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Children’s Vision Month marks progress, some setbacks in exam initiatives
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May marks the National Eye Institute’s Children’s Vision Month, serving as a reminder of an initiative that continues to gain momentum year-round. Although no legislation has recently been passed that would mandate comprehensive vision exams, the individual states have continued to make steady progress toward achieving this goal.
Georgia: bill tied to funding
According to Georgianne Bearden, executive director of the Georgia Optometric Association, a resolution was passed during the 2002 legislative session to form a study committee examining the issue.
“The study committee had three meetings during the interim, so they could take testimony from experts from across the country and then present a report to the senate with recommendations,” Ms. Bearden told Primary Care Optometry News. “The committee recommended that every child entering a Georgia public school, whether pre-kindergarten, kindergarten or Head Start, should have a comprehensive eye exam before starting school.”
At the federal level, Ms. Bearden said, bipartisan legislation was introduced with the idea in mind that states would be able to apply for grants to pay for children’s eye exams.
“Right now, our state is like the others — we are in a financial bind as far as funding is concerned,” Ms. Bearden said. “Georgia, unfortunately, is in a position where they are going to cut back on children’s health care, our Peach Care program, Medicaid, all of it.”
Because of this lack of funding, Ms. Bearden said, the federal legislation began to seem like a viable solution. At the recommendation of Sen. Gloria Butler, the GOA opted to prepare legislation that would be tied to the $75 million in grant money that would be available through the federal legislation.
“We decided to take the federal legislation and track it exactly, so that when the $75 million does become available, we will have something in place that we will be able to plug in, and we won’t have to wait,” she said.
Illinois Senate Bill 0805
In Illinois, a different approach is being taken toward ensuring comprehensive eye exams for children. Rather than mandating comprehensive exams, Senate Bill 0805 is aimed at informing parents that there is a difference between a screening and an examination.
“Before I became involved in the movement for children’s vision, I thought a screening/test/exam were all the same thing,” said Janet Hughes, the Chicago-area parent who is the author of the bill.
Mrs. Hughes, whose daughter, Amy, completed kindergarten with an undetected vision problem, is now an advocate for comprehensive eye exams. Her goal, she said, is to prevent other children from having to begin their school experiences the way Amy did.
“Unfortunately, at the present time, parents are led to believe these vision screenings are an adequate assessment of eye health and visual abilities if one passes, and they never get a complete examination performed by an eye doctor for their child,” she said. “Sadly, a child who really needs vision correction then loses out.”
Mrs. Hughes said this legislation is basically a disclaimer for the Illinois Department of Public Health. Senate Bill 0805, titled the Vision Screening Notification Bill, provides that the Illinois Department of Public Health shall require individuals conducting vision screening tests to give a child’s parent or guardian written notification, before the vision screening is conducted, that states that “vision screening is not a substitute for a complete eye and vision evaluation by an eye doctor.”
Mrs. Hughes said the bill also states that a child “is not required to undergo the vision screening if an optometrist or ophthalmologist has completed and signed a report form indicating that an examination has been administered within the previous 12 months.”
Mrs. Hughes addressed the Senate Education Committee, testifying on behalf of the bill on March 11. SB 0805, which was sponsored by Sen. Christine Radogno (R-41), passed the committee 11-0 and gained seven additional sposors, showing bipartisan support before passing the senate unanimously on March 24. The bill, sponsored by Rep. Eileen Lyons (R-82), then passed the House Elementary and Secondary Education Committee in the House of Representatives unanimously on April 15.
SB 0805 also amends the school code to provide that “parents are encouraged to undergo vision examinations at the same pints in time required for health examinations.”
“Once parents know a screening doesn’t take the place of an examination performed by an eye doctor, I believe they will naturally want to do what is best for their child,” Mrs. Hughes told Primary Care Optometry News.
Kentucky studies: further validation
The only state that currently mandates comprehensive preschool eye exams, Kentucky has recently been the focus of a study that substantiates this legislative step. Published in Optometry: Journal of the American Optometric Association, the study calls into question the efficacy of visual screenings.
