As much of our energy is focused the “big” policy issues of coverage and the implementation of the Affordable Care Act, an often overlooked health issue for children is vision care. Vision issues impact 5 percent to 10 percent of the nation’s preschool aged children and disproportionately impact children of color and children with special health care needs. This issue may seem small in number, but children with preventable vision issues (the majority of which can be corrected if identified by the age of 3) deserves “all eyes on them.”
So why do so many children go undetected? Kira Baldonado, Director, National Center for Children’s Vision & Eye Health at Prevent Blindness, attributes the problem broadly to inconsistent vision screenings, lack of coordination and a need for national guidelines.
Vision screenings vary widely
There are varying rates of vision screening state to state. According to the National Survey for Children’s Health, approximately 74.5 percent of 4 to 5 year olds in the New England region had their vision tested in 2011-2012 – this is the nation’s highest screening rate while other regions fall well below ranging from 36.3 to 44.3 percent in the Great Lakes, Midwest, and South-Central regions. In addition, the tools that providers use to screen children vary within and across states and depend upon the screening setting. To add complexity, vision screening is more than identifying shapes at the end of a hallway. Additional tests such as stereopsis screening are important for detecting amblyopia (lazy eye) or strabismus (crossed eyes)—conditions that can lead to blindness if not detected early.
Lack of systems of coordination and communication
Vision testing can occur in multiple settings: a pediatrician’s office, a school, a childcare center or as a part of a community-based effort. This can result in multiple communications to parents and differing results. Most states lack a systematic approach to vision screening surveillance where data is captured in a single format and is accessible across multiple settings (Ohio stands out as a leader). There is also a lack of communication with the public about the importance of vision screenings, comprehensive exams and treatment. Children and their families must be at the center of care, but also must be partners in elevating the issue of vision health. (We illustrate one way to do this below.)
Maternal and Children’s Health Bureau and its partner Prevent Blindness America are spearheading a National Center for Children’s Vision and Eye Health that will provide recommendations for establishing national guidelines for children’s eye health.
Moving Vision Issues on the Ground
Massachusetts is a leader in elevating the importance of vision screening and treatment. Children’s Vision Massachusetts seeks to advance the practice of appropriate vision screening and treatment for children and insure that all children have the opportunity to develop and retain their best possible vision to support healthy development and academic success. The coalition works through multiple approaches including public education, workforce training, and facilitating greater coordination and communication across care settings.
Cognizant that pediatricians have the greatest access to children ages zero to five, the Pediatric Physicians’ Organization at Children’s (PPOC) and Children’s Vision Massachusetts decided to better understand what was happening in the pediatric office setting. Through a survey and chart review of their pediatric practices, they found that approximately 63 percent of 3, 4, and 5 year old children were vision acuity screened during well visits. Armed with this information, PPOC and Children’s Vision Massachusetts embarked on a massive education effort to train pediatric practices on proper vision screening techniques and better understand the implementation barriers. PPOC continues to monitor the success of their efforts and proactively engage their pediatric practices to ensure continued support for vision screenings for our youngest children. We applaud the transparency of PPOC in its efforts to improve the quality of pediatric care delivery.
This past month, Children’s Vision Massachusetts began a campaign to tell their story. We are proud to share their efforts! It teaches us not just the value of children’s vision but also the value of working with a diverse group of stakeholders: early childhood educators, school nurses, pediatricians, optometrists, ophthalmologists and other vision providers, AND, most importantly, the children and families impacted.
Children’s Vision Massachusetts documented the value of vision screening for the public as a part of their work for the American Academy of Pediatrics. Leveraging their pediatrician supporters and optometrist and ophthalmologist partners, they began to tell the narrative of child vision. Advocates developed a series of stories of children and families and ultimately, developed this public education video that highlights vision health through the eyes of children. We are very proud to support Children’s Vision Massachusetts as they begin this important work. They are at the initial stages of educating the public, bringing diverse stakeholders to the table, and developing a stronger uniform system that ensures that every child has a vision screen before entry to school (the US Preventative Task Force (USPTF) now recommends age 3). We invite you to spread the word that children’s vision matters: It opens eyes and opens doors.