Children’s Vision And Eye Health: A Snapshot Of Current .
Children’s Vision and Eye Health:A Snapshot of Current National Issues(2nd Edition)
Table of ContentsAbout Prevent Blindness .3References . 44The National Center for Children’s Vision and EyeHealth (NCCVEH) .3BoxesEverything Is So Clear.5Introduction .5Common Vision Disorders in Children .7Early Detection of Children’s Vision Disorders .9Screening Rates.10Equity Matters in Vision .121. Vision Impairment Definitions .62. Vision Screening and Eye Examinations:Definitions .93. The Importance of Reliable Data for VisionScreening Goals .104. Equity Graphic .165. Analyze Your State’s System for Children’s Vision.29Vision Screening in Preschool and School-AgeEducation Settings . .176. Vision Screening for Children 36 to 72 Months:Recommended Practices .30Treatment and Follow-Up .187. A Bright Future for NCCVEH .32Special Considerations .18National Guidance and Recommendations .19TablesState Approaches to Ensuring Children’s Visionand Eye Health .231. Percentage of Children Receiving Vision Testingby Age and Race/Ethnicity .11State Highlights .252. Vision Testing Sites for Children in the U.S.: inChildren Age 17 Years and Younger ( 2016–2017).11Building a Comprehensive State Vision HealthProgram .29Call to Action .31AppendicesAppendix A. Vision Screening Percentages byState, Age and Race and Ethnicity by age 0–5,6–11, and 12–17 .33Appendix B. Vision and Eye Health Requirementsby State .35Appendix C. The 12 Components of a StrongVision Health System of Care .39Appendix D. Prevent Blindness Model Children’sVision Legislation .413. Vision Testing: Children age 17 years andYounger in Children Age 17 Years and Younger(2016–2017) .134. Percentage of Children Receiving Vision Testingby Ethnicity & Primary Household Language inChildren Age 17 Years and Younger (2016-2017) .145. Parent Difficulty in Affording Needed Eyeglassesfor Their Children by Child’s Health InsuranceStatus (2004–2006) .156. Visual Impairment in Preschool Children Aged36–72 Months by Race/Ethnicity, (2015–2060) .15
About Prevent Blindness and the National Center forChildren’s Vision and Eye Health (NCCVEH)Prevent Blindness is the leading national nonprofit 501(c)(3) organizationdedicated to preventing blindness and preserving sight across all life stages.We bring together science and policy to implement positive population-basedchange with an emphasis on early detection and access to appropriate care.We focus on improving the nation’s vision and eye health by educating theAmerican public on the importance of caring for their eyes and vision bypromoting advances in public health systems that support eye health needsand advocating for public policy that emphasizes early detection and access toappropriate eye care.Quality practices and systems for children’s vision include establishment ofa surveillance system, coordination, and collaboration among agencies andcommunity partners, a comprehensive screening and referral infrastructure,a uniform approach to training, technical assistance resources, improvedpolicies, and increased public and professional education and awareness.Realizing that all stakeholders across the spectrum must be engaged in thischallenge, Prevent Blindness established our National Center for Children’sVision and Eye Health (NCCVEH) in 2009 to strengthen the nation’s publichealth system for children’s vision. Over the past 10 years the NCCVEH hasreshaped the system for children’s vision health through strong partnerships,sound science, and targeted policy initiatives to ensure that no child isimpeded in school or life because of an undiagnosed vision problem.The NCCVEH is supported by a grant from HRSA’s Maternal and Child HealthBureau (Grant # H7MMC24738– Vision Screening for Young Children).About this ReportThe Children’s Vision and Eye Health: A Snapshot of Current National Issues2nd Edition offers a compilation of current research, survey data, and bestpractices that outline the current landscape for children’s vision and eye healthin the U.S. It is our intent that the information and examples provided in thisreport will translate into effective community- and state-level health promotionstrategies that lead to improved vision. The report is designed to give diversestakeholders the knowledge to implement systems-level changes, includingbut not limited to public health practitioners, primary health care providers,parent advocates, early childcare providers, policy makers, community andbusiness leaders, community-based organizations, educators, school nursesand others interested in improving the health of children.This report should be used along with technical assistance offered by theNCCVEH, local and state health experts, public health program managers,researchers, and others with relevant expertise to ensure successful changesin your vision health system for children.–3–
