Ohio tackles pediatric eye health initiatives with Children’s Vision Strike Force
The strike force involves more than a dozen medical and nonmedical professionals to help bridge the gap between failed vision screenings and follow-up examinations.
Image credit: AdobeStock/LenaMay
The state of Ohio, much like the rest of the country, is facing a pediatric eye care problem. Although several nonprofit organizations and government-funded programs and initiatives are working to ensure children’s eyes are examined, the fight continues to keep these examinations regular and consistent with a given patient’s needs in the state. However, these initiatives may see statewide regulation and growth thanks to a formative visit to southeastern Ohio made by Governor Mike DeWine.
According to Elizabeth Muckley, OD, FAAO, who is CEO and executive director for the Ohio Optometric Association (OOA), the organization’s immediate past president Shane Foster took the opportunity to chat with the governor about the work the organization was doing in partnership with Foundation for Appalachia Ohio. It was a short month later, when DeWine gave his 2024 State of the State address on April 10, that he announced plans to form the Children’s Vision Strike Force in an effort to bridge the gap between vision screening failings and follow-up comprehensive eye examinations.1
The strike force consists of more than a dozen medical and nonmedical professionals from a variety of sectors, including public health, vision care and health, academia and education, and state government.1 The members plan on meeting once a month for the next 4 months to identify current initiatives and programming that have proven successful to model a new plan. “The idea of the strike force is to come up with the idea of a plan that could be implemented statewide to try and close the gap between children getting screenings and children getting eye examinations,” Jeffrey J. Walline, OD, PhD, acting dean of The Ohio State University College of Optometry in Columbus and member of the strike force, said.
Bruce Vanderhoff, MD, MBA, director of the Ohio Department of Health and chair of the strike force, said that the strike force has had 2 successful meetings thus far and is making good progress. “I think they’ve been very productive,” he said. “They have exceeded my expectations on a number of levels, including the level of dialogue and information exchange that has gone on.”
Additionally, Walline finds power in having such a diverse group collaborating on the strike force. “When we combine all our forces and all our knowledge, it makes it a powerful way to be able to do it,” he said. “I think Ohio could lead the nation in this type of system to make sure that we close that gap.”
Identifying needs
Muckley said that although every geographic region or socioeconomic population in Ohio may not struggle with accessibility, the consistency for follow-up examinations remains a common thread throughout the state. According to results from a 2019-2021 Ohio Department of Health Children’s Vision Program survey report, more than 80% of pediatric patients from preschool to grade 12 did not have referrals completed when they had failed vision screenings.2 For those conducting vision screenings, registered nurses are conducting approximately 68% of screenings for pediatric patients. The professionals least likely to be conducting vision screenings are other school personnel at 1.5% and early childhood personnel at 0.01%; that is only 1294 employees of more than 82,500 reported in the survey.2 “From the work that we’re doing through our foundation, we know from the school nurses who contact us asking for assistance that it’s a persistent problem. It’s statewide,” Steve Dorman, MS, chief operating officer of the Ohio Optometric Foundation (OOF), said.
Dorman said that at a recent clinic held by the OOF in Mansfield, Ohio, they found that of 49 students screened for their vision, all 49 needed vision correction. He also said that a handful of high school students screened had never had their vision evaluated and came back with excessively high refractive errors, including –8 and +6 D. “We’re glad that we could provide that intervention at that point, but it would have been better for them, I’m sure, socially and academically, had that happened earlier,” Dorman said.
On a national scale, improvements needed for pediatric vision screenings and eye examinations remain. From 2016 to 2020, caregiver-reported vision screening declined more than 13.5%, with less than 55% of pediatric patients younger than 17 years completing vision screening, according to results from the National Survey of Children’s Health.3
To mitigate this decline in vision screenings, a 2023 study cited the importance of follow-up referrals to eye care providers.4 “Connecting children to eye care following a referral continues to be a challenge and should remain a top priority in developing systems to address barriers to pediatric eye care. Building partnerships and communication with vision health stakeholders are also key priority areas. Partnerships with local eye care providers may help vision screening programs to better navigate follow-up after vision screenings and coordinate care for children with complex ocular conditions. Eye care providers may also inform and support efforts to engage with the local community,” the authors stated.
What models are working?
