Championing childrens eye care

Championing children’s eye care

AOA Focus-July/August 2019

Excerpted from page 28 of the July/August 2019 edition of AOA Focus

Back-to-school season for families with children is a flurry of activity: buying school clothes, stocking up on pencils and erasers and getting a checkup with the pediatrician. But this year, doctors of optometry should encourage parents in their communities to add another item to their checklist: a comprehensive pediatric eye exam.

A child's eyes go through rapid changes, especially in the first six years of life. But fewer than 15% of preschool children receive an eye exam by a professional, according to the Centers for Disease Control and Prevention. And while vision screenings have become ubiquitous in schools across the country, they aren't enough. School vision screenings miss up to 75% of children with vision problems. And 61% of the children found to have eye problems through screenings never visit the doctor or get help, according to the AOA's evidence-based clinical practice guideline, Comprehensive Pediatric Eye and Vision Examination.

That's why the AOA recommends children receive comprehensive eye exams on a regular schedule that begins in infancy:

  • A comprehensive baseline eye exam between the ages of 6 months and 12 months
  • At least one comprehensive eye exam between the ages of 3 and 5 to check for any conditions that could have long-term effects
  • An annual, comprehensive eye exam starting before first grade

Many parents aren't aware of these guidelines, so it's up to doctors of optometry to spread the word about the importance of children's vision.

"This is our chance in our profession to make life changes for kids," says Jennifer Smith Zolman, O.D., chair of AOA's InfantSEE® & Children's Vision Committee.

Here are a handful of ways doctors can champion children's eye care.

Leverage the national campaign

The AOA provides its members with a wealth of resources to make it easier for doctors to educate the public about children's vision from infancy and beyond, ranging from social media messages to fact sheets to infographics. New resources are available as part of the AOA's 2019 Ready for School campaign, a patient-facing initiative meant to encourage parents to include a comprehensive eye exam on their child's back-to-school checklist.

A major part of the campaign is educating parents about the importance of comprehensive pediatric eye exams. Parents may not be aware that children who are struggling in school or dealing with behavior issues could be suffering from undiagnosed vision problems that can be identi­fied through a comprehensive eye exam. Additionally, myopia has become one of the most common vision issues in children ages 3 to 13 due to an increase in time spent indoors on digital devices. According to the AOA's 2018 American Eye-Q Survey, three-fourths of parents are concerned their children may damage their eyes due to prolonged use of electronic devices.

To get the word out-and bring children in for exams-AOA members can access Ready for School resources on the AOA website. Resources from current and past campaigns include a back-to-school checklist infographic, a customizable press release, a pediatric eye exam frequency chart, sample social media posts and virtual reality demonstration videos that show participants what it's like to suffer from vision problems in the classroom.

Become an InfantSEE provider

Without the vision system functioning at its best, Dr. Smith Zolman says, children are more susceptible to developmental and academic delays. That's where InfantSEE comes in. A public health program managed by Optometry Cares®—The AOA Foundation, InfantSEE enables doctors to provide no-cost, comprehensive eye and vision assessments for infants ages 6 to 12 months. Any AOA member can volunteer to be an InfantSEE provider. "We try to make it as easy as possible to become a provider," Dr. Smith Zolman says.

Not only does InfantSEE set children up for a lifetime of healthy vision, Dr. Smith Zolman says, but it also serves as a fantastic patient education tool and public health outreach initiative. Many parents aren't aware that babies and young children even need eye exams, she says, so promoting InfantSEE to local pediatricians, hospitals, community groups and parenting clubs can help spread the word.

Here's how InfantSEE resources can help:

Most often, InfantSEE assessments uncover relatively common vision issues, such as refractive differences, Dr. Smith Zolman says. But she's also seen more serious issues, including pupil abnormalities and congenital cataracts. Undetected de­ficits in any visual area can impact a child's entire life, from school to sports to social interactions, Dr. Smith Zolman says.

"I have seen the difference that early intervention can make in a child's life."

Use the pediatric guideline

The AOA's Evidence-based Optometry Committee has created, and updated, Comprehensive Pediatric Eye and Vision Examination, the result of a three-year systematic review of the latest research on children's vision. The goal of the guideline is to put comprehensive eye exams on par with other annual pediatric health exams.

"It provides a broad-based area of things that are looked at in the care of a child," says Diane Adamczyk, O.D., chair of the AOA's Evidence-based Optometry Committee. "It provides the tools and information to the doctor of optometry that can really, truly change the lives of children."

Considered optometry's "north star," these clinical practice guidelines have evolved from consensus-based to evidence-based. The committee developing the pediatric guideline included expert stakeholders, such as two doctors of optometry who specialize in pediatrics, a patient advocate and a pediatrician, at least one of whom also is a parent, Dr. Adamczyk says. Once approved by the AOA Board of Trustees, the pediatric guideline was accepted by the National Guideline Clearinghouse, maintained by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, just two days after submission. Throughout the 67-page document are various "action statements" that highlight key takeaways from the guideline and are applicable to clinical practice, Dr. Adamczyk says.

These include:

  • A list of what a comprehensive pediatric eye and vision exam should include
  • A recommendation that children, parents and caregivers should be educated about potential risks for eye injuries at home, school and during sports and recreational activities
  • A recommendation that children should be tested as soon as possible for color vision deficiency
  • A recommendation that patients, parents and caregivers should be counseled about the benefits of spending more time outdoors when it comes to children's vision

This general pediatric guideline is just the beginning, Dr. Adamczyk says. Evidence-based guidelines for specific children's vision issues, such as myopia, are expected to be developed in the future.

Reach beyond your exam chair

The AOA's Health Promotions Committee (HPC) is the group that translates best practices, such as the pediatric evidence-based guideline, into resources doctors can share with their communities via their website, patient newsletters or emails and social media. As the goal of this year's Ready for School campaign is to get the word out among parents that a comprehensive eye exam should be on their child's back-to-school checklist, the HPC has developed these fast facts to print in your practice newsletter or post on social media this season:

  • Much of a child's learning is visual. How well can your child see? If you don't know, it's time for a comprehensive eye exam.
  • Blurry vision is not the only reason to have an eye exam. Your child could have difficulty using both eyes together, a critical reading skill, and you might not know. Back to school means it's time to get a comprehensive eye exam.
  • Undetected and untreated vision problems can elicit some of the very same signs and symptoms commonly attributed to attention deficit/hyperactivity disorder. A yearly comprehensive eye exam can help make the right diagnosis for your child's needs.

"It is critical that we get our patients with children to remember that their most important tool for learning is their vision," says Sue Lowe, O.D., HPC chair.

A draft letter for doctors to send to local pediatricians and family physicians is a particularly rich resource provided by the committee. It serves as an introduction to both the doctor of optometry and the pediatric guideline, as well as the AOA's recommendations for the frequency of children's eye exams. It includes optional language for InfantSEE providers and for optometrists with a specialty in sports and performance vision. The letter ends with pediatric eye care resources, including links to AOA's Children's Vision webpage, the InfantSEE website and the pediatric guideline.

"We know more about the frequency of changing the oil in our car than when to have a child's eyes examined," Dr. Lowe says. "As optometrists, we are part of the public health care community. Therefore, it is critical that we stay involved in public health, as well as in our private practice, so we can get the word out."

July 24, 2019

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