BUSINESS 101

Creating a Universal Approach

Children’s vision group works for better screenings

although early recognition of vision problems and eye diseases is critical in optimal treatment, eye health in children under age six is often not given the kind of priority it deserves. Besides getting children to see an optometrist or other eyecare provider, one of the biggest problems is a lack of consistency when it comes to screening recommendations in regards to frequency, referral criteria, and follow-up criteria.

A vision screening sponsored by the Essilor Vision Foundation
Photo courtesy of Essilor Vision Foundation

A CHALLENGE

The lack of standards for surveillance of children’s vision and eye health in the U.S. is yet another public health challenge. The National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness is currently addressing the challenges and seeking to improve the system. They believe there are many benefits that will come from creating a universal approach to children’s eye health.

“Vision screening is an essential element of a strong public health approach to preservation of vision and eye health,” says Kira Baldonado, director of the NCCVEH. “The benefit of uniformity in vision screening approaches used by public health professionals, educators, child care providers, and primary care staff leads to improved confidence in the vision screening outcome as well as improved coordination of care since all stakeholders on the vision health spectrum would be ‘speaking the same language.’”

In turn, that improved coordination of care also leads to better follow-up, Baldonado adds. And uniformity in screening approaches allows for consistency in data that can be collected from the screening.

That can lead to opportunities for public health surveillance and identification of populations that need further interventions to reduce the incidence of eye disease, she explains.

CREATING AN EFFECTIVE PROGRAM

According to Baldonado, there are a number of factors that are important in creating a successful vision screening program. These include programs that:

Utilize age-appropriate and scientifically validated devices and approaches.



Provide understandable results to the person or caretaker of the person being screened.



Have a defined follow-up to care component to ensure follow-through on the referral.

The NCCVEH was created for the very purpose of improving the screening programs on a universal level. In 2009, Prevent Blindness was awarded a grant from the Maternal and Child Health Bureau at the Health Resources and Services Administration of the U.S. Department of Health and Human Services to establish the NCCVEH. The mission of the Center has been to develop a coordinated public health infrastructure to promote and ensure a comprehensive continuum of vision care for young children.

Among its efforts so far, the NCCVEH has convened a National Expert Panel (NEP) comprised of leading professionals in the ophthalmology, optometry, pediatrics, public health, and related fields to review the most current literature and develop consensus on the best approach to children’s vision care.

Recently, the NEP published recommendations providing an evidence-based approach to vision screening in children ages 3 to 5, as well as system-based public health strategies to ensure improved surveillance and screening program accountability.

“It is our hope that…the recommendations of the National Expert Panel to the National Center for Children’s Vision and Eye Health at Prevent Blindness will encourage eyecare providers to serve as leaders for change within their own state in the development of a comprehensive public health system to serve children’s vision and eye health,” Baldonado says. “Eyecare providers must be at the table when states discuss data system approaches, measures of program performance, and tactics to improve early identification of vision problems and family education.”

POSITIVE CHANGES

The NCCVEH says there are several key ways that eyecare practitioners can take action right away. These include:

Identifying gaps in the delivery of vision services, in data collection, and in state performance measures.



Clarifying confusion or lack of understanding of existing state laws, mandates, and protocols to align vision screening guidelines in your state.



Establishing a support system for your improved vision health approach, which may include hiring new program staff or establishing a technical advisory body.

With more eyecare providers invested in reaching children at a younger age, it’s possible that many of the common vision problems can be prevented or at least better managed.

— Lindsey Getz

RECOMMENDATIONS FOR PRESCHOOL-AGE CHILDREN

A summary of the recommendations from the National Expert Panel to the NCCVEH include:

Children should be screened annually (best practice) or at least once (acceptable minimum standard) during the interval between their third and sixth birthdays.



Vision screening requires training and certification of screening personnel with recertification of personnel completed every three to five years.



Screening results must be recorded and effectively communicated to the child’s parents, and to the medical home/primary care provider, the school, and necessary state agency, with subsequent referral for examination and treatment when indicated. Exam outcomes should be shared among key stakeholders with patient permission.



Specific data systems must be established to facilitate this process and programs should monitor overall system performance at the state and national level via specific measures to ensure that screening goals are met (including referral to eyecare professionals).

Screenings can be a first good step to comprehensive care—everybody’s end goal