Document 232370
Dr. Marla Moon, Early Development and Screening of Vision 3/25/2013 Part 3 MARLA L. MOON, O.D., F.A.A.O. EARLY DEVELOPMENT AND SCREENING OF VISION THE ABCs OF IT PaTTAN APRIL 2013 Pediatric and Low Vision Rehabilitation Specialist Optometrist Nittany Eye Associates State College, PA 814‐234‐2015 [email protected] TOPICS TOPICS COVERED IN THIS SECTION • What might indicate a possible vision problem? What to look for? • Vision Screenings vs. Eye Exams • How to examine an infant/young child • InfantSEE Program WHAT TO LOOK FOR HOW TO IDENTIFY VISION DIFFICULTIES PaTTAN APRIL 2013 1 Dr. Marla Moon, Early Development and Screening of Vision WHAT MIGHT INDICATE A VISION PROBLEM • APPEARANCE • BEHAVIOR • (COMPLAINTS) 3/25/2013 Part 3 APPEARANCE (Infants/Toddlers) • Irregularly shaped pupil or iris • Cloudy appearance on the clear surface of the eyeball • Cataracts – an opacity of the lens – may look like a white or grey dot in the pupil “ABC’s” (see check list) APPEARANCE • Droopy eyelid(s) • “White pupil” • Extreme sensitivity to light • “Eyes just don’t look right” BEHAVIORS • Close or cover one eye • Head turn or tilt (torticollis?) • Frequent eye rubbing • Delays in motor development – walks late • Afraid of depth perception challenges COMPLAINTS • Young kids actions must speak louder than their words 2 Dr. Marla Moon, Early Development and Screening of Vision 3/25/2013 Part 3 VISION SCREENING VS. PROFESSIONAL EYE EXAM VISION SCREENING VS. EYE EXAM • What is typically included in each • What is the purpose of each • Pros and Cons PA SCHOOL VISION SCREENING PROGRAM MANUAL AVAILABLE www.dsf.health.state.pa.us/health/lib/health /VisionGuideline2002.pdf PA SCHOOL VISION SCREENING PROGRAM • Purpose – “to identify students with visual impairments”; “to provide standards for the school vision screening program throughout the Commonweath……” 3 Dr. Marla Moon, Early Development and Screening of Vision 3/25/2013 Part 3 PA SCHOOL VISION SCREENING PROGRAM PA SCHOOL VISION SCREENING PROGRAM • Manual states – “Vision problems affect one in 20 preschoolers and one in 4 school‐ age children. Visual problems can and do affect the educational, social and emotional development of children.” • Manual states – “90% of all information is transferred to the brain via the eyes. Most vision problems are correctable, at least to some degree.” PA SCHOOL VISION SCREENING PROGRAM PA SCHOOL VISION SCREENING PROGRAM • Manual states – “Early detection of vision problems assures the child of the opportunity of taking the best advantage of his/her educational opportunities.” PA SCHOOL VISION SCREENING PROGRAM • Manual states – “However, the opportunity for vision screenings (or professional exams) is not always afforded to every child in the early years of life.” • Manual states – “Although it is recommended that every child have an eye examination very early in life, vision screenings continue to provide an important tool in early detection of vision disorders in the pediatric population.” PA SCHOOL VISION SCREENING PROGRAM • Manual states – “Vision screening is not diagnostic, but is a practical approach to identifying children needing professional eye services.” 4 Dr. Marla Moon, Early Development and Screening of Vision PA SCHOOL VISION SCREENING PROGRAM • Manual states – “Because vision screening is not diagnostic, children who fail the test must be referred to an eye specialist for a diagnostic exam.” 3/25/2013 Part 3 PA SCHOOL VISION SCREENING PROGRAM • Manual states – “The most important aspect of the screening program is referral with follow‐up. The child who fails the screening should receive a comprehensive eye exam by an eye care specialist. If the child does not…… then the program has not accomplished its goal.” VISION SCREENINGS VISION SCREENING • Relatively short • Typically can indicate the presence of a vision problem or a potential vision problem • Cannot diagnose exactly what is wrong, though…….. VISION SCREENING • Can be performed in various settings • Typically no standardization • Various methods and techniques accessible 5 Dr. Marla Moon, Early Development and Screening of Vision VISION SCREENING TAKES ON MANY FORMS * Schools * Pediatrician/PCP * Social Service Groups (i.e. Lions Clubs, PABs, etc.) VISION SCREENING • Can provide a false sense of security – thinking that an actual professional eye exam was performed • Can miss a lot of problems as well HOWEVER….. • Of children aged 3‐5 seen by pediatricians, only 66% received a “vision screening” (defined as spending 10 or more SECONDS trying to get the child to cooperate) 3/25/2013 Part 3 VISION SCREENING • Subjective component vs. objective component – especially when trying to screen very young, non‐verbal, uncooperative children • Many times provided by untrained personnel VISION SCREENING • When a problem is identified or a potential problem is noted, a referral for a professional comprehensive eye exam is to occur HOWEVER….. • A screening was NOT attempted on more than 60% of 3 year‐olds in pediatrician offices (Pediatrics, The Journal of the American Academy of Pediatrics, Vol. 89, No 5) (Pediatrics, The Journal of the American Academy of Pediatrics, Vol.89, No 5) 6 Dr. Marla Moon, Early Development and Screening of Vision IN ADDITION….. • Of children who failed a screening, 50% of the parents were unaware of the fact even two months later 3/25/2013 Part 3 SAMPLE OF VISION SCREENING FOR PEDIATRICIANS (FROM: Children’s Hospital of Pittsburgh of UPMC – Accessed – 3/2013 – www.chp.edu/CHP/P02307) (Pediatrics, The Journal of the American Academy of Pediatrics, Vol. 89, No 5) SAMPLE OF TESTS IN A VISION SCREENING • INFANT ‐> Response to Light ‐> Pupil Response ‐> Ability to follow a target ‐> (Visual Evoked Response Test – VER/VEP) 7 Dr. Marla Moon, Early Development and Screening of Vision SAMPLE OF TESTS IN A VISION SCREENING • Older Infant/Toddler ‐> Previous Tests …. Plus…. ‐> Cover/Uncover Test 3/25/2013 Part 3 SAMPLE TESTS IN A VISION SCREENING • Preschooler ‐> Previous Tests….. Plus….. ‐> Visual Acuity Tests ‐> Color Vision Test STATS STATISTICS • Only 1/3 of children between 3 and 4 years of age have undergone an eye examination (www.cdc.gov/nchs/data/series/sr_10/sr10_157.pdf ‐ Accessed ‐ 10/2012) STATS • Study showed that preschool children with uncorrected refractive error had significant reduction in visual motor functioning (FROM: Roch‐Levecq, AC, et.al – Ametropia, preschoolers’ cognitive abilities and effects of spectacle correction – Archives of Ophthalmology (2008), 126(2), 252‐ 258) 8 Dr. Marla Moon, Early Development and Screening of Vision STATS • Undetected and untreated eye disorders, such as amblyopia, strabismus, and uncorrected refractive errors, are major child health problems in the U.S. that are associated with poor reading and other poor school outcomes • (FROM: Vaughn, W. et.al – Association between vision quality of life and academics, etc.‐ Optometry‐2006, 77, 116‐123) 3/25/2013 Part 3 STATS • According to the CDC and Prevention’s Morbidity and Mortality Weekly Report – 2005 ..... (last data) • Only 36% of all preschool children received a vision screening STATS WHEN TO EXAMINE • Fewer than 20% of children are adequately screened for vision problems in the U.S. today (FROM: Prevent Blindness America website – May 2010) APHA RESOLUTION • “Realizing that infant and early comprehensive childhood eye care is a neglected area…. (APHA) encourages a regular comprehensive eye examination schedule as opposed to just screening….so that all children have exams performed at……..” • WHEN SHOULD A CHILD HAVE THEIR FIRST PROFESSIONAL EYE