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Creating Effective State Systems for Children’s Vision

State advocates and program and policy decision makers have multiple “entry points” to the system of services affecting children’s vision and eye health. Actions that strengthen screening protocols, improve access to diagnostic exams and treatment, and bolster capacity for surveillance and performance measurement all contribute to the development and support of a comprehensive approach. These actions could include:

  • Examining existing data to identify geographic, socioeconomic, and racial disparities in access to services and outcomes.
  • Identifying gaps in data capacity.
  • Clarifying existing state mandates, protocols, and guidelines for vision screening, and gauging the uniformity of their application across jurisdictions and the degree to which they align with current standards of practice.
  • Convening stakeholders for priority setting and planning.

To be successful, these efforts require the knowledge, insights, and contributions of many stakeholders:

  • Families
  • Public health leaders
  • Ophthalmologists and Optometrists
  • Primary care providers (including pediatricians, community health centers, and other “medical homes”)
  • Early childhood educators
  • Early care and education agencies
  • Community organizations
  • Insurance providers, Medicaid/CHIP, and other funders
  • Epidemiologists and health information system specialists
  • Legislators

Each of these stakeholders has a unique role to play in building and sustaining a comprehensive, effective system. Working together, they—and you—can forge a stronger vision and eye care system, ultimately improving the health and wellbeing of all children in your state.

  • Is vision screening for children mandated by law? At what ages and frequency?
  • Who is doing the vision screening? Who trains the vision screeners? Are there certification or training requirements for screeners?
  • Are the results of vision screening and eye examination outcomes communicated to the child’s medical home/primary health care provider?
  • Is there a standard protocol for referrals? Who follows up to ensure referred children access needed eye care? Is this follow-up process/protocol in place for all children, or only segments of the state’s population?
  • Are there populations that are being missed, are unable to access eye care, or need special considerations?
  • What percentage of children ages 3 through 5 years receive a vision screening or eye examination?
  • Who monitors the quality of vision screening programs?
  • Who maintains the data on children’s vision in your state? Is there any statewide tracking of vision screening and follow-up? If so, does it integrate systems, sites, and providers to support population-based (all children) data?

Vision screening, eye examinations, population-based data systems, and measures of accountability are the cornerstones of a comprehensive system to ensure children’s vision and eye health. A National Expert Panel convened by the NCCVEH has issued guidelines for each of these critical components.

Vision screenings

Usually conducted in a school, primary care practice, or community health center, vision screenings identify general vision problems at an early stage.

  • Screening should occur annually (best practice) or at least once (acceptable minimum standard) between the ages of 3 and 6 years, and periodically throughout the school years for children who do not receive comprehensive eye exams.
  • Vision screening personnel should be trained and certified, with recertification completed every 3 to 5 years.
  • Vision screening programs require planning for acquiring and maintaining the necessary space and equipment.
  • Screening results must be recorded and communicated to the child’s parents, medical home/primary care provider, and school, along with the necessary state agency, with subsequent referral to an ophthalmologist or optometrist for examination and treatment when indicated.

Eye examinations

Performed by optometrists or ophthalmologists, eye exams are necessary to diagnose and treat eye disorders.

  • Children who have failed a vision screening should be referred for a comprehensive eye exam.
  • Children at high risk of vision disorders should be referred directly to an eye care specialist without undergoing screening.
  • Exam outcomes should be shared among key stakeholders with patient permission.

Population-based data systems

These data systems provide the capacity to document receipt of services, measure the performance of screening and follow-up programs, track progress toward public health goals, and improve outcomes for children.

  • Data systems should incorporate unique child identifiers to reduce duplication of services.
  • Data systems must be able to accept data from all sites of screening and sources of care.
  • Ideally, data systems for monitoring vision screening and eye care would be incorporated into state-level integrated health information systems.

Performance measures

Performance measures guide the use of aggregate population data for program accountability and system improvement.

The National Expert Panel’s detailed recommendations for vision screening methods, integrated data systems to track screening and follow-up exams, and performance measures to monitor progress are available the National Center for Children’s Vision and Eye Health