The following staff members of Prevent Blindness and the NCCVEH assisted inthe development of this publication: Donna Fishman, Kira Baldonado,Arzu Bilazer, Sara Brown, P. Kay Nottingham Chaplin, EdD., andPaulette Tattersall. Linda C. Wolfe, EdD, RN served as editor. The AdvisoryCommittee to the NCCVH provided content and review.Children’s Vision and Eye Health: A Snapshot of Current National Issues 2020 by The National Center for Children’s Vision and Eye Health at PreventBlindness. Permission is given to photocopy this publication or to forwardit, in its entirety, to others with the suggested citation included. Requests forpermission to use all or part of the information contained in this publication inother ways should be sent to the address below.Cite as: National Center for Children’s Vision and Eye Health at PreventBlindness. 2020. Children’s Vision and Eye Health: A Snapshot of CurrentNational Issues (2nd ed.). Chicago, IL: National Center for Children’s Visionand Eye Health at Prevent Blindness.AcknowledgementsThis report was supported by the Health Resources and Services Administration(HRSA) of the U.S. Department of Health and Human Services (HHS) undergrant number H7MMC24738 – Vision Screening for Young Children Grant(the current grant total award amount 300,000; percentage financed withnongovernmental sources .5%). This information or content and conclusionsare those of the author and should not be construed as the official position orpolicy of, nor should any endorsements be inferred by HRSA, HHS or the U.S.Government.The National Center for Children’s Vision and Eye Health expressessincere appreciation to the members of its Advisory Committee for their expertguidance in developing the Children’s Vision and Eye Health: A Snapshotof Current National Issues 2020 report and their ongoing support of theorganization. The Committee’s time and expertise contributed significantly tothe vision and content of this publication.NCCVEH Work Group Members: Laura Anderko, PhD, RN, Sandra Block, OD,MEd, MPH, Alejandra de Alba Campomanes, MD, MPH, Phoebe Lenhart, MD,M. Kathleen Murphy, DNP, RN, FAAN, and Michael Repka, MD, MBA.Please visit ist-2020-for-Website-003.pdf for a fulllist of Advisory Committee members.–4–
INTRODUCTIONEverything Is So ClearWhen my daughter Zoe wasin the first grade, her teacherrecommended we have hereyesight checked. I found therequest odd as Zoe had regularcheck-ups with her pediatricianand had not complained of thingsnot “looking right.” However, ofcourse I wanted to make sureshe was okay. When we met withthe eye doctor, she walked usthrough several comprehensivetests. We discovered Zoe neededeyeglasses. A few weeks later afterreceiving the glasses, we walkedout of the office, and Zoe said,“Wow! Everything is so clear! Thetrees used to look like blobs ofcolor but now I see their shape.Everything is so pretty!”1When Samantha was a toddler,I asked my husband, “Do you seeher squinting?”In sharing this concern withSamantha’s pediatrician, we werereferred to an ophthalmologistwho diagnosed her withhyperopia (farsightedness) andprescribed eyeglasses. We satat the kitchen table, put a pairof pink frames on a squirming,fussing 18-month-old Samantha,and instantly saw a child go quietand become enthralled by thebook in front of her. Magic. Or ifyou have normal vision—sight!2There are many success storiesof children who have receivedtreatment for visual disorders.However, for too many children,such disorders are often notidentified and thus not treated early.These children may fall behind inschool, exhibit behavioral disordersin the classroom, and lag inreaching developmental milestones.Everyone has a role in the earlyidentification of children’s visiondisorders—parents, pediatriciansand primary care providers, preschool program