EXAMINATION?? (screening does not count) (American Public Health Association, “Improving Early Childhood Eyecare,” Policy Number 2001‐1) 9 Dr. Marla Moon, Early Development and Screening of Vision WHEN ?? • American Public Health Association – encourages regular comprehensive eye examinations scheduled at approximately 6 months of age, 2 years, and 4 years. (American Public Health Association, “Improving Early Childhood Eyecare,” Policy Number 2001‐1) 3/25/2013 Part 3 WHEN ?? • Prevent Blindness of America • Advocates professional eye exams for children, including those without any signs of eye trouble at birth – at six months of age, before entering school and periodically throughout the school years (Maurice F. Rabb, M.D., Prevent Blindness of America Medical Director, Chicago Sun Times – Letter to the Editor, June 26, 2001) TESTS THAT SHOULD BE PERFORMED IN AN EYE EXAM • Visual Acuity • Binocular Vision/Eye Alignment • Ocular Muscles/Motilities • Refractive Status ***** • Ocular Health Status ***** OBSERVATIONAL PREFERENTIAL LOOKING VISUAL ACUITY TESTING 10 Dr. Marla Moon, Early Development and Screening of Vision A Public Health Program for America’s Youngest Patients 3/25/2013 Part 3 • One-time no-cost public health program provides eye care for infants ─ for babies 6-12 months of age ─ complements pediatrician well-baby vision screenings ─ no cost regardless of income 11 Dr. Marla Moon, Early Development and Screening of Vision Vision is Learned • Most critical stages of vision development occur in the first year of life. • Undetected vision problems can lead to permanent vision impairment. 3/25/2013 Part 3 Infant Eye Care Background • Pediatric clinical care guidelines recommend a basic eye screening as part of a well-baby health exam. – Red pupil reflex and eye alignment • Studies show physicians do not consistently conduct pediatric vision screening during clinical visit. • Only 14% of all children have had an eye exam prior to entering school. Child Eye Care Background • Of 3-5 year olds seen by pediatricians, only 66% received a vision screening. • Screening was not attempted on more than 60% of three-year-olds. • Of children who failed a screening, 50% of the parents were unaware of the fact 2 months later. SUMMARY OF THE PROGRAM Screenings vs. Examinations • Comprehensive eye exams and vision screening programs should not be confused. – Each has different purpose, generates different results – Examinations are necessary even if screenings are done periodically …is a public health program to ensure that optometric eye and vision care becomes an integral part of infant wellness care to improve a child’s quality of life. 12 Dr. Marla Moon, Early Development and Screening of Vision 3/25/2013 Part 3 A free visual assessment for children 1 year of age or under Sponsored by the American Optometric Association and Johnson and Johnson Vision Care (NOW Allergan Foundation) www.InfantSEE.org QUESTIONS ??? Marla L. Moon, O.D., F.A.A.O. Nittany Eye Associates 428 Windmere Drive State College, PA 16801 814‐234‐2015 [email protected] MARLA L. MOON, O.D., F.A.A.O. EARLY DEVELOPMENT AND SCREENING OF VISION THE ABCs OF IT PaTTAN APRIL 2013 Pediatric and Low Vision Rehabilitation Specialist Optometrist Nittany Eye Associates State College, PA 814‐234‐2015 [email protected] 13 Dr. Marla Moon, Early Development and Screening of Vision 3/25/2013 Part 3 TOPICS TOPICS COVERED IN THIS SECTION • Screening Techniques • When to Refer • Resources and Coverage for Eye Exams PEDIATRICIAN/PCP VISION SCREENING TECHNIQUES FOR INFANTS • • • • Response to Light Pupil Response Ability to Follow a Target (VER/VEP) VISION SCREENING TOOLS OTHER VISION SCREENING TOOLS • PHOTOSCREENER ‐> Spot ‐> PlusOptix ($5750‐$6000) ‐> MTI **** 14 Dr. Marla Moon, Early Development and Screening