Our Vision That all children receive comprehensive vision care within an established continuum of care; and that all pediatricians, family practice providers, and other healthcare professionals dealing with children, adequately address vision and eye health during their regular course of patient services.

What We Know

• While it is understood that early identification and treatment of health problems typically reduces complications and leads to improved healthy outcomes, according to a recent report from the Centers for Disease Control and Prevention (CDC), only one in three children in America has received eye care services before the age of six.¹




• Although policies and guidelines exist, fewer than one half of all children are screened in pediatric offices, and currently only 21 percent of preschool-age children are screened for vision problems.^2,3




• A recent study involving children with special healthcare needs found that those who are patients of pediatricians had a lower risk of unmet need for vision care than those with other types of providers.⁴




• A leading preschool vision screening study recommends that methods be developed to improve communication between eye care specialists and primary healthcare professionals about an individual child’s eye problems.⁵

Our Positions

Prevent Blindness America supports a healthcare delivery system that includes a continuum of eye care for children, to include both vision screening and comprehensive eye examinations.⁶ All children, even those with no signs of trouble, should have their eyes checked at regular intervals. Based on the recommendations of key health organizations, we endorse a combination of screenings and exams, utilizing the following timetables, for children’s vision and eye health:

• Any child who experiences vision problems or shows symptoms of eye trouble at any time should receive a comprehensive eye examination by an optometrist or an ophthalmologist.




• Newborn infants should have their eyes checked while still in the hospital nursery. This examination in the nursery should be for general vision and eye health and include a red reflex test. This examination can help detect several congenital eye problems, some of which can be very serious and permanently threaten vision.
• During regular well-baby exams, from birth to 2 years of age, pediatricians should use history and a vision evaluation to see if vision problems exist. Beginning at well-child exams at age 3 and continuing through 10 years of age, vision screenings should be performed assessing visual acuity and ocular alignment.




• If a child fails a vision screening or there is any concern of an eye or vision problem the child should be referred for a comprehensive professional eye examination.

This combination of primary care physician eye examinations and vision screenings with referral for a comprehensive professional eye examination is the recommendation of the American Academy of Family Physicians, the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Association of Certified Orthoptists and the American Association for Pediatric Ophthalmology and Strabismus.⁷

The American Optometric Association supports primary care physician evaluations and regularly scheduled vision screenings, but also recommends that asymptomatic/risk free pediatric patients should have a comprehensive examination at age 3 followed by another examination before first grade and at least every 2 years thereafter. They further recommend, however, that vision screening programs that are well-designed and properly administered in public or private schools should be utilized to assist in the identification of children in need of care who have not had access to comprehensive examination services.⁸

There are several key professions which play a vital role in the vision and eye healthcare of our nation’s children. Among these are primary care providers, eye care professionals, school nurses and low vision specialists.

Primary Care Providers

Primary care providers (specifically pediatricians and family care providers) have the most regular contact with preschool-age children. Well-child visits provide an excellent opportunity for the early detection of vision-related problems in children. It is during these well-child visits that children should receive an evaluation of their vision and eye health, including an overview of family history, objective vision screening and physical assessment of the eyes.

Prevent Blindness America supports the American Academy of Pediatrics’ policy promoting the “medical home” – a belief that the medical care of infants, children and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective; and that it should be delivered or directed by well-trained professionals who provide primary care and help to manage and facilitate essentially all aspects of pediatric care. Such a level of care should be available to all children, regardless of family income.⁹

Eye Care Professionals

A professional eye examinations by an ophthalmologist or an optometrist is, without doubt, the “gold standard” of eyecare and should be at the forefront of children’s vision and eye health. Eye examinations not only identify eye and vision-related disorders, but can also potentially serve as systemic indicators of overall health and wellness through linkages with various chronic disease states and health-related conditions.

Although screenings can help to determine which children might have an eye disorder, a comprehensive eye examination is necessary to make a formal diagnosis prior to initiating treatment.

While the concept of the medical home is ideal, to ensure appropriate vision care is available and accessible to the medically underserved, Prevent Blindness America supports the expansion of services within Federally Qualified Health Centers and other community health centers, to include vision care; and the inclusion of doctors of optometry in the outreach efforts of the Agency for Healthcare Research and Quality, the United States Preventive Services Task Force and the National Health Services Corps.

Prevent Blindness America also applauds efforts of the professional associations and private sector providers to engage their respective members in programs to educate the public and increase access to eye care. Efforts such as the American Academy of Ophthalmology’s Eye Care America®, the American Optometric Association’s InfantSEE® and VSP Vision Care’s Sight for Students educate and serve the public while simultaneously enhancing the connection between eye care professionals and their communities.