The study indicated that nearly one in seven children entering school in Kentucky needed eyeglasses. Additionally, it was found that significant numbers of children (3.4%) were diagnosed with amblyopia, and 2.3% were diagnosed with strabismus. These visual problems were detected only through comprehensive eye exams. The study concluded: “without exams, these vision problems might have gone undiagnosed and untreated for years.”
Approximately 50,000 children enter kindergarten in Kentucky each year. The study was based on a sampling of 5,316 exams performed on children between July 15, 2000, and April 1, 2001.
“The important thing about the law is that it enables the early diagnosis and treatment of children’s vision problems,” said Joel Zaba, OD, the study’s lead author and a specialist in learning-related vision problems. “The study shows that the law works — children’s vision problems are being diagnosed and treated.”
Steven Thornquist, MD, a pediatric ophthalmologist and secretary of the Connecticut Society of Eye Physicians (CSEP), told Primary Care Optometry News: “The study actually shows only how many children were sold glasses,” he said. “No specific criteria for when glasses were prescribed are given in the study, nor is any comparison made to the numbers of children who were being diagnosed and treated before the law took effect. Therefore, no conclusion about the impact of the law can be reliably stated.”
Connecticut: ophthalmology’s bill
In Connecticut, a bill has been introduced by the CSEP that proposes “to mandate documentation of proper screening performed as early as possible.” Dr. Thornquist gave a presentation on RB 1106 before the Senate Public Health Committee.
“There has been a great deal of discussion lately that some children’s vision problems may be ‘falling through the cracks’ of our current system,” Dr. Thornquist said. “While a few anecdotal cases have been mentioned, there are no data showing that significant numbers of children are being missed. However, given the opportunity to do better, we should try to improve the system responsibly. RB 1106 does just that.”
Dr. Thornquist discussed vision screenings vs. comprehensive exams in terms of cost. “If a disease is present in 4% of people, and a complex test will detect it in an hour at a cost of $100, then, on average, out of every 100 people tested, 96 will be found to have no problems, and 4% will have the problem detected,” he said. “A hundred hours will have been used and $10,000 spent to find them, for a cost of 25 hours and $2,500 per patient helped.”
Dr. Thornquist then presented the alternative of more affordable screenings.
“Now, consider the same population, with the same rate of disease. This time, however, we will use a cheaper, easier screening process to find a subgroup most likely to have the disease,” he said. “Suppose that the screen costs $5 and takes 6 minutes, but falsely identifies some people as possibly having the disease when they do not. Further, suppose that only one of every three people identified actually has the disease. Using this test, we find 12 potential patients at a cost of 600 minutes, or 10 hours, and $500.”
Dr. Thornquist maintained that the legislation would be beneficial to children in Connecticut. “This provides early detection at minimal cost, allowing better intervention and focusing resources on those who need them for treatment, rather than squandering them on examinations that find nothing,” he said.
Dr. Thornquist also discussed the importance of timeliness in detecting children's vision problems.
"What is proposed in RB 1106 is to mandate documentation of proper screening performed as early as possible. Since the only practical time for the state to exercise this control is on entry to a state-supported program like school or state funded pre-school, that is when we ask for the documentation," Dr. Thornquist said. "However, the testing is encouraged to be performed earlier by stipulating a longer lead-in period: 1 year in the bill, though we would amend that to 2, for school, and include state-funded pre-K programs with a 6-month grace period."
According to Brian Lynch, OD, president of the Connecticut Optometric Association, the bill is redundant and attempts to “unbundle” the visual screening, or separate it from the overall physical examination.
“Unbundling always leads to increased medical expense for patients and third-party payers,” Dr. Lynch said. “If we’re already paying a pediatrician to provide this service, how will we save money by allowing a different provider to perform this same service?”
Dr. Lynch further stated that screenings are not as effective as comprehensive exams in detecting visual problems. “Screenings simply do not work, and re-mandating them won’t make them work any better,” he said. “When administered properly, 6% to 11% of children’s vision problems go undetected. And of those children identified with a problem, close to 40% never go on to get a comprehensive eye examination.”
Dr. Lynch proposed Substitute Bill 1105, which would require that each child have an eye examination before entering school. Both bills currently remain in committee.