providers, schoolnurses, and teachers, amongothers.that in 2015, there were 174,000preschool-age children in the U.S.with a visual impairment, withconditions including uncorrectedrefractive error amblyopia, andother eye diseases.13 Blindness inchildhood is particularly concerning,as many disorders leading toimpairment are preventable.12 One ofthe greatest concerns is that visionloss will impact a child’s quality oflife, affecting financial, social, andemployment opportunities over hisor her lifespan.Vision has a critical role in children’sphysical, cognitive, and socialdevelopment. Up to one in 17 youngchildren and one in five preschoolage children enrolled in HeadStart has an undiagnosed visiondisorder.3 Without early detectionand treatment, uncorrectedvision disorders can impair childdevelopment, interfere with learning,and even lead to permanentvision loss.4,5,6,7,8 Moreover, visualfunctioning is a strong predictor ofacademic performance in schoolage children,9 and vision disordersin childhood may continue to affecthealth and well-being throughadulthood.10Vision is a global concern.According to the World HealthOrganization (WHO), 2.2 billionpeople have vision impairment,with 1 billion estimated to be beingchildren.11 The majority of childrenhave uncorrected refractive error(URE). Blindness resulting fromURE and other causes have beendiagnosed in 1.4 million children12(Box 1). Researchers estimate–5–The economic costs of children’svision disorders are significant,amounting to 10 billion yearly inthe U.S.14 Typically, families shoulder45% of these costs.14 This estimateaccounts for the costs of medicalcare, vision aids and devices,caregivers, special education,federal assistance programs, visionscreening programs, and quality oflife losses, and does not take intoaccount any limitations in futureemployment or social opportunities.On the global level, several notableorganizations have identifiedthe need for comprehensivewellness and addressed the socialdeterminants impacting health.The United Nations has developedSustainable Development Goals(SDG) to address the health needsof the global population.15 The thirdSDG, often referred to as UniversalHealth, focuses on good health andwellness for all. Although eye healthfalls under this heading, vision andeye health also impact other SDGs.For example, SDG Goals 1 and4—poverty and quality education,respectively—are both directlyimpacted by visual ability. Numerousresearchers have shown
BOX 1. Vision ImpairmentDefinitionsLegal Blindness: Visual acuitythat does not exceed 20/200 inthe better eye with a correctinglens; and the field of vision nogreater than 20 degrees in itswidest angle (visual acuity of20/200 means that a person cansee at a distance of 20 feet whata person with “normal” sight cansee at 200 feet).Severe Visual Impairment:An inability to read ordinarynewspaper print, even with theaid of glasses. The impairmentindicates no useful vision ineither eye and includes thosewho are legally blind.Visually Impaired: Personswho have some difficulty seeingwith one or both eyes even withthe use of glasses.Source: Prevent Blindness, 2019.that vision disorders, if not identifiedand addressed in a timely fashion,can compromise a child’s academicsuccess. Poverty also restrictsaccess to quality eye services, andchildren with disabilities have ahigher prevalence of vision and eyehealth disorders.critical to a child’s long-term visionhealth, and vision screenings servea useful role in identifying childrenin need of eye care and promotefurther evaluation by a professional.Many children in the U.S. do notreceive timely vision screenings oraccess to professional eye care,17and wide variation exists amongthe laws and regulations related tovision and eye health.The WHO reports that “vision,the most dominant of our senses,is vital at every turn of our livesyet it is overlooked worldwideand often untreated.”11 In 2018,the G20 Development WorkingGroup called for “investing inearly childhood [ages 0–8 years]development,” which includesreducing the cycle of poverty andinequality.16 Development is definedas the “continuous acquisitionof skills and abilities across thedomains of cognition, language,motor, social and emotionaldevelopment.”16 As vision is vital toeach of these developmental areas,the NCCVEH advocates for eyehealth as a part of this