Pediatric Eye Care: Where Do We Stand?
Vision screenings are second best -- a distant second.
BY NEIL B. GAILMARD, O.D., M.B.A., F.A.A.O., Chief Optometric Editor
It is unique for an optometric journal to interview a world leader and renowned humanitarian. We at OM are proud to have done just that in this issue with my interview with former president and recent Nobel Peace Prize laureate, Jimmy Carter. Eye care and the prevention of blindness are strong interests of Mr. Carter's.
The Carter Center works toward eradicating disease in developing countries, such as River Blindness and Trachoma. We don't see much of those in the United States. Here, we have amblyopia. Mr. Carter has an interest in that as well, stemming from his own grandchildren, as you will read starting on page 46. Because Mr. Carter finds it fitting to call optometrists to action by "reaching each child at an early age," I would like to echo his comments with some specific ideas.
Perform an altruistic act
The majority of children in our communities are from families that can afford to pay for eye exams or have insurance that would cover the cost. We need to make sure we see those children by educating the public on the importance of early eye care.
For those who can't afford the care, some excellent programs can help assist, including Vision USA, Operation Bright Start, local Lion's Clubs and state Medicaid programs. Of course, we needn't be too hung up over who's going to pay for the eye exam of the occasional needy child in our community. Imagine the goodwill if we all provided this care without worrying about getting the credit
Work toward better laws
I believe in legislation in all 50 states mandating comprehensive exams by an eye doctor before entering school. I know that when an optometrist says this, it appears self-rewarding, but most states require complete physical and dental exams. And my state just implemented mandatory blood tests to check for lead poisoning -- can't we work vision in there somewhere? It's such a vital part of the learning process.
Screenings are second best
The single biggest obstacle we face in enacting legislation for pre-school eye exams is vision screenings and the lack of understanding about their effectiveness. Most of these are eye chart tests performed by a school nurse or teachers. Educators and parents don't realize that the 6-D, hyperopic 5-year-old can read the chart just fine and will pass the screening. Or the clever student who gets a look at the Snellen chart while standing in line, reads the necessary line with his dominant eye first, then repeats it from rote with his amblyopic eye.
I know many optometrists have participated in school screenings in local communities for many years, and I recognize that this is a selfless effort to work within the system and to help find kids who need care. There is no doubt that when optometrists are involved, the accuracy of the screening goes way up. But we should all make it clear that this is a second best approach -- full exams would be much better. Parents already think their child had an "eye exam" when the nurse does a screening, so when a doctor administers it, that false security is made even stronger. It's a Catch-22, where well-meaning doctors enable a process that does not really serve children with optimum care, but the care would be much worse without them.
Finally, let's consider how we handle the children we do see in our practices. Our training is second to none in binocular vision development and in exam techniques for children, so we already do a great job. But many optometrists don't specialize in vision therapy or developmental vision -- yet we all know a colleague who does. Let's get over our long-standing hesitancy to refer a patient to another local O.D. Pediatric eye care is a good place to start.