In November 2008, a group of optometrists led by Primary Care Optometry News Editorial Board member J. James Thimons, OD, collaborated with nurses and technicians to screen about 2,700 children in 16 public schools in Hartford, Conn., over the course of 1 week. According to Dr. Thimons, this project was developed to address a number of concerns he and his colleagues found among children in their practices.

Addressing a need

“A significant number of children who my colleagues were examining in Connecticut had remarkable refractive errors or decreased visual performance and had no vision correction or — maybe even more importantly — had actually made it through the system without being identified as a visual concern,” Dr. Thimons said in an interview with PCON.

Dr. Thimons and 75 optometrists from the CAO worked with nursing director and program coordinator Pamela Clark, RN, MPH, who contacted school administrators and nurses to organize vision screenings. Of the 2,700 children screened, 972 had acuity worse than 20/50 and were sent for eye exams. Ms. Clark said she was shocked by the level of refractive error.

“Having good vision is so important for a child’s academic achievement,” she said in an interview. “Everything is about supporting student learning and helping kids achieve their potential. To achieve that potential, they need to have decent vision.”

After identifying and examining the students in need, the volunteer optometrists provided more than 900 pairs of glasses donated by Precision, Encore, Hoya and ODG labs in Connecticut.

Dr. Thimons said these children are slipping through the cracks because health care is often inaccessible to those on Medicaid or Title XIX. In Hartford, 30.6% of the population is below the poverty line, according to the U.S. Census Bureau.

The study showed that the average refractive error for myopic children was -1.60 D with -1.25 D of astigmatism. For hyperopia, the average was 1.25 D with 1.75 D of astigmatism. More importantly, about 10% of all participants were referred for either amblyopia, elevated IOPs, enlarged cup-to-disc ratios, corneal disease or other concerns.

Making exams a requirement

According to the American Optometric Association, all Kentucky, Missouri and Illinois students entering kindergarten or enrolling for the first time in grade school are required to receive a comprehensive eye exam. After failed attempts at similar legislation in Connecticut in 2001 and 2003, Dr. Thimons is determined to create more awareness for the necessity of this.

This program and the data it created were evidence that exams conducted by pediatricians are not sufficient to identify children with vision problems, Dr. Thimons said. It must be a community-wide commitment that involves ophthalmic clinicians, school nurses, educators, volunteers and parents.

“There’s a disconnect between the current system and the one that optometry is recommending,” he said. “We feel there should be a general eye exam for pre-K or first graders and then again in the 3rd or 4th grade to identify children with visual problems. This should be accompanied by screenings conducted by trained personnel who can identify children at increased risk.”

The project team plans to continue screening, examining children and collecting data in Hartford as more cities — such as Bridgeport — open their doors to help their children. However, Dr. Thimons feels that state governments should take responsibility and create programs that work.

“There’s a difference between coverage and coverage that’s available,” he said. “Doctors need to understand that we’re part of that process and we need to help develop programs that create a pathway for kids to get better care.”

One way is to encourage optometrists to conduct similar studies in their states to raise awareness of the importance of eye examinations and the needs that exist in their community, he said.

For more information:

• J. James Thimons, OD, is a Primary Care Optometry News Editorial Board member. He can be reached at Ophthalmic Consultants of Connecticut, 75 Kings Highway Cutoff, Fairfield, CT 06430; (203) 257-7336; fax: (203) 330-4958; e-mail: jthimons@sbcglobal.net. Pamela Clark, RN, MPH, can be reached at 960 Main Street, Hartford, CT 06106; (860) 462-0580; e-mail: pclark@hartfordschools.org.

References:

• U.S. Census Bureau; http://quickfacts.census.gov/qfd/states/09/0937000.html.

• Connecticut Department of Social Services: http://www.ct.gov/dss/site/default.asp.

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