Healthy People 2010, the national prevention initiative developed by the US Department of Health and Human Services, places special emphasis on the importance of vision which states that the national goal is to
improve the visual health of the nation through prevention, early detection, treatment, and rehabilitation.
Healthy People 2010 has a full chapter devoted to eye health and safety. Four of its 10 “vision” goals support the vision screening training and certification program goal of PBO in this project:
Increase the proportion of persons who have a dilated eye examination at appropriate intervals.
Increase the proportion of preschool children aged five years and under who receive vision screening.
Reduce uncorrected visual impairment due to refractive errors.
Reduce blindness and visual impairment in children and adolescents aged 17 years and under.
According to the Ohio Department of Health’s most recent School-Aged Vision Screening Survey in 2002-2003, 7.9% of children in kindergarten and 7.1% of children in first grade failed a vision screening (approximately 20,000 children), thus indicating a potential eye problem that was not detected and treated in the preschool years. State-Negotiated Performance Measure #15 for the Ohio Department of Health’s 2000-05 MCH Block Grant was to decrease the percentage of children in Kindergarten and 1st grade failing a vision screening through improving and increasing training on vision assessment and referral for primary care providers and increasing public/parent awareness of the important and need for early and professional eye care for children.
State-negotiated performance measure #9 for the 2006-10 Ohio Department of Health’s MCH Block Grant is: Increase the proportion of children who receive age- and risk-appropriate screenings for lead, vision, and hearing.
The need for improving and increasing training on vision assessment and referral for primary health care providers is further documented by a study conducted by the Ohio Department of Jobs and Family Services of Ohio Medicaid managed care plans for SFY 1999, which indicated that only 35% of children received the required vision assessment during their HealthChek visit. A similar study of Ohio Medicaid fee-for-service providers indicated that only 16% of children received a vision assessment during their HealthChek visit.
In a 1996 survey conducted by the Ohio Department of Health, Children’s Hospital Columbus and Prevent Blindness Ohio, 41% of primary care providers in Central Ohio do not vision screen three year olds and 33% of providers do not screen five year olds. The same survey determined that 46% of the primary care practices that do vision screening agreed that their vision screening could be improved via updated techniques, training and equipment.
Unfortunately, most parents are unaware of the importance of having their child’s vision examined on a regular basis prior to age 5 or 6 (when the child enters kindergarten and is required to participate in a vision screening). One of the most logical places to conduct vision screenings for preschool children is in the primary health care setting, as the child is regularly examined for well-child check ups.
It is imperative and required that vision screenings be performed in these primary care settings, and PBO plans to continue to assist Medicaid providers and their staff with this initiative by informing them of the training and equipment opportunities available and targeting this population for inclusion in the proposed SOS-funded program. During SFY 2007, PBO sent a mailing to all pediatric Medicaid providers in Ohio (over 4,000) informing them of the opportunity to attend a preschool vision screening training in selected cities (Ashland, Athens, Barberton, Bowling Green, Cleveland, Columbus, Fayetteville, Goshen, Lorain, Miamisburg, Toledo, Zanesville). A total of 13 trainings are scheduled.
Children under the age of six who do not receive proper and regular vision screenings and eye examinations are at risk of facing a lifetime of vision loss due to several common and correctable visual difficulties. Amblyopia (lazy eye) and strabismus (crossed eyes), if not detected and treated early enough, can cause loss of vision. Fortunately, if these diseases are detected and treated before the age of six, their blinding effects can be reversed, often with fairly simple treatment (i.e. covering the "good" eye with a patch to force the "lazy" eye to be used.) Sadly however, after the age of six, little effective treatment is available, and the child is faced with living his/her life with only one good eye (monocular vision).
It is estimated that amblyopia is responsible for loss of vision in more people younger than 45 years than all other eye diseases and trauma combined. Monocular vision eliminates the ability to view the world with depth perception, increases the susceptibility to accidents, makes certain sports activities difficult to play because of problems with coordination, and eliminates certain career choices. With only one "good" eye, the child is left more vulnerable and at risk for total blindness should sight be lost in the "good" eye due to disease or an accident.
If more primary health care professionals routinely provided vision screening at well-child visits, the percent of children with undetected and untreated vision problems upon entry to school will decrease. It is easier to teach professionals these skills in the context of their early educational environment, thus the need for medical education for family practice residents, pediatric residents and nurses/nursing students on children's vision health/safety/screening.
Parker, S. , “Comprehensive Adult Eye and Vision Examination”, American Optometric Association’s Clinical Practice Guideline, 1994. Original Source: “The Eye and Seeing”, rev. ed., Franklin Watts, New York, 1989, p. 4.
Navon, SE, and McKeown, CA: Amblyopia. International Ophthalmology Clinic, 22(1): 35-50, 1992.