importantinitiative. We must recognize theparamount importance of visionwithin the current contexts ofcomprehensive health and thesocial determinants of health.The purpose of this report is toprovide facts and strategies to helpreaders facilitate change on a stateand local level in order to eradicateblindness and visual impairment.This document brings togetherinformation on the scope of visiondisorders in children, national andstate-level policies, and efforts tobuild comprehensive systems topromote children’s vision and eyehealth. Research is continuouslyproviding new knowledge on riskfactors, better access to neededservices, and estimates of theprevalence of vision disordersamong U.S. children.Given the importance of vision inearly childhood development, theNCCVEH will continue to advocatefor appropriate vision and eye healthservices to help all children reachtheir full potential. Much workremains to build awareness of thesignificance of vision disordersand ensure that every stateinitiates a comprehensive systemto promote vision and eye health.This report is intended as a tool toengage readers in supporting ourefforts.In the U.S., vision care for children(including eye health education,screenings, care coordination, eyecare, and treatment) is addressedin a variety of venues, includingprimary care offices, public healthclinics, schools, childcare facilities,eye care provider offices, andcommunity health program settings.Early detection, diagnosis, andtreatment of a vision disorder is–6–
CommonVisionDisordersin ChildrenAmblyopiaNormal VisionVISION LOSSAccording to the 2016–2017National Survey of Children’sHealth, 1.6% of U.S. children frombirth through 17 years suffered fromblindness or had problems seeingeven with the use of glasses, whichrepresents over 1.1 million children.18The number of preschool children(ages 3 to 5) in the U.S. with visionimpairment is estimated to bemore than 174,000.13 An analysis ofchildren’s vision disorders in 2015with projections to 2060 indicatessignificant increases in visualimpairment among Hispanic, AsianAmerican, and multi-racial childrenages 36 months to 72 months old13(Table 6). California, Florida, andTexas are estimated to be the statesmost impacted. 13AMBLYOPIAAmblyopiaStrabismusNormal EyesMisaligned EyesAmblyopia (sometimes called “lazyeye”) is the most common cause ofvision loss in children and occurs inabout 2% to 4% of young children(ages 6 months to 6 years)19,20,21With amblyopia, vision is impaireddue to abnormal development ofthe neural connections betweenthe brain and the eye during earlychildhood. The primary causesare misalignment of the eyes(strabismus) and high-uncorrectedrefractive error or unequal refractiveerror between the eyes.22 Amblyopiamay also occur with other causesof vision loss. Typically, the visionloss affects only one eye, butpeople with amblyopia are nearlythree times more likely to developvision impairment in their betterseeing eye later in life.23 Earlydetection of amblyopia is critical–7–as treatment is most successfulwhen initiated before age 7. Thebattle to prevent vision loss dueto amblyopia is a winnable battle;other countries have made stridestoward eradicating vision lossdue to amblyopia.24 Without earlytreatment, amblyopia can lead topermanent vision loss in one or botheyes.25STRABISMUSStrabismus, or misalignment ofthe eyes, occurs in 2% to 4% ofchildren under the age of 6.19,20,21The term “eye alignment” refersto how the eyes align and worktogether when looking at anobject. Strabismus orients theeyes in different directions andthus the brain receives conflictingvisual input, interfering withbinocular vision development anddepth perception. Terms used todescribe the direction of the eye(s)are: esotropia (eye turns inwardtoward the nose), exotropia (eyeturns outward and to the side),hypertropia (eye turns upward), andhypotropia (eye turns downward).Without treatment, vision lossin one eye can occur and theappearance of misaligned eyesmay negatively affect the emotionalhealth, social relationships, and selfimage of children.4 Risk factors forstrabismus are family history of thecondition, prematurity, and maternalsmoking.26
