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
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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?