Pulse
School Work
The Phillips Eye Institute is bringing the eye test back to Minneapolis elementary schools.
The Phillips Eye Institute has revived a tradition that had gone the way of the blackboard and filmstrip in the Minneapolis Public Schools. Cut from the school district’s nursing budget several years ago, vision screenings had been deemed a lesser priority than, say, dealing with asthma and diabetes.
Eye screenings might have remained a quaint memory of teachers and parents except that staff at Phillips thought vision screenings were important for identifying problems that they end up treating later on.
Several years ago, Phillips president David Orbuch had encouraged the institute’s doctors, employees, and board members to explore how the eye care hospital could reach beyond its walls. A staff member noted that screenings were no longer done in the Minneapolis schools and proposed partnering with the district to reinstate them. By early 2008, the Early Youth Eyecare (EYE) initiative was being piloted in eight Minneapolis elementary schools. This last school year, it was going full-throttle, screening children in all 44 of the district’s elementary schools.
Meeting a Need
When representatives from Phillips first approached the Minneapolis Public Schools about reviving vision screening for schoolchildren, nursing services manager Carmen Teskey, R.N., was concerned that the hospital would want to focus on just one neighborhood or school. What was needed, she thought, was a program that would serve all elementary school children in the district.
Teskey had started her career during a time when vision screenings were a routine part of what school nurses did. With the help of parent volunteers, they’d lead children who were nervously wondering whether they needed glasses to a masking-tape line on the floor where they’d cover one eye and try to read the eye chart on the wall across the room. Such a screening was how Teskey herself learned she needed glasses when she was in fifth grade.
Minneapolis stopped doing mass screenings when budgets tightened and nursing priorities changed in 2004. (Minnesota is one of 10 states that doesn’t mandate that schools do the screenings.) School nurses suddenly found themselves assigned to two or three buildings and their time taken up with new tasks such as coordinating the care of a growing number of children with chronic illnesses and emergency preparedness planning.
Although Teskey was pleasantly surprised when she learned that Phillips wanted to screen all elementary-aged children in all Minneapolis public schools, she was still concerned. She knew that screenings were only part of the equation. Children who failed the screenings needed to see an eye care specialist, and the schools didn’t have the resources to make sure they did. So Teskey was even more pleased when she found out that Phillips wanted to follow up with parents.
The EYE program currently provides trained staff and volunteers who administer the screenings to children in kindergarten, first, and fifth grades. (It will add third graders next year.) Children who fail the first screening are retested. If they fail a second time, parents are notified that their child needs to see an eye doctor. If EYE staffers don’t hear about a particular child within a month, they follow up with a phone call to the parents in order to find out what’s keeping the child from getting care.
“We recognize there’s a big difference between giving somebody a phone number and saying ‘Here are the resources, good luck,’ and somebody contacting you with some assistance,” says Pamela Ross, director of the EYE program. Ross explains that Phillips has a network of physicians who can see those children who don’t have a regular eye care provider. The program pays for care and glasses if the family can’t afford them; it will also pay and arrange for interpreter services and transportation to the clinic, if needed. All services are covered by the Phillips Institute Foundation’s EYE SPY Treatment Fund.
The Importance of Screening
Nancy Benegas, M.D., a HealthPartners pediatric ophthalmologist who is closely involved with the EYE program, says the school screenings serve as a “huge safety net” for children. She notes that although primary care providers do vision screenings, they can’t always catch problems. Any one screening may not be accurate because a child may be anxious, distracted, or tired on a particular day, she says. “Multiple screenings increase the chance that we’re going to identify treatable conditions.”
Repeated screenings are also valuable because vision can change as the child grows. A child who has normal vision when he is in the first grade may need glasses by the time he is in the fourth or fifth grade, a time when nearsightedness is commonly identified.
Benegas says it’s critical for children’s problems to be identified early. Amblyopia, for example, is treatable only until a child is around the age of 9. Yet it easily can be missed because a child can function normally with sight in only one eye.
Ross tells about a student in one of the screenings who was discovered to have perfect vision in one eye and no vision in the other. He was referred to an ophthalmologist, who ordered an MRI that revealed advanced optic atrophy. “There wasn’t an intervention that could be done,” she says. “Had this child been identified earlier, there might have been a different outcome.”
Fortunately, there are happier endings to some of the stories emerging from the screenings. One is the case of a 6-year-old Ethiopian-born boy with congenital glaucoma. Although he had been diagnosed and treated before immigrating to the United States, he had no medical insurance and was receiving no care when he turned up in school. He came to the attention of the EYE staff who connected him with and paid for the care he needed.
Most often, however, the EYE screenings are identifying children who simply need glasses. Children themselves often don’t know they have a vision problem or can’t articulate that they do. “They’ve always seen the world the way they see the world,” Ross says. “They don’t know that [glasses] can make it crisper, more distinct, or clear.”
Although poor vision is painless, not life-threatening, and is generally not something children will complain about, it can have a lasting impact. Children who can’t see well often disengage from school and learning; low vision itself is associated with poverty. Ross notes that the effects of many efforts on behalf of kids aren’t felt for years. “But when you give a kid a pair of glasses, their vision improves, and their engagement and academic performance is enhanced dramatically as well. It’s almost instantaneous.”
Big Deal
As of this May, EYE volunteers had screened 7,500 Minneapolis children. They had referred 925 for an examination with an optometrist or ophthalmologist, and the program had funded the care of more than 100 children. By next year, it will be screening 11,000 children. An estimated 15 percent of those will be referred for an eye exam and receive follow up.
“It’s huge,” Benegas says of the scale of the initiative. “They’ve gone steps beyond just screening. They’re providing a wonderful service, the full service.”
As a result, the current generation of Minneapolis students will consider vision screenings as much a part of their school experience as SMART boards and videos.—Carmen Peota
To get involved in the EYE program, contact Pamela Ross at 612/775-8968 or pamela.ross@allina.com.