REFRACTIVE ERRORSNormal VisionMyopiaHyperopiaAstigmatismThe most common vision disordersin children are refractive errors:myopia (“nearsightedness”),hyperopia (“farsightedness”), andastigmatism (irregular shape ofthe front surface of the cornea,the transparent “window” at thefront of the eye). Refractive errorsoccur when light does not focuson the retina (the “film” in the“camera”), causing blurred vision.Uncorrected refractive errors inyoung children are associatedwith parental concerns aboutdevelopmental delay, as well asdeficits in cognitive and visual-motorfunctions that may affect schoolreadiness and performance.5,6,7Estimates of prevalence vary due todifferences in diagnostic criteria andexamination methods. Refractiveerrors make up 70% of decreasedvisual acuity in Asian and nonHispanic White children and morethan 90% of decreased vision acuitywith an identifiable cause.27Myopia is a condition in whichobjects in the distance are blurry.Four percent of children aged 6months to 6 years28 and 9% ofolder children (ages 5 to 17 years)29have myopia, or nearsightedness.Prevalence varies by age andrace/ethnicity.29,30,31Hyperopia is a condition wherebyclose objects are blurry. Theprevalence of hyperopia, orfarsighted
The Children’s Vision and Eye Health: A Snapshot of Current National Issues 2nd Edition offers a compilation of current research, survey data, and best-practices that outline the current landscape for children’s vision and eye health in the U.S. It is our intent that the information and examples provided in this
Spot Vision Screener Sample Results Vision screening does not replace a complete eye examination by a vision care specialist. This material, trademarks & property are copyrighted 2014 by PediaVision Holdings, LLC.File Size: 3MBPage Count: 15Explore furtherA quick guide to interpreting eye test results - The Eye .www.theeyepractice.com.auHow to Read Your Vision Screening Results - hospitalninojesuswww.hospitalninojesus.comHow to 101: Interpreting Spot Vision Screening Resultsdepisteo.com10 Best Free Printable Preschool Eye Charts - printablee.comwww.printablee.comThe Different Types of Eye Charts and 20/20 Vision - Eyecarewww.optometristoakville.caSnellen Eye Chart Eye Charts - EyeGlass Guidewww.eyeglassguide.comRecommended to you b
Eye Drops to Hold 48 Hours Before Allergy Testing Prescription Nasal Sprays Astelin Nasal Spray All Over-the-Counter Eye Drops Visine A Eye Drops Op-Con A Naph-Con A Alomide Eye Drops Prescription Eye Drops Patanol Eye Drops Zaditor Eye Drops Optivar Eye Drops Elestat Eye Drops Medicines That You MAY CONTINUE .
The term eye gaze tracking includes also some works that track the whole eye, focus on the shape of the eye (even when it is closed) and contains the eyebrows in the eye tracking. Consequently, the term eye gaze tracking represents a lot of different types of eye tracking [6]. 2.1.2 Eye Gaze and Communication Gaze is one of the main keys to .
Eye Consultants of Atlanta Eye Doctors of Washington Eye Physicians and Surgeons of Atlanta Glaucoma Care Center Great Lakes Ophthalmology Henry Ford Hospitals Johns Hopkins University Jules Stein Eye Institute, UCLA Kellogg Eye Center Kresge Eye Institute Krieger Eye Institute Maryland Center for Eye Care
Gross & microscopic anatomy of the eye a. Identify the accessory eye structures, the tunics, the optical components and the neural components of the eye. 2. Roles of specific tissues of the eye in vision . 2 Image 1: Eye in its orbit Creative Commons Attribution 4.0 International Openstax URL: Eye in its orbit
AMBLYOPIA or Lazy eye is where the vision in one eye is weaker than the other. The child's brain ignores the weak eye and uses the stronger eye in an attempt to see. If left untreated, the child's brain develops a clear picture in the good eye and a blurry picture in the weak eye.
Vision Eye Institute laser eye surgeons are some of the most experienced in Australia. Through their participation in international trials, presentations at conferences and involvement in teaching, our surgeons stay at the cutting edge of laser eye surgery. In fact, our surgeons have been among the first to perform laser eye procedures, including
California LASIK & Eye Surgery Guide. LASIK EYE SURGERY . Section 1 . How do we see? An explanation of how a healthy eye works . Section 2 . Common vision problems . A description of the visual imperfections that limit the quality of vision . Section 3 . How LASIK fixes visual imperfections. Explanation of how LASIK can make your eye optically .
