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REQUIRED VISION EXAMINATIONS AND VISION SCREENINGS FOR CHILDREN: CURRENT RESEARCH

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required vision examinations and vision screenings for children: current research william t. reynolds, o.d. richmond, kentucky joel n. zaba, m.a., o.d. – PowerPoint PPT presentation

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Title: REQUIRED VISION EXAMINATIONS AND VISION SCREENINGS FOR CHILDREN: CURRENT RESEARCH


1
REQUIRED VISION EXAMINATIONS ANDVISION
SCREENINGS FOR CHILDRENCURRENT RESEARCH
  • WILLIAM T. REYNOLDS, O.D.
  • RICHMOND, KENTUCKY
  • JOEL N. ZABA, M.A., O.D.
  • VIRGINIA BEACH, VIRGINIA

2
PREVALENCE OF VISION PROBLEMS
  • Amblyopia is the most common cause of monocular
    visual impairment in children and young and
    middle-aged adults. Rutstein R. Contemporary
    Issues in Amblyopia Treatment. Optometry Journal
    of the American Optometric Association Volume
    76/Number 10/October 2005.
  • It has been estimated that Amblyopia, the leading
    cause of vision loss in young Americans, affects
    500,000 preschoolers.

3
PREVALENCE OF VISION PROBLEMS
  • "Conclusions Visual impairment due to
    uncorrected refractive error is a common
    condition in the United States. Providing
    appropriate refractive correction to those
    individuals whose vision can be improved is an
    important public health endeavor with
    implications for safety and quality of life.
  • Vitale, S, Cotch, M, Sperduto, R. Prevalence of
    Visual Impairment in
  • the United States JAMA, May 10, 2006Vol 295,
    No. 18.

4
PREVALENCE OF VISION PROBLEMS
  • Vision disorders have been considered the fourth
    most common disability in the United States and
    they are one of the most prevalent handicapping
    conditions in childhood.
  • Ciner E, Dobson V, Schmidt P, et al. A
    Survey of vision screening policy of preschool
    children in the United States. Surv Opthalmol
    1999 March-April 43(5) 445-457.

5
Prevalence of Vision Problems
  • The Prevent Blindness America organization states
    that vision problems affect one in four
    school-aged children.
  • Prevent Blindness America. Your childs
    sight . Illinois September 1997.
  • The National Parent Teacher Association reports
    that more than ten million children experience
    vision problems.
  • National PTA Resolution. Learning-related
    Vision Problems Education and Evaluation, June
    1999.

6
Vision, Child Development, and Education
  • The importance of vision and its relationship to
    childhood development and the educational
    environment has been noted in both the education
    and vision care literature.
  • Zaba J, Johnson R, Reynolds W. Vision
    Examinations for All Children Entering Public
    School The New Kentucky Law. Optometry Journal
    of the American Optometric Association 2003
    March 74 (3) 149-158.

7
Vision, Child Development, and Education
  • Impaired vision can affect a childs cognitive,
    emotional, neurologic and physical development by
    potentially limiting the range of experiences and
    kinds of information to which the child is
    exposed.
  • U.S. Centers for Disease Control and
    Prevention (CDC) 2005.

8
Vision, Child Development, and Education
  • Two in three children do not receive any
    preventive vision care before entering elementary
    school.
  • Centers for Disease Control and Prevention,
    Morbidity and Mortality Weekly Report, May 6,
    2005.

9
Consequences of Undetected and Untreated Vision
Problems
  • Significant numbers of vision problems have been
    found in the following groups
  • Behaviorally at risk children
  • Academically at risk children
  • Adjudicated adolescents
  • Title I children
  • Zaba, J. Social, Emotional, Educational
    Consequences of Undetected Childrens Vision
    Problems Journal of Behavioral Optometry Volume
    12/2001/Number 3/Page 66.

10
VISION SCREENING
  • Examiner tests the accuracy of vision in each eye
    and possibly whether the eyes are straight and
    working together. A screening detects potential
    problems but does not diagnose them.

11
COMPREHENSIVE EYE EXAM
  • Gold Standard, according to NIH study an
    Optometrist or Ophthalmologist dilates the pupils
    and evaluates the ocular health of the eye,
    including the optic nerve and retina. The
    examination produces a diagnosis, and, if
    indicated, a spectacle lens prescription.

