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
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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
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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……”
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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.”
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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.”
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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
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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)
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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)
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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
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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)
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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
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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)
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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)
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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)
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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)
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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
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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
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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.
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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.
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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 ****
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Dr. Marla Moon, Early Development and
Screening of Vision
3/25/2013
Part 3
VISION SCREENING TOOLS
• AUTOREFRACTORS
‐> SureSight ($5000 ‐$6000)
‐> RetinoMax VEP/VER
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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
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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
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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
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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
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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”)
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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
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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
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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!!
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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]
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