School Nurses

School nurses play a critical role in the continuum of vision and eye healthcare. For many students, a school-based vision screening may be the only opportunity they have to assess their vision. While many states have varying levels of screening requirements, Prevent Blindness America endorses the National Association of School Nurses’ policy of encouraging all nurses to conduct screenings, even when not required by the state.¹⁰

Beyond the screening itself, school nurses are appropriately situated to assist children and families in understanding vision conditions and in accessing care through referral to appropriate eye care professionals and vision-specific programs, agencies and services. They can also assist teachers and fellow students in understanding situations related to a child’s vision care, such as patching.

Vision Rehabilitation Specialists

The role of this classification of eye care professional cannot be minimized. While it should certainly be our goal to reduce the number of children with any vision loss, vision rehabilitation specialists train children with vision impairments to better use the vision they do have.

Communication among all the professionals involved in a child’s vision care is critical to closing the loop on the continuum of eye care, as well as to supporting the concept of a medical home. Sharing of information related to screening results, diagnoses, treatments and outcomes (compliant with HIPAA standards) must be encouraged and facilitated.

Our Efforts

In the best interests of the nation’s children, Prevent Blindness America commits to supporting healthcare professionals and advancing vision care in public health policies and primary healthcare delivery systems by:

1. Increasing the implementation of vision screening in the pediatric office setting by fully developing a replicable vision screening and training program for pediatric primary healthcare providers, utilizing the Preschool Vision Screening for Healthcare Professionals manual developed collaboratively between the American Academy of Pediatrics and Prevent Blindness America.




2. Working with the American Academy of Pediatrics to ensure the inclusion of appropriate vision and eye health coverage in the Academy’s Bright Futures initiative.




3. Working with members of Congress and partner organizations toward the passage of the Vision Preservation Act, with key pediatric vision and eye health strategies and goals included as appropriate.




4. Pursuing and securing federal funding for pediatric vision screening and public health programs from the SPRANS (Special Projects of Regional and National Significance) Program within the Labor, Health and Human Services (LHHS) Appropriations Bill.




5. Monitoring federal legislation pertaining to children’s vision loss prevention and, as appropriate, responding to ensure greatest access to prevention and treatment of vision problems.




6. Creating and implementing a communications action plan targeting pediatricians and the vision industry to further build Prevent Blindness America’s positioning as a referral source and advocate of vision loss prevention for children.




7. Working to increase the number, consistency and adequacy of health plans that include vision care benefits, including reimbursement for vision assessments conducted in physicians’ or optometrists’ offices.




8. Promoting communication across professions, as it relates to children’s vision and eye health.




9. Sustaining and/or increasing government and private funding to support efforts to improve children’s vision and eye health.




10. Sustaining and/or increasing federal funding for the CDC National Vision Program within the LHHS Appropriations Bill.




11. Working toward the reinstatement of optometry as a covered profession under the National Health Services Corps.




12. Undertaking an analysis of the current availability of eyecare providers to fulfill the existing need for services.

References

1. Centers for Disease Control and Prevention. Visual impairment and use of eye-care services and protective eyewear among children – United States, 2002. MMWR 2005;54(17):425-429.

2. Schmidt P. Current screening programs. In: Hartmann E, ed. Vision Screening in the Preschool Child: Proceedings of a Conference Held September 10-11, 1998. Bethesda, MD: Genetic Services Branch, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services; 1999.

3. Poe GS. Eye Care Visits and Use of Eyeglasses or Contact Lenses. United States 1979 and 1980. Hyattsville, MD: US Department of Health and Human Services; 1984. Vital and Health Statistics Series 10, No. 145. DHHS publication 84-1573.

4. Heslin KC, Casey R, Shaheen MA, Cardenas F, Baker RS. Racial and ethnic differences in unmet need for vision care among children with special health care needs. Arch Ophthalmol. 2006;124:895-902.

5. Hartmann EE, Bradford GE, Chaplin PK, Johnson T, Kemper AR, Kim S, Marsh-Tootle W; Project universal preschool vision screening: a demonstration project. Pediatrics. 2006;117:226-237.

6. Prevent Blindness America. Guidelines for Children’s Vision Health Position Statement. http://www.preventblindness.org/children/child_position_statement.html.

7. American Academy of Pediatrics. Eye Examination in Infants, Children, and Young Adults by Pediatricians. http://aappolicy.aappublications.org/cgi/reprint/pediatrics;111/4/902.pdf.

8. American Optometric Association. Optometric Clinical Practice Guideline: Pediatric Eye and Vision Examination. http://www.aoa.org/documents/CPG-2.pdf.

9. American Academy of Pediatrics. The Medical Home Policy Statement. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;110/1/184.

10. National Association of School Nurses. School Vision Screening Issue Brief. http://www.nasn.org/Default.aspx?tabid=284.