Other ophthalmology bills
Joseph LaMountain of Vision Council of America stated that similar bills are being proposed by ophthalmology in other states.
“The American Academy of Ophthalmology is launching a mandatory screening initiative,” he told Primary Care Optometry News. “That includes mandatory follow-up care for all kids who fail the screen. This is a good first step, and we’re pleased to see that the academy recognizes one of the problems in the current screening system and seeks to improve it.”
A recent survey conducted by Harris Interactive for the Vision Council of America shows that 58% of Americans are not aware of the importance of complete eye care exams — as opposed to vision screenings — in detecting and diagnosing pediatric eye conditions.
Other initiatives
Other programs seek to tackle the issue of children’s vision on non-legislative levels.
With baseball season kicking off across the country, Vision Service Plan has partnered with professional sports organizations in its Kids Get Focused program. This program helps emphasize the importance of regular eye exams by providing vision screenings for children at sporting events throughout the country. Among the participating sports teams are the Orlando Devil Rays, the New York/New Jersey Metro Stars, the Camden RiverSharks and the San Antonio Missions.
In each of the host cities, about 100 children from local Boys and Girls Clubs, YMCAs or Head Start programs will be able to meet at the ballpark and receive a vision test. They also will have the opportunity to participate in batting, kicking and catching drills wearing glasses that blur their vision so they can understand the impact of poor vision on athletic performance.
“Eye exams for children are essential to their health as well as their success in school,” said Catherine Amos, OD, VSP board chairman. “Kids Get Focused is a fun way to educate parents and the community about the importance of proper eye wear for young children.”
In January 2003, Optos North America launched a campaign designed to educate parents about the importance of regular eye examinations for children. The campaign, which features “Orra the Optomap Alien” — a child-friendly character designed to educate and entertain — has been well received by practices and parents.
For the program, Optos has developed promotional materials, including posters and stickers for children, for use in more than 400 ophthalmic sites.
“Overall, I have been examining more and more children with the Optomap retinal exam and feel Optos’ new children’s campaign will help us further in continuing to educate parents about the importance of having their children’s eyes examined regularly,” said Phillip Smith, OD, a private practitioner in San Diego. “It’s fun for children, yet educational for parents.”
For Your Information:
- Georgianne Bearden is executive director of the Georgia Optometric Association. She can be reached at 1000 Corporate Center Dr., Morrow, GA 30260; (770) 961-9866; fax: (770) 961-9965.
- Janet Hughes is a former full-time teacher and currently a stay-at-home mom in the Chicago area. She can be reached by e-mail: anetJ221@attbi.com.
- Joel Zaba, OD, is a specialist in learning-related vision problems and he practices in Norfolk and Virginia Beach, Va. He can be reached at 281 Independence Blvd., Pembrooke 1, Suite 105, Virginia Beach, VA 23462; (757) 497-9575; fax: (757) 497-1292.
- Steven Thornquist, MD, is a pediatric ophthalmologist practicing in Trumbull, Conn., and Secretary of the Connecticut Society of Eye Physicians. He can be reached at 26 Sally Burr Road, Litchfield, CT 06739-0834; (860) 567-3787; fax: (860) 567-3591.
- Brian Lynch, OD, is president of the Connecticut Optometric Association. He can be reached at 60 Montowese St., Branford, CT 06405; (203) 488-9544; fax: (203) 481-2028.
- Joseph LaMountain is vice president of strategic communications for Vision Council of America. He can be reached at 1700 Diagonal Rd., Alexandria, VA 22314; (703) 548-4560; fax: (703) 548-4580.
- Catherine Amos, OD, is board chairman of VSP. She can be reached at 2957 Hoover Ct., Birmingham, AL (805) 823-9000; fax: (205) 823-9080. Phillip Smith, OD, practices in San Diego. He can be reached at 3666 4th Ave., San Diego, CA 92103; (619) 297-4331; fax: (619) 297-6572.
- For a copy of the Kentucky study that appeared in Optometry: Journal of the American Optometric Association, e-mail Joseph LaMountain at jlamountain@visionsite.org.