Child Vision Screening

1. Child Vision Screening A partnership between Virginia Chapter, American Academy of Pediatrics And Prevent Blindness Mid-Atlantic

2. Objectives • Outline the partnership between VA AAP and Prevent Blindness Mid-Atlantic to provide appropriate vision screening for visual impairment to children in schools and pediatric offices. • Provide observations on quality assurance in child vision screening. • Present issues for universal vision screening.

3. Visual impairments • Amblyopia: a developmental brain impairment that results from either no transmission or inadequate transmission of visual images for a sustained period during early childhood • Estimated between 1 to 5% of population in children under age 8 to 10.

4. Visual impairments in infancy and childhood • Congenital cataract • Congenital glaucoma • Strabismus • Retinopathy of prematurity • Optic nerve atrophy/ other retinopathy • Refractive errors

5. Opportunities for identification of visual impairment • MEDICAL HOME for pediatric trained physicians: • Newborn exam • Well baby and child exams (Early and Periodic Screening, Diagnosis, and Treatment – EPSDT) • Preschool health entry form completion (school physical) at 4 or 5 • Parental concern

6. Opportunities for identification of visual impairment • School and community screening by Prevent Blindness Mid-Atlantic • Optometric examinations • Parent education on signs of visual impairment

7. American Academy of Pediatrics Policy Statement • Joint policy statement of AAP, Amer Assoc of Certified Orthoptists, Amer Assoc for Pediatrics Ophthalmology, and Strabismus, and Amer Acad of Ophthalmology. • “Eye examination in infants, children, and young adults by pediatricians” Pediatrics, Vol 111 (4), April 2003

8. American Academy of Pediatrics Policy Statement • …ensure that eye examinations are performed using appropriate testing conditions, instruments, and techniques. • …newborns should be evaluated for ocular structure abnormalities. • …children should have eye examinations on a regular basis age 3 and above. • … results should be clearly communicated to parents. • … children with abnormality should be referred to an appropriately trained eye specialist.

9. Virginia School Health Entry Forms School health entry form required for admission of a child to any school in the Commonwealth for preKindergarten (4 years) or Kindergarten and above • Requires visual acuity screening • Requires stereopsis testing (random dot E) Implemented without legislation by Virginia Department of Health based on Bright Futures (AAP)

10. Pediatric Office Screening – Quality Assurance • Most visual screening in pediatric offices is performed by RNs, LPNs, certified clinic assistants, or on the job trained staff. • Equipment used and screener skills are variable (Titmus, Snellen Charts) • Stereoposis testing variable although VA AAP recommends the Random Dot E test available from Prevent Blindness Mid-Atlantic.

11. Certified Vision Screening Training by PBMA • Prevent Blindness offers nationally certified screener training for pediatric office nursing staff. • Kaiser Permanente pediatric nursing staff • Project Universal Preschool Vision Screening provided training and certification to staff of 3 large practices in the Richmond area (AAP Grant) • Training offered to other pediatric practices • Appropriate vision screening materials available from PBMA.

12. Certified Vision Screeners in School and Community • Over 80 percent of preschool and school age children do not receive a PBA or AAP approved vision screen. • Prevent Blindness Mid-Atlantic trains and certifies school nurses, health professionals, and school volunteers. • Prevent Blindness Mid-Atlantic provides each school, with certified trainers, a screening kit containing all the components for acuity testing and the Random Dot E kit.

13. Prevent Blindness Mid-Atlantic Vision Screening • PBMA programs have provided free vision screening for over 220,000 (63%) children in grades K, 3, 7, and 10 per year • Prevent Blindness Mid-Atlantic Programs are funded through proceeds from special fund raising events and private donations. • Lions Club International is a primary sponsor.

14. Inclusion in Virginia Budget Due to high visibility of PBMA, Virginia Governor Kaine’s Budget included funding for school screening programs. Virginia General Assembly approved $87,000 in the Commonwealth’s budget beginning in July 2007 to support Prevent Blindness Mid-Atlantic school programs (certification training and screening kits)

15. Issues for Child Vision Screening • Prevention of visual impairments requires assessment for all children at all ages. • Physician office screening may not meet PBA or AAP standards (quality assurance) • Health plan benefits or reimbursement for vision assessment in physician or optometrist offices not consistent or adequate, leading to no or limited screening. • Funding for school based screening programs is mostly supported by charitable donations.

16. Virginia’s Initiatives • Strong partnership between Prevent Blindness and VA AAP • Jointly promote PBA and AAP Policy recommendations • Provide training and certification to physician office staff to assure appropriate screening • Provide school based vision screening by certified staff and volunteers within the limits of charitable donations.

17. Prevent Blindness Mid-Atlantic • Edward Hutson Titmus, Jr., Center for Sight 11618 Busy Street, Richmond, VA 23236 • 1 888 790 2020 • www.TheEyeSite.org • Tim Gresham, CEO • Leslie Ellwood MD FAAP, Prevent Blindness Mid Atlantic Advisory Committee Chair (lellwood@cox.net)