12
Preschool Vision Screening in Pediatric
Practices
  • Our findings underscore the importance of
    financial issues for vision screening. We were
    surprised that half of the respondents reported
    that there should be separate reimbursement for
    vision screening.
  • Kemper, P., MD, MH, MS Clark, S., MPH.
    Preschool Vision Screening in Pediatric
    Practices Clinical Pediatrics, April 2006.

13
Preschool Vision Screening in Pediatric Practices
  • Among those pediatricians who routinely attempt
    formal preschool vision screening, half (51)
    reported that they bill insurance separately for
    that activity.
  • Kemper, P., MD, MH, MS Clark, S., MPH.
    Preschool Vision Screening in Pediatric
    Practices Clinical Pediatrics, April 2006.

14
Preschool Vision Screening in Pediatric Practices
  • Barriers to Vision Screening (n 377)
  • Practice-related factors
  • Children are not cooperative with
    screening 49
  • Screening is too time-consuming 23
  • Lack of training 15
  • Referral-related factors
  • Lack of insurance for follow-up care
    17
  • Lack of eye care provider
    15
  • Concern about parent reaction to
  • false-positive referral
    3
  • Kemper, P., MD, MH, MS Clark, S., MPH.
    Preschool Vision Screening in
  • Pediatric Practices Clinical Pediatrics,
    April 2006.

15
Follow Up After Failed Vision Screenings
  • Lack of Follow-up Exams after
  • Failed School Vision Screenings An
  • Investigation of Contributing Factors
  • Kimel, L., RN, MS. The Journal of School
    Nursing, June 2006.
  • Why are so many students not
  • receiving follow up exams?

16
Follow Up After Failed Vision Screenings
  • Barriers to Follow-up Care (n55)
  • Financial barriers
  • Cost and money concerns 31
  • No insurance coverage 11
  • Waiting for insurance 9
  • Logistical barriers
  • Appointment problems 22
  • Cant plan ahead 16
  • No phone 11
  • No car 9

17
Follow Up After Failed Vision Screenings
  • Barriers to Follow-up Care (n55)
  • Social/Family barriers
  • All adults work 45
  • Family Issues 34
  • Large family 29
  • Parent disabled 13
  • Change in residence 11
  • Perceptual barriers
  • Do not believe results 38
  • Not a priority 38
  • No need for an exam 29
  • No interest in follow-up 18

18
Follow Up After Failed Vision Screenings
  • The study population had significantly more
    minority and low-income families than the general
    school population has. Cost was a barrier
    mentioned by almost one-third of the
    participants. When examined closer, only 11 of
    participants did not have readily available
    funding sources. Most of this group would have
    qualified for assistance through Vision Service
    Plan Sight for Students vouchers or Lions Club
    International, but did not request the support.
    (emphasis added)
  • Kimel, L., RN, MS. Lack of Follow-up Exams
    after Failed School Vision Screenings An
    Investigation of Contributing Factors The
    Journal of School Nursing, June 2006

19
www.2020advocacy.com
  • www.2020advocacy.com
  • Links
  • Home
  • Advocacy Advocacy Center Your elected
    officials
  • Vision Facts Legislative Alerts Current
    legislation
  • Get involved Key votes Capital Hill
    Basics
  • Links Action Alert Enter your zip code
  • News Archive New Kids Vision Bill Needs Your
    Help
  • Contact us Take action now

20
Vision Screenings
  • SCREENING ADVOCATES ARGUE--
  • Screenings do an adequate job of detecting
    problems
  • Eye exams are not cost effective
  • Not enough manpower for exams
  • Primary care O.D.s are not qualified to do
    pediatric exams
  • Vision is not related to learning

21
Vision Examinations
  • VISION EXAM ADVOCATES ARGUE--
  • Screenings do not do an adequate job of detecting
    problems
  • Exams are cost effective
  • Vision is related to learning and every child
    deserves to enter school visually ready to learn

22
Vision Screening Performance
  • Vision in preschoolers study (VIP)- Under ideal
    circumstances about 1/3 of the children with
    targeted conditions were missed.
  • National Institute of Health Study (2004)
    Screenings failed to detect roughly 10 of
    childrens problems including Amblyopia and
    strabismus.

