, 83.1% had normal findings and only 1.8% required treatment. No strabismus was detected in this group. In contrast, of the 1,077 children referred due to concern, 66% had abnormal findings, including 6.1% with strabismus. Most treatable conditions were identified among concern-based referrals. CONCLUSION: In this cohort, concern-based referrals to a pediatric ophthalmologist identified the large majority of treatable ocular conditions in children aged 6-24 months, while routine specialist examinations of asymptomatic children yielded few actionable findings. These data support a tiered screening model in which primary care providers perform initial vision screening, with specialist referral reserved for children with identified concerns, abnormal screening results, or recognized risk factors. These findings suggest that, within a tiered screening framework, specialist pediatric ophthalmology consultations may be most effectively utilized when guided by abnormal screening findings or clinical concern.