Optimizing Vision Development through Early Intervention

Overview

Children's Vision MA Coalition

Kathy Majzoub, RN, Prevent Blindness

Early Intervention to Support Vision Development

Bruce Moore, OD, New England College of Optometry

Birth to 3 ProjectGayathri Srinivasan, OD, New England College of Optometry

Children’s Vision Massachusetts

1. BackgroundPrevent Blindness Center for Children’s Vision and Eye Health MA Pilot Children’s Vision Massachusetts Coalition

Design & Vision--Situation Analysis--Resource Development--Solution Development—Implementation

2. ProcessPartnerships Informed New Programs and Initiatives

3. OutcomesPrograms and Initiatives Uncovered Rationale for Policy Change and Legislative/Regulatory Advocacy

4. Developing Eyes Video

A sixty member coalition comprised of ophthalmologists, optometrists, opticians, nurses, pediatricians, family physicians, public health professionals, families and others…. the coalition’s vision is that “every child has the opportunityto develop and retain their best possible vision to support healthy development and academic growth.”

Vision

Mission

To build a statewide systematic approach to vision care for children that is:

• universal

• comprehensive

• cost effective

• collaborative

• multidisciplinary

• dynamic

• sustainable

• evidence based

National Recommendations

1040-5488/15/9201-0024/0 VOL. 92, NO. 1, PP. 24Y30OPTOMETRY AND VISION SCIENCECopyright * 2014 American Academy of Optometry

1040-5488/15/9201-0017/0 VOL. 92, NO. 1, PP. 17Y23OPTOMETRY AND VISION SCIENCECopyright * 2014 American Academy of Optometry

1040-5488/15/9201-0006/0 VOL. 92, NO. 1, PP. 6Y16OPTOMETRY AND VISION SCIENCECopyright * 2014 American Academy of Optometry

www.childrensvisionmassachusetts.orgwww.nationalcenter.preventblindness.orgwww.preventblindness.orgkmajzoub@preventblindness.org

Thank you

Follow us on Facebook

Follow us on Twitter

Follow us on Instagram

Bruce Moore OD

Marcus Professor of Pediatric Studies

New England College of Optometry

Early Intervention to Support Vision Development

Why Vision Problems are Important to the Early Intervention Community

• Very high prevalence

• Relationship to other health and developmental issues

• You may be the first to detect vision problems

• Regulatory requirements

Why an Infant May Not Return a Smile From a Smiling Adult

Early Visual Development – the First Year of Life

• Looks at mom’s face very early

• Follows bright objects by 6-12 weeks

• Eye contact by age 8 weeks

• Social smile at 12 weeks

• Finding hands at 14 -16 weeks

• Copying motor functions of hands at 5-6

months

• Recognition of familiar faces at 7-8 months

Early Visual Development – What’s Not Normal?

• Strabismus

• Nystagmus

• Inability to fixate for more than a brief time

• Eye movement anomalies

• “Funny looking eyes”

90%87%

81%77%

72% 72% 72%

59%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ov

era

ll S

en

sit

ivit

y

NCR Retinomax SureSight Lea VA HOTV VA PowerRef S Smile RDE

Sensitivity to Detect AmblyopiaVIP Phase 1

Sensitivity to Detect AmblyopiaVIP Phase 2

82%

50%

56%

78%

58%60%

83%

88%85%

0%

20%

40%

60%

80%

100%

Retinomax SureSight Lea Symbols* Stereo Smile

Sen

siti

vity

Nurse

Lay

Lay-5ft

* p<0.0001, p<0.001

Uncorrected Hyperopia & Preschool Early Literacy: Results of the Vision In Preschoolers – Hyperopia In Preschoolers

(VIP-HIP) Study

Supported by NIH/NEI R01EY021141

•Significantly lower TOPEL scores in hyperopic children with ≥4D as compared to emmetropic children.

•Greatest deficits in print knowledge •Print awareness•Ability to identify letters and/or written words•Ability to identify letters associated with particular sounds

•Support findings of an association between hyperopia & reduced reading ability in children.

•Support theory that extra accommodative effort and/or inefficient visual function:

•May make reading more difficult

•Asthenopia may cause young children to read less

Take Home Messages

• Vision disorders are highly prevalent in the EI population

• Vision disorders are of great importance in the EI population:

• In terms of overall health

• In terms of associated conditions

• In terms of future education

• Every EI child needs a comrehensive eye examination early in the process

Thanks!

Approaches for identifying children birth to three years of age at risk of having vision problems- novel visual development

assessment tool and photoscreening - A Pilot Study

“Birth to Three Project”

Gayathri Srinivasan ODBruce Moore ODKathy Majzoub

Paulette TattersallBlair Germain

Birth to Three Project

Objectives:

• Compare current recommendations for vision screening in 0-3 year old children in Early education and care centers in Boston and Springfield

• Procedures compared to gold standard eye exam:

– Photoscreening

– Novel visual development questionnaire

Questions asked

• Are current recommendations efficient in identifying children with eye problems

• How do they compare to the “gold-standard” eye exam performed by eye doctors?

• How testable is the newly developed questionnaire for screening of vision problems in this age group?

Why is this important?

• Efficacy needs to be tested to ensure that children with problems are identified and treated

• Identify pitfalls in current methods • Alter current methods

• Develop new techniques

Literature?

• Limited– Age group makes testing difficult

– ? Is screening even meaningful?

Current AAP/AAPOS recommendations

PEDIATRICS Volume 137, number 1, January 2016

PhotoscreeningSpot Vision Screener

Spot Vision Screener

• Uses Infrared Camera to capture the light reflected from the retina• Identifies refractive errors/strabismus and indicates results as Pass/Fail• Test distance 3m• Suitable for testing children as they are fast and non-contact

Visual development questionnaire

• Visual development related questions that are age appropriate are broken down in 6 month intervals

• Divided into two parts:

– Visual development assessment (Q1-6)

– Risk assessment (Q7-11)

• Same concept as Ages and Stages Questionnaire

• Brain child of Lea Hyavarinen MD and her colleagues from Finland

• To be filled out by parents/guardians

– Broken down into age groups in 6 month intervals

Visual Development Questionnaire

Problems with these techniques

• Efficacy unknown

• Accuracy when performed by intended personnel unknown

• Comparison to gold standard unknown

Study Protocol

• ~200-250 infants and toddlers

• Administered by early education and care staff

• Deadline for return: 1 week Questionnaire

• Order of testing:

• Masked Photoscreening

• Comprehensive eye exam by licensed ODs

Procedures visit

Order of testing

Early Education and Intervention Staff:

• Obtain study consent

• Distribute age appropriate questionnaire

– Ex: A 9 month old infant should receive 6-12 month questionnaire

• Visit by the On-Sight Mobile van to perform photoscreening and comprehensive eye exam

Questions?