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)