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Baltimore-The political realities of implementing mandatory vision-screening programs offer hard lessons for the dedicated individuals involved in the process. Small victories have been scored, but enormous efforts still need to be made to meet the goal of vision screening for all pre-kindergarten children with follow-up care for those identified as needing it, according to Mary Louise Collins, MD.
She called for participation by all individuals interested in the vision care needs of children.
"Pediatric ophthalmologists, orthoptists, and others interested in vision screening for children have long wanted the implementation of screening programs to be of interest to the general public and to those who set health policy," said Dr. Collins, director of Pediatric Ophthalmology and Strabismus, Greater Baltimore Medical Center, Department of Ophthalmology, Baltimore, and chairman of the Legislative Committee, American Association for Pediatric Ophthalmology and Strabismus (AAPOS).
Funding, she claimed, will help in the development of the optimal vision screener, which should be inexpensive, have high specificity and sensitivity, and be capable of being used in all geographic and socioeconomic regions.
"We also want good public health policy to be set by vision-screening programs that use scarce health-care dollars wisely," she said. "We want funding for follow-up care and treatment of children who fail vision screening. In order to get what we want, and what children need, we must be more involved and more active; not all physicians appreciate this."
An industry strategy spurred attempts at comprehensive eye exam legislation when the Vision Council of America, a trade association for spectacle manufacturers, pinpointed a decline in the sale of eyeglasses in 1999.
By marketing to children, the industry hoped to increase the sale of eyeglasses. The initial strategy was to use a campaign to mandate comprehensive eye examinations legislatively for all children of pre-kindergarten age, a strategy that Dr. Collins called "fiscally irresponsible."
In 2000, the first law was passed in Kentucky to mandate comprehensive eye examinations for all children before entering kindergarten. In the past 5 years, there have been attempts in other states to pass similar laws.
In 2003, a federal bill that was supported by optometrists and the Vision Council of America was submitted to the U.S. House of Representatives. If passed, the legislation would have provided $75 million for comprehensive eye examinations in the form of state grants. The bill did not carry the requirement that children had to have failed a previous vision-screening test to be eligible for funding and the funds were not prohibited for use in vision therapy.
Comprehensive eye exam legislation was enacted in North Carolina during a legislative session last year when the Speaker of the House of Representatives, an optometrist, amended the budget bill to include mandatory comprehensive eye examinations for all pre-kindergarten children. There were no public hearings on the issue of pre-kindergarten comprehensive eye exams and because the bill was signed into law, a judge in North Carolina has instituted a 1-year injunction.
In a 2005 legislative session in Arkansas, a new tactic was used: "enhanced vision-screening" legislation.
"This bill would mandate enhanced vision screening seven times for children between the ages of 4 and 13," she said. In addition, to the normal components of a vision screening, this includes a test of the "lateral muscles at far and near, a test of vertical muscles at far, and distance and near stereopsis.
No requirements were outlined for who would conduct the testing or the manner in which they would be conducted. In addition, no requirement for follow-up care was made in the bill."
In addition, InfantSee, a partnership between the American Optometric Association and Johnson & Johnson Vision Care Institute, was launched recently. This partnership provides free comprehensive eye examinations to infants during the first year of life. Dr. Collins pointed out that volunteer optometrists run this program. The optometrists can attend a 1-day training session at Johnson & Johnson to learn to examine infants.