REQUIRED VISION EXAMINATIONS AND VISION SCREENINGS FOR CHILDREN: CURRENT RESEARCH

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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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

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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

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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

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www.2020advocacy.com

• www.2020advocacy.com
• Links
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  Help
• Contact us Take action now

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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

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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

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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.

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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

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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.

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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.

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Eye Exams for ChildrenTheir Impact and
CostEffectivenessAlan J. White, Ph.D.Prepared
by Abt Associates for the Vision Council of
America
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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.

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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.

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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.

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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.

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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
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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.

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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.

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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.

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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.

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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.

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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.

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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

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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

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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

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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.

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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.

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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.

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The Kentucky Experience

• Educators response
• Lawmakers response
• Governors response

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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.

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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.

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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.

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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.

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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.