23
Making the Grade?
  • An analysis of state and federal
  • childrens vision care policy
  • July 2005
  • Vision Council of America
  • 1700 Diagonal Road 500
  • Alexandria, VA 22301
  • www.2020advocacy.com

24
Making the Grade?
  • Current Updates as of September, 2006
  • Seventeen states do not require children to
    receive any preventive vision care before
  • starting school or during the school years.
  • Thirty-three states (including the District of
    Columbia) require vision screening, but
  • 29 of them do not require children that fail
    the screening to receive an eye exam by
  • an eye doctor.

25
Making the Grade?
  • One state requires all children to receive an eye
    exam by an eye doctor before entering elementary
    school.
  • Four states (Kentucky, Arkansas, Massachusetts
    and Ohio) have enacted or
  • enhanced existing laws since 1999 to increase
    the number of children that receive an eye exam
    by an eye doctor.

26
Eye Exams for ChildrenTheir Impact and
CostEffectivenessAlan J. White, Ph.D.Prepared
by Abt Associates for the Vision Council of
America
27
Cost Effectiveness of Preschool Eye Examinations
Conclusions
  1. Eye exams would detect, treat and cure
    significantly more cases of amblyopia in children
    than a universal vision screening program or the
    usual patterns of care that would exist without
    a formal vision screening program in place.

28
Cost Effectiveness of Preschool Eye Examinations
Conclusions
  • 2. A universal comprehensive eye exam program
    would be highly cost effective and produce a
    greater return on investment than many other
    health care interventions.

29
Cost Effectiveness of Preschool Eye Examinations
Conclusions
  • That a vision screening costs less to perform
    than an eye exam is not the only relevant factor
    in assessing cost effectiveness. What is
    relevant is a comparison of the costs and the
    benefits associated with each procedure.

30
Cost Effectiveness of Preschool Eye Examinations
Conclusions
  • Based on our evaluation, the higher costs
    associated with eye exams are more than offset by
    the gains that result from the additional
    children who are successfully treated as a result
    of receiving an eye exam.

31
Vision Care for Kids Act of 2006 (Introduced in
Senate)109th Congress2d SessionS. 3685To
establish a grant program to provide vision care
to children, and for other purposes.IN THE
SENATE OF THE UNITED STATES July 19, 2006
32
Vision Care for Kids Act of 2006
  • Mr. Bond introduced the following bill which was
  • read twice and referred to the Committee on
    Health,
  • Education, Labor, and Pensions
  • Section 1. Short Title.
  • This Act may be cited as the Vision
  • Care for Kids Act of 2006.

33
Vision Care for Kids Act of 2006
  • Section. 2. Findings.
  • Congress makes the following findings
  • Good vision is essential for proper physical
  • development and educational progress in
  • growing children.
  • Many serious ocular conditions are
  • treatable if identified in the preschool and
  • early school-aged years.

34
Vision Care for Kids Act of 2006
  • Congress makes the following findings
  • Section 3.
  • Early detection of ocular conditions provides the
    best opportunity for effective, inexpensive
    treatment and can have far-reaching implications
    for vision.

35
Vision Care for Kids Act of 2006
  • Section 4.
  • Various identification methods, whether vision
    screening or comprehensive eye exams required by
    state laws, will identify children needing
    services. A child identified through vision
    screening should receive a comprehensive eye exam
    followed by subsequent treatment as needed.

36
Vision Care for Kids Act of 2006
  • Section 4 (contd)
  • A child identified through a
  • comprehensive eye exam should receive
  • subsequent treatment as needed. All
  • children identified as needing services
  • should have access to subsequent
  • treatment as needed.

37
Vision Care for Kids Act of 2006
  • SEC. GRANTS REGARDING VISION CARE FOR CHILDREN.
  • (2) Providing treatment or services, subsequent
    to the examinations described in paragraph (1),
    necessary to correct vision problems and
  • (3) developing and disseminating, to parents,
    teachers, and health care practitioners,
    educational materials on recognizing signs of
    visual impairment in children.

