One by one, toddlers ambled toward the back of the classroom at a Mount Hood Community College Head Start preschool in Southeast Portland.
After each child plopped down in a short purple chair, a woman asked in a warm voice if they were ready to take a picture. Next, she lifted a handheld photo-screening device and encouraged each child to focus on the playful eyes, nose and smiling mouth drawing that adorns the device’s front lens.
With a push of a button, a screen on the back of the device displayed a close-up image of the small set of eyes. While the device quickly made a series of eye measurements, it emitted a series of beeps and boops as if was playing a Saturday morning cartoon. The display screen ultimately helped the woman and her Oregon Health & Science University colleagues recommend if a child should be referred to an ophthalmologist or optometrist for further evaluation.
This same scenario plays out every fall in more than 200 Head Start and other preschool classrooms across Oregon through the OHSU Casey Eye Institute’s Elks Preschool Vision Screening Program. Since 2003, the program has provided free vision checks to more than 65,000 toddlers, about 15% of whom need glasses. The program’s $350,000 annual budget is fully supported by the Oregon State Elks Association.
“A screening that lasts just a few seconds can save a child’s sight,” said program director Joannah Vaughan, M.B.A., who is also an assistant professor of ophthalmology in the OHSU School of Medicine.
Improving both sight and learning
About 80% of early learning is done visually, and children can fall behind in school without clear vision. Vaughan has personally seen the difference an eye check can make. She described how, after receiving eyeglasses, some children have danced and admired posters on the wall that they could see clearly for the first time. Teachers have also told her that behavioral issues in some children decline or disappear after they get glasses.
Vaughan founded the program after realizing that few providers were screening children at a young enough age. Twenty years ago, many screenings were given too late in a child’s visual system development process, making it challenging to reverse the vision-threatening condition amblyopia, also referred to as lazy eye. Amblyopia occurs when one or both eyes stop developing. When caught early enough, treatments like patches, special drops and glasses can help affected eyes catch up. But if not treated by age 7, children may be left with permanent vision loss. The ideal timeframe to treat amblyopia is between the ages of 3 and 5, when many children attend preschool.
Kosmo Quiroz Acero was 3 years old when the Elks Preschool Vision Screening Program visited his Head Start classroom in 2011. Vision screeners found a potential problem and referred him to the OHSU Casey Eye Institute’s Elks Children’s Eye Clinic, where a pediatric ophthalmologist diagnosed him with amblyopia in both eyes. The physician showed his mother, Delfina Acero Chuma, how to help her son place an eye patch over one eye at a time, which sharpens vision in the other eye by forcing it to develop further. Routine use of prescription eye drops and prescription eyeglasses also helped improve his vision.
“When I first found out about the lazy eye, I felt sad,” Acero Chuma recalled through a Spanish interpreter. “But later the doctor said other boys also have lazy eye and that glasses can make it better. I didn’t realize Kosmo had a vision problem until that screening. We never would have known about it without this program coming to his school.”
Now 15, Kosmo can see well with the help of eyeglasses. He’s currently a junior at Cleveland High School in Southeast Portland and is considering becoming an engineer. To date, the Elks Preschool Vision Screening Program has correctly identified amblyopia in at least 1,000 kids like Kosmo.
In addition to amblyopia, the program also screens for farsightedness, nearsightedness and astigmatism. When a potential vision issue is flagged, the program sends a letter to a child’s guardians that recommends they make an appointment with an eye doctor for further evaluation and treatment if needed. To encourage timely follow-up, the program also calls guardians up to three times; provides a list of trusted providers who are accepting pediatric patients; and offers bilingual support to make an appointment if needed. The Oregon Health Plan, the state’s Medicaid health insurance plan, covers pediatric eye exams and prescription glasses free of charge.
With guardian permission, the program team also follows up with the children they screen to evaluate the accuracy of their screenings, and understand the outcomes of referrals and follow-up care. The team has published 19 peer-reviewed papers, presented at numerous medical and health conferences, and advises the state and others on vision screening best practices. Following advocacy by Vaughan and others, the Oregon Legislature passed a bill in 2013 that now requires students entering a public school to have a vision screening or eye exam as they begin their education.