Article Date: 3/1/2012

A Vision System for Children
in the clinic

A Vision System for Children

The Good-Lite VIP System offers a kid-friendly method of vision testing.

J. James Thimons, O.D., F.A.A.O.

In a world of high technology and elaborately priced scanning systems, it is refreshing to see a product that is simple and elegant in its ability to provide accurate data for a population of patients that has historically been challenging for most clinicians.

Through “real-life” testing in clinical situations (see “Creating a Technology Center,” below), I’ve found the Good-Lite VIP (Vision in Preschool) System (www.Good Lite.com) is just that type of product. Based on the scientific work of Hyvärinen, MD, Ph.d., FAAP, and colleagues, the developer of Lea Letter testing systems for children, Good-Lite has created a product that is simple, extremely effective and priced at a modest $270.

Creating a Technology Center
A resource to assess new devices
One of the most difficult tasks for any clinician is dealing with the decisions surrounding the purchase of new equipment. Can I afford it? Is this going to give me the kind of improved patient care I desire? Will my staff embrace the new technology, and will my patients appreciate the increased level of care?
When I first discussed this column for Optometric Management with my editors, I proposed that it would be a valuable service to colleagues if equipment could be assessed in a real clinical situation, and useful information related to cost, ease of use, importance of information generated, durability, etc. could be developed.
To that end, the Ophthalmic Technology Center at Ophthalmic Consultants of Connecticut was established. The center serves as a resource to clinicians in the assessment of new technologies across a wide spectrum of important considerations related to how they work in the primary care arena.
Understanding the current economic pressures that are present in general practice, this inaugural review is on an accurate, money-saving product that been assessed in the last 12 months at the Center. Interestingly, it is also the least expensive technology that has been reviewed this year.

The system is composed of a fixed base (about the footprint of a lensometer) with standardized illumination that gives you an easy, quantified and time-saving method for measuring visual function in three-, four- and five-year-old children.

Designed for children

The device employs a system of standardized “Crowded LEA Symbols” (circle, square, apple and house) that are designed for each age group to provide similar test stimulus for each target. You or your technician administers the test at a distance of five feet in order to create a very child-friendly space that makes testing easy for you and the parent.

This Good-Lite VIP was one of 11 evaluated for the Vision In Preschoolers (VIP) study sponsored by the National Eye Institute. It was one of only three clinical technologies that made it to the Phase II clinical study and was used throughout the study. The other two systems were refractive error and stereoacuity measuring devices.

As I am sure is the case for most active clinicians, I’ve found that the number of children presenting to my practice is increasing, with the ages of these patients decreasing. The school nurse is no longer solely referring the myopic child. With child vision initiatives, such as InfantSEE (www.infantsee.org), optometry’s role in the visual welfare of children of all ages has increased dramatically.

Increasing pediatric referrals

My interest in the Good-Lite VIP developed as a result of noting an ever-increasing number of referrals by fellow optometrists and other healthcare practitioners, such as pediatricians, regarding children with poor visual performance at the pre-school and kindergarten level. I, like many practitioners, was very frustrated by the poor data that was being developed due to lack of cooperation and relative absence of subjective information to go along with my objective assessment. Fortunately, at a recent trade show, I spent some time with the scientists at the Good-Lite company. Our discussions prompted me to purchase the first unit for evaluation.

The results? For the first time, I was generating valid information from children regarding their visual performance, and I was able to acquire it easily and efficiently. Several immediate benefits were evident to me after a week or so of use, which include:

The Good-Lite VIP system provides the practice with an easy, time-saving method for accurately measuring visual function in three-, four- and five-year-old children.

The reduction in test distance to five feet for the calibrated symbols. This brought the environment into “kid space,” as opposed to the typical 20-foot adult distance. As a result, it really increased participation in the testing.

Performance was enhanced because most children could sit on Mom’s or Dad’s lap. In other words, because the children were seated at a comfortable, safe place, they were happy and, therefore, more amenable to testing.

Overall test data improved in accuracy, due to the simple fact that the LEA symbol card does not require verbalization on the part of the child with this device. This is especially crucial. Many children are just too shy to speak, which makes standard Snellen acuity often impossible. With this system, all they have to do is point at the symbols.

This device’s basic assessment of visual function improves office efficiency. How so? Your technician, or another staff member, can perform the testing. This provides you with free time to accomplish other tasks.

Impact on consultations

When I first received the system for review, I could not have been more surprised by the impact it had on the consultations that I was evaluating. These consultations were significantly more streamlined than they had been with previous methods of testing, and I was much more confident that the data represented the true performance of the child.

Since that initial trial, I have purchased a unit for each office and now look at the technology with the same level of enthusiasm that I used to reserve for optical coherence tomography and related systems.

Most optometric clinicians do not specialize in pediatric vision. As a result, for many of us it is an area in which we sometimes feel uncomfortable because we do not have the tools to produce the type of quantifiable data that we are used to producing with adults. This technology brings to the busy practitioner the type of information that makes consulting with pediatricians, teachers and colleagues simple and productive at a price point that makes it available to everyone with an interest in improving the quality of their child patients’ vision care. OM

DR. THIMONS PRACTICES IN FAIRFIELD, CONN. IN ADDITION, HE IS ADJUNCT CLINICAL PROFESSOR AT THE NEW ENGLAND COLLEGE OF OPTOMETRY AND THE PENNSYLVANIA COLLEGE OF OPTOMETRY AT SALUS UNIVERSITY. ALSO, HE'S CHAIRMAN OF THE NATIONAL GLAUCOMA SOCIETY. E-MAIL HIM AT JTHIMONS@SBCGLOBAL.NET, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.


Optometric Management, Volume: 47 , Issue: March 2012, page(s): 72 74