Muckley said that 1 of the current initiatives in the state that the strike force is citing as a success is the OOF’s In-School Eye Exam (iSee) program, which works in collaboration with the OOA to bring local optometrists into schools as volunteers to organize and conduct eye examination clinics with school staff. The examinations and glasses given to students in need are both free. “It completely eliminates almost all the barriers that children could have to overcome in order to get an eye exam and get correction if necessary,” she said.
Muckley cites the iSee program as a community-based approach, using the resources in the community to be sure that students have local access to eye care outside their school. “The good news for Ohio is in 86 of 88 counties, we have optometry present,” she said.
A benefit of bringing in local volunteer optometrists is improving communication between schools and medical professionals, according to Walline. “Because these examinations will be done at the schools or in coordination with the schools [in a community-based model], the treatment plan should be sent back to the schools so that they have an idea of what else needs to be done,” he said. “If a child has glasses but doesn’t wear them, they’ll at least know that the child should be wearing the glasses so that they can help get the child the help that they need.”
Other successful models, particularly in rural regions of the state that require more intensive transportation to reach optometric and pediatric offices, include mobile services. With programs such as Vision to Learn, clinicians are outfitted with a van that has the equipment necessary to conduct examinations and to provide eyeglasses as needed. Since bringing its services to Ohio in 2021, Vision to Learn has provided more than 5500 eye examinations and 4400 pairs of glasses to students in 16 different counties in southeastern Ohio alone.5
Some of the original eye care providers to drive the vans, married couple Thomas G. Quinn, OD, MS, FAAO, and Susan Quinn, OD, took on the job after retirement and have committed to 18 examinations a day for those 16 counties in southeastern Ohio. They said the collaborative effort from the schools and from parents allows children to be screened, examined, and outfitted with new glasses within 2 weeks. “Every Monday we’re driving home, we look at each other and go, ‘Can you believe this kid and that kid has been going around with that kind of vision?’” Thomas Quinn said. “It’s so gratifying to be doing what we’re doing. It feels like you’re making a difference.”
Currently, the strike force is weighing its options in terms of how to structure initiatives that are to all school districts’ advantages. “No one model is going to fit,” Muckley said. “I think [state officials are] going to hopefully leave it up to the schools to decide which model works best for the school district.”
What’s next?
Vanderhoff said plans for the next 2 strike force meetings include discussions on scaling delivery models, best practice examples on a national level, referral models, and access to continuing vision care. “[We’re] recognizing that as important as those eyeglasses to kids who need them are, inevitably, a comprehensive eye examination will identify the need for care that goes beyond eyeglasses,” he said. “So we want to be sure that we understand referral models really well.” After a review of this information, discussions surrounding funding models will also require a deep dive to decide the extent of state and Medicaid funds to be used for the initiative.
At the end of the planning process, Muckley said that it is up to DeWine and his health care policy team to see whether new legislative items are needed to start the initiative. The earliest that new legislative items can be submitted for review would be during the Ohio General Assembly in January 2025. Walline said the hope is to have an initiative solidified and in play in the next 2 years.
Muckley said the funding behind the initiative will be integral to the growth and expansion of Ohio’s pediatric eye care initiatives. “If you give enough funding to a program, you can make a lot of important changes and reach things on a wider scale,” she said. “So that’s what we’re hoping this will do: bring what we’ve already been doing [to] a bigger and wider scale so that we can help these kids. Because if you can’t see, you can’t learn.”
References:
Children’s Vision Strike Force. Ohio Department of Health. Accessed August 12, 2024. https://odh.ohio.gov/know-our-programs/cvsf/childrens-vision-strike-force
Children’s Vision Program Annual Report 2019-2021. Ohio Department of Health. Accessed August 12, 2024. https://odh.ohio.gov/know-our-programs/children-s-hearing-vision-program/documentation/childrensvisionprogramannualreport19-21
Child and Adolescent Health Measurement Initiative National Survey of Children Health 2020–2021. Data Resource Center for Child & Adolescent Health. Accessed August 12, 2024. http://www.childhealthdata.org
Chauhan MZ, Elhusseiny AM, Samarah ES, Rook BS, Sallam AB, Phillips PH. Five-year trends in pediatric vision screening and access in the United States. Ophthalmology. 2023;130(1):120-122. doi:10.1016/j.ophtha.2022.09.018
Southeastern Ohio. Vision to Learn. Accessed August 12, 2024. https://visiontolearn.org/where-we-work/ohio/