of Vision 3/25/2013 Part 3 VISION SCREENING TOOLS • AUTOREFRACTORS ‐> SureSight ($5000 ‐$6000) ‐> RetinoMax VEP/VER 15 Dr. Marla Moon, Early Development and Screening of Vision 3/25/2013 Part 3 VISION SCREENING VISION SCREENING TECHNIQUES FOR TODDLERS (more cooperative/higher development) • Telebinocular (Titmus, Keystone, etc) • Separate/Hand Held Items VIP – PART I VIP STUDY RESULTS (Vision In Preschoolers Study – NEI – 2004‐2005) • Found that non‐cycloplegic retinoscopy, Retinomax AR, SureSight and Lea Symbol Cards were similar screeners (eye docs) • The best tests still detected only 2/3 of the children having one or more eye conditions 16 Dr. Marla Moon, Early Development and Screening of Vision VIP – PART II • Utilized RetinoMax and SureSight • Involved nurse screeners and trained lay screeners • Found to achieve similar results • But still only detected 68% of serious vision problems in children 3/25/2013 Part 3 Given the findings from VIP study, there has been more attention placed on the value of comprehensive eye exams as the most effective way of detecting child health vision problems and eye disease. (From: Abt Associates, Inc. – Building a Comprehensive Child Vision Care System – National Commission on Vision and Health – www.visionandhealth.org – June 2009) PROFESSIONAL EYE EXAM WHEN TO REFER FOR A PROFESSIONAL EYE EXAM HAVE AN EYE EXAM (BY AN EYE DOCTOR) • 6‐12 months of age even if no problem is noted ‐ via InfantSEE it’s FREE!!!! WHO PAYS FOR THIS CARE ??? • Any problems noted in the ABC’s • Any categories that are checked on the “Risk” list 17 Dr. Marla Moon, Early Development and Screening of Vision PAYMENT • InfantSEE is FREE for the 1st assessment (before 1st birthday) PAYMENT Sight for Students Program (www.sightforstudents.org) Vision USA Program (www.OptometrysCharity.org) EyeCare America (www.eyecareamerica.org) PAYMENT • MAJOR MEDICAL INSURANCE ‐> If a medical diagnosis is present (or) ‐> Typically if a referral is may by a physician to rule out a problem 3/25/2013 Part 3 PAYMENT • Vision Care Insurance Programs – pay for “wellness exams” ‐> VSP ‐> VBA ‐> Davis Vision ‐> Eye Med ‐> Access/MA/CHIP plans PAYMENT • SERVICE ORGANIZATIONS ‐> Lions Clubs ‐> Rotary *** ‐> Kiwanis *** ‐> Churches ‐> VIM clinics PAYMENT • AGENCIES ‐> BUREAU OF BLINDNESS AND VISUAL SERVICES ??? (“investigation status”) 18 Dr. Marla Moon, Early Development and Screening of Vision RESOURCES • www.aoa.org • www.poaeyes.org • www.allaboutvision.com • www.preventblindness.org • www.nei.nih.gov • www.childrensvision.com 3/25/2013 Part 3 RESOURCES • www.pattan.net (search “Dr Moon videos” “TAKE HOMES” THINGS TO REMEMBER • A child’s vision develops very quickly • The most critical period of vision development occurs during the first 18 months of life • Early detection of vision problems is critical to a child’s development and learning THINGS TO REMEMBER • InfantSEE Brochures (e‐mail me if you need more) SPREAD THE WORD • While vision screenings are useful, they are not a replacement for a comprehensive professional eye examination 19 Dr. Marla Moon, Early Development and Screening of Vision THINGS TO REMEMBER • Kids need to undergo professional eye exams EARLY!!!! (1 – 3 – 5) • Kids with special needs, family history, certain health/birth conditions are at even greater risk and should be seen EARLY!! 3/25/2013 Part 3 THINGS TO REMEMBER • Most families have insurance that will cover eye exams (vision insurance vs. major medical insurance) • If not, there are other resources that can be explored to help (InfantSEE, Lions Clubs, Sight for Students, Vision USA, local churches, Give Kids Vision Day, BBVS, etc.) QUESTIONS ??? Marla L. Moon, O.D., F.A.A.O. Nittany Eye Associates 428 Windmere Drive State College, PA 16801 814‐234‐2015 [email protected] 20
© Copyright 2024