Our Vision That the proper role of vision screening in the continuum of children’s vision and eye health is universally understood; and that a uniform set of vision screening protocol is established and accepted as the gold standard for vision screening.

Healthy People 2010 Goal

The U.S. Department of Health and Human Services has established a framework for prevention for the nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. Objective 28-2 (Vision Screening for Children) establishes a goal of increasing the proportion of preschool children aged 5 years and under who receive vision screening.

What We Know

• The Partnership for Prevention, in reviewing the U.S. Preventive Services Task Force’s listing of recommended clinical preventive services, found that pediatric vision screening is inexpensive, treatment is effective and it improves the quality of life. The U.S. Preventive Services Task Force recommends screening to detect amblyopia, strabismus and defects in visual acuity in children younger than five years of age.¹




• A leading preschool vision screening study notes that vision screening is critical to the welfare of our children and can have an impact not only on vision and eye health but also on social development and productivity.²




• This same study notes that a national consensus about the adequacy of current methods for preschool vision screening has not been reached, and recommends certification and recertification programs for individuals who conduct vision screenings should be further developed to improve accurate and reliable implementation of screening and referral guidelines in both community and primary care settings.³




• From 2002-2007 Prevent Blindness America-certified vision screeners screened more than 11 million children, referring almost 935,000 for comprehensive eye care. Many of these children would have otherwise gone undetected.




• While Head Start currently requires children to be screened for vision problems, there is no consistent protocol for training, tracking or even conducting the screening. Such a lack of uniform national standards could cause many Head Start enrollees to fall through the cracks.

Our Positions

Prevent Blindness America acknowledges that professional eye examinations are the “gold standard” of eye care and should always be encouraged, but we also believe that vision screening is an appropriate and essential element of a strong public health approach to children’s vision care. The purpose of vision screening is to increase the number of children in need of care who ultimately receive comprehensive eye exams.

While we fully support the role of primary healthcare professionals and school nurses in conducting vision screenings, we also believe that community and school-based screenings conducted by trained vision screeners and utilizing a scientifically-validated and approved screening protocol enhance the public health model of vision care.

Prevent Blindness America and other volunteer-based organizations often perform vision screenings for children at schools, daycare centers and other settings. While vision screenings and eye examinations are complementary approaches to assessing the eye problems of a child, a screening is used to identify a child at risk for vision problems and does not replace a comprehensive examination performed by an eye doctor.

The role of vision screenings in the continuum of vision and eye healthcare is fully supported by 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.⁴

While the American Optometric Association recommends that all pediatric patients should have regular comprehensive eye examinations throughout childhood, they further suggest that well-designed and properly administered vision screening programs 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. The Association does, however, raise a concern that potential under referrals resulting from poor screening efforts jeopardize the effectiveness and credibility of well-designed and administered screening endeavors.⁵

Prevent Blindness America agrees that the key to successful vision screening programs is that they be well-designed and properly administered. Otherwise, they fail in their intended role to advance children’s vision and eye health care. Unfortunately, while a comprehensive eye examination is understood to include an evaluation of the refractive state, dilated fundus examination, visual acuity, ocular alignment, binocularity and color vision testing where appropriate, similar standards for vision screening do not uniformly exist; nor do integrally-related standards for ensuring follow-up care. This can allow for wide deviations in protocol and administration.

In order to ensure effective, quality pediatric vision screenings, Prevent Blindness America calls on the vision community to rally around a standard national protocol for vision screenings. We further believe that the Prevent Blindness America protocol should serve as the standard for volunteer-based screenings, as it relies on the guidance of a cadre of leading experts and is based on the continual review of scientifically-validated advances in vision and eye care.

To ensure our vision screening program is well-designed, Prevent Blindness America relies on the guidance of its Pediatric Vision Advisory Committee, which is made up of leading experts in child health and vision care from across the country, including ophthalmologists, optometrists, pediatricians, public health strategists, and vision and eye health researchers. To ensure our protocol is properly administered, Prevent Blindness America sponsors a unique national certification program for children’s vision screening and vision screening training. This certification is a central element to Prevent Blindness America’s program offerings and, as such, the designated minimum protocols must be strictly followed in order to maintain certification.

Prevent Blindness America’s approved vision screening protocol includes distance visual acuity testing and stereopsis testing using approved tools, as well as observation of the child and the child’s eyes. Additionally, a critical component of the screening is the referral for a comprehensive exam upon the suspicion of any potential problems, as well as appropriate follow-up with the child and the child’s caregiver. Further, it is always pointed out that a screening is not a comprehensive exam and should not be seen as replacing one.

(See Appendix B for the Prevent Blindness America Pediatric Vision Screening Program Protocol)

Our Efforts

In the best interests of the nation’s children, Prevent Blindness America commits to promoting well-designed, properly-administered vision screenings as an integral part of a public health approach to children’s vision and eye health by:

1. Regularly reviewing and updating its pediatric vision screening, training and follow-up protocols to ensure they are aligned with the most recent scientifically-validated approaches, embrace a public health philosophy and promote the full continuum of care.




2. Pursuing a core performance measure for children’s vision screening through the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services.




3. Seeking opportunities for connecting vision screening training programs to related continuing education programs.




4. Maintaining a national instructor, trainer and screener certification process, including the distribution of certificates and the auditing of field programs.




5. Continuing as a leading partner in VSP Vision Care’s Sight for Students program.




6. Seeking opportunities to partner with national, regional or local organizations and individuals to provide free or low-cost services to uninsured and underinsured children.




7. Working with the Office of Head Start at the Administration for Children and Families to ensure that existing regulations requiring that all Head Start enrollees be vision screened are fulfilled in a manner that promotes consistency and quality in protocol and administration.




8. Working with professional organizations to encourage all ophthalmologists and optometrists to close the loop on the screening process by returning all screening referral letters to the designated screening organization and/or primary care provider.

References

1. U.S. Preventive Services Task Force. Screening for Visual Impairment in Children Younger than Age 5 Years. http://www.ahrq.gov/clinic/3rduspstf/visionscr/vischrs.htm.
2. 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.
3. Ibid.
4. 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.
5. American Optometric Association. Optometric Clinical Practice Guideline: Pediatric Eye and Vision Examination. http://www.aoa.org/documents/CPG-2.pdf.