Project Universal Preschool Vision Screening: A Demonstration Project

Abstract

OBJECTIVES. Visual disorders among preschool-aged children are common, yet screening is infrequent. The purpose of this project was to implement the vision screening recommendations proposed by the Maternal and Child Health Bureau and National Eye Institute Vision Screening in the Preschool Child Task Force: monocular visual acuity and stereopsis testing.METHODS. Four sites fully participated in the implementation of the task force recommendations with 3-and 4-year-old children. Two of the sites worked with primary care practices (testing performed by staff); 2 worked with communitybased programs (testing performed by lay volunteers). Each site tracked number of children screened by age, as well as proportion testable, referred, and with documented follow-up evaluation.RESULTS. Variations in implementation of the recommendations were observed. Successful screening among 3-year-olds ranged from 70% to 93%; referral rates were 1% to 41%, and follow-up rates were 29% to 100%. Successful screening among 4-year-olds ranged from 88% to 98%; referral rates were 2% to 40%, and follow-up rates were 41% to 100%. The proportion of 3-year-olds who were treated was significantly different between the community-based sites (n ϭ 20) and the primary care sites (n ϭ 2). Similarly, the proportion of 4-year-olds who were treated was significantly different between the community-based sites (n ϭ 36) and the primary care sites (n ϭ 11).CONCLUSIONS. The variability across pilot sites in numbers successfully screened and numbers referred suggests that all aspects of preschool vision screening need thorough review before the goal of universal preschool vision screening can be realized. 5 In a joint policy statement with the AAO, the AAPOS, and the American Association of Certified Orthoptists, the AAP recommended that physical inspection of eye functioning and overall eye health begin at birth and that "objective evaluation" of acuity be initiated by 3 years of age. 6 As many as 34 states have endorsed programs for vision screening to improve the rates of preschool vision screening. 7,8 However, there is state-to-state variability regarding whether the programs are mandated, as well as how they are implemented. In addition, studies in primary care settings indicate that few preschool-aged children are screened for vision problems. [9][10][11] In 1998, the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), collaborated with the National Eye Institute (NEI), National Institutes of Health (NIH), and various national and state agencies to review research and policies related to vision screening in preschool-aged children. The specific mission was to determine "useful screens to efficiently detect amblyopia risk factors and other significant problems" and "to provide and evaluate the practicality and effectiveness of ocular screening services for young children, including photoscreening technology." An expert panel, the MCHB/NEI Preschool Vision Screening Task Force, was convened in Septem...

Vision screening in preschoolers: the New South Wales Statewide Eyesight Preschooler Screening program

“…[71] The results showed that significantly more children were referred and treated following a communitybased screen than a primary care practice screen. Unfortunately, the authors could only speculate as to why this occurred, suggesting that perhaps lay screeners were more conservative, or that nurses and doctors lacked an understanding of the systematic screening of young children.…”

“…The studies reported that orthoptists were effective screeners; [68] that health visitors were just as effective as orthoptists; [27] that nurses achieved better results than teacher questionnaires, [57] similar results to optometrists, [69] and results of sufficient specificity and sensitivity to be considered primary screeners [10]; that parents were effective administrators of vision tests in the home, [70] and that referral and treatment rates differed substantially between lay screeners and primary care practitioners, although little information was provided as to why this was the case. [71] The final non-randomised controlled trial, examining screening in children aged six years and over, concluded that nurses could perform the role of primary screener with appropriate training from other eye health professionals. It was reported that training was particularly required for the detection of strabismus [72] and it was hoped that this training would address the high false positive rate obtained by the nurses in the study.…”

Preschool Vision Screening in Primary Care Pediatric Practice

“…12 Barriers to primary care vision screening may include deficiencies in reimbursement, incomplete primary care education in screening, and limitations of the testing techniques themselves. 12,13 Problems have been reported with primary care screening related to screening penetrance, testability, and referral. 13,14 Evidence for the real-world effectiveness of preschool vision screening in the primary care setting is lacking.…”

“…12,13 Problems have been reported with primary care screening related to screening penetrance, testability, and referral. 13,14 Evidence for the real-world effectiveness of preschool vision screening in the primary care setting is lacking. 15 Therefore, the Children's Eye Foundation (CEF), the charitable foundation of AAPOS, established its See by Three program with the goal of significantly reducing amblyopia in young children.…”

The visual status of children ages 3 to 6 years in the vision screening program in Taiwan

“…1 Visual plasticity is limited to a critical early period in life, and preschool vision screening programs or recommendations have been discussed in several articles. [2][3][4] In addition, uncorrected refractive error, such as myopia, recently has been identified as a significant visual problem in children. 5 Myopia is also a major public health concern in Taiwan, which has a 20%, 61%, and 81% rate of prevalence among schoolchildren ages 7, 12, and 15 years, respectively.…”