Advantages of school-based eye care programs over traditional children’s vision screening models

Posted on By Catherine Nielson

Advantages of school-based eye care programs over traditional children’s vision screening models

By Dr Shelley Hopkins

Globally, uncorrected refractive error is the leading cause of vision impairment in children.1 Importantly, early correction of vision conditions in children is critical for best visual outcomes. School screenings play a key role in identifying children with vision conditions; however, they do not provide treatment and require follow-up with local eye care providers.  Unfortunately for many children (up to 70 – 80%), further eye care following a school screening is either not available or not accessed.2, 3  School-based eye care programs that provide comprehensive eye care services onsite for children who fail a vision screening, including the capacity to dispense spectacles and initiate referral pathways as necessary, have become an alternative model to manage uncorrected vision conditions in school children.

Follow-up rates with an eye care provider are a critical component of a vision screening program.4 However in traditional screening models, they tend to be very low or delayed.4-6 Reasons for not attending follow-up eye care are multi-faceted and include financial, logistical and perceptual barriers.2 A different approach that addresses some of these barriers is through school-based eye care, which includes both vision screening and comprehensive eye examinations (for those who fail the vision screening), with spectacle dispensing and referral as appropriate.  In many school districts in the USA, school-based eye care programs have been successful in providing spectacles to children with correctable vision loss.

The successes of these programs in the USA raises the question of whether a school-based eye care model might have the same impact in Australia.  Optometry Australia’s LOOK scholarship facilitated the opportunity for Centre for Vision and Eye Research and Centre for Child and Family Studies member, Dr Shelley Hopkins, to gain a more comprehensive understanding of school-based eye care. Consultation with three experts in school-based eye care programs was undertaken (two paediatric ophthalmologists and one optometrist/researcher).  A series of recommendations have been developed based on the literature and consultation undertaken and are published in Optometry Connect (November 2021).  Key themes within the recommendations are firstly the importance of consulting with health services and schools to establish whether a need exists in their region and collaborating with these stakeholders early to improve service provision and referral pathways.  Secondly, development of clear guidelines for school-based vision screenings and eye examinations (including minimum test batteries, prescribing criteria and referral criteria to community optometry or ophthalmology).

The work Dr Hopkins has undertaken through Optometry Australia’s LOOK scholarship provides an exciting opportunity to reduce the impact of uncorrected vision conditions experienced by many Australian schoolchildren through new knowledge gained on school-based eye care programs.

References

  1. Sharma, A., Congdon, N., Patel, M., & Gilber, C. (2012). School-based approaches to the correction of refractive error in children. Survey of Ophthalmology, 57(3), 272-283.
  2. Kimel, L. S. (2006) Lack of follow-up exams after failed school vision screenings: an investigation of contributing factors. Journal of School Nursing, 22(3), 156-162.
  3. Manny, R. E., Sinnott, L. T., Jones-Jordan, L. A., Messer, D., Twelker, J. D., Cotter, S. A., Kleinstein, R. N., Crescioni, M., & CLEERE Study Group. (2012). Predictors of adequate correction following vision screening failure. Optometry and Vision Science, 89(6), 892-900.
  4. Mark, H., & Mark, T. (1999). Parental reasons for non-response following a referral in school vision screening. Journal of School Health, 69(1), 35-38.
  5. Yawn, B. P., Lydick, E. G., Epstein, R. E., & Jacobsen, S. J. (1996). Is school vision screening effective? Journal of School Health, 66(5), 171-175.
  6. Shakarchi, A. F., & Collins, M. E. (2019). Referral to community care from school-based eye care programs in the United States. Survey of Ophthalmology, 64(6), 858-867.