38
State of Arkansas House Bill 1734
  • (a) (1) Beginning with the 2006-2007 school year,
    all children in pre-kindergarten (pre-k),
    kindergarten (k), grade one (1), two (2), four
    (4), six (6), and eight (8), and all transfer
    students shall receive an eye and vision
    screening.
  • (b) An eye and vision screening shall include the
    following tests, procedures, equipment, and
    insurance approved by the Arkansas Commission on
    Eye and Vision Care of School Age Children and
    the Department of Education

39
State of Arkansas House Bill 1734
  1. Observation and external inspection of the eye
  2. Distance and visual acuity test using a Snellen
    Eye Chart at twenty feet (20) or an age
    developmentally appropriate chart at ten feet
    (10) feet outside a vision screening instrument,
    and
  3. A plus lens visual acuity test using a Snellen
    Eye Chart at twenty feet (20) or an age
    developmentally appropriate chart at ten feet
    (10) feet outside a vision screening instrument,
    and

40
State of Arkansas House Bill 1734
  • 4. Visual screening instruments which include
  • Lateral muscle balance test at far
  • Vertical muscle balance test at far
  • Fusion or binocularity at far
  • Lateral muscle balance test at near
  • Fusion or binocularity at near, and
  • Color perception

41
State of Arkansas House Bill 1734
  • Eye exams
  • (a) (1) A child who does not pass the eye and
    vision screening tests, except for the color
    perception test, shall be required to have a
    comprehensive eye and vision examination
    conducted by an Optometrist or Ophthalmologist
    within sixty (60) days of receipt of the vision
    screening report identifying the need for the
    examination.

42
State of Arkansas House Bill 1734
  • The standardized forms shall include
  • A screening form
  • A parent notification form
  • A doctor report form
  • A form to report the results of screening and
    examination, and
  • Any other forms deemed necessary by the
    commission.

43
The Kentucky Law
  • A vision examination by an optometrist or
    ophthalmologist shall be required by the Kentucky
    Board of Education. The administrative
    regulations shall require evidence that a vision
    examination that meets the criteria prescribed by
    the Kentucky Board of Education has been
    performed. This evidence shall be submitted to
    the school no later than January 1 of the first
    year that the child is enrolled in public school,
    public preschool, or Head Start programs.

44
The Kentucky Experience
  • Educators response
  • Lawmakers response
  • Governors response

45
The Kentucky Experience
  • Martin L. Bell
  • Deputy of Superintendent
  • Jefferson County Public Schools (Louisville, KY)
  • The eye exam has been successful in finding
    numerous cases
  • of previously undetected eye and vision problems
    in children.
  • We firmly believe as the statute reads the vision
    exam must be
  • completed by and Optometrist or Ophthalmologist
    and meet the
  • criteria prescribed by the Kentucky Board of
    Education. We
  • would oppose any amendment that would be offered
    to the
  • statute to change this program. We have worked
    diligently
  • and cooperatively with our local Optometrists and
  • Ophthalmologist to see that nearly all young
    children are
  • examined.

46
The Kentucky Experience
  • Bill Scott, Executive Director
  • Kentucky School Boards Association
  • Schools can offer the most outstanding
    educational programs possible, but if children do
    not come to the school healthy and ready to learn
    they will miss the opportunities set before them
    to succeed. Our model of requiring every child
    entering public school for the first time to have
    an eye examination by and Optometrist or
    Ophthalmologist no later than January 1st of the
    school year is one that you may want to bring
    forth for replication in every state.

47
The Kentucky Experience
  • Tom Burch, Chairman-Health and Welfare
  • Kentucky House of Representatives
  • Conditions from brain tumors to Amblyopia have
    been diagnosed in children during the
    comprehensive eye exam required by Kentucky law.
    These conditions were not suspected by the parent
    or found on visits to the family doctor. The eye
    care provider community has been generous in
    assisting schools when these is a need and in
    helping low-income families obtain the exams.
    There is adequate access to Optometrist and
    Ophthalmologist who are willing to see children
    for these examinations. In the past six years, I
    have received no complaints from parents
    participating in this program.

48
The Kentucky Experience
  • Robert J. Bob Leeper, State Senator
  • Kentucky State Senate
  • As you know, I was somewhat hesitant of this
    mandate and anticipated a possible outcry from
    parents over this additional requirement. I am
    happy to report that after several cycles, I have
    yet to receive the first complaint.

49
The Kentucky Experience
  • Ernie Fletcher, M.D.
  • Governor, Kentucky
  • Our Commonwealth has made great strides in
    identifying and treating the vision ailments that
    have for too long limited the ability of many of
    our children to learn and make academic progress.
    Kentuckys attention to this issue serves as a
    model for other states that want to ensure that
    vision problems receive early attention.
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