How to Reach Them All Preschool Vision Screening in the Inland Empire

Jennifer A. Dunbar MD

November 4, 2018

Amblyopia

Affects 1-3% of the population

Is the most common cause of unilateral blindness in adults1

Amblyopia is treatable

Glasses

Patching

Atropine penalization

1Buch H, et al. Acta Ophthalmol Scand. 2001. The prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population. The Copenhagen City Eye Study.

George P. Cheng MD Vision Screening

Program

2010-2012 Pilot Program Funded by First 5 Riverside

2015-Present Funded by Cheng Family Foundation

In partnership with Lions KidsSight

Our Mission

Promoting vision development in children ages 6 months to 6 years

Providing free vision screening

Connecting parents to a network of informed caregivers

Provide parents and caregivers with resources

Improving access to vision care for children.

Preschool Vision Screening

Photoscreening Designed to Detect Amblyopia Risk Factors

Refractive error, especially anisometropia

Strabismus

Cataract

SPOT Infrared Camera

Spot Photoscreening

Child-Friendly

Gentle colors and sounds

No-touch, focal length about a yard away

School-Friendly

Efficient-dozens of names pre-loaded

Downloadable and printable results

User-friendly to lay personnel

Screening Algorhythm

MOU with Local School Districts

Screening Coordinator schedules with Individual Schools

Lions Club KidSight Volunteers perform photoscreening

Coordinator and volunteers call families to facilitate follow up if required

Vision Screening Data

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

# Screened

2015 2016 2017

Vision Screening Data

0

20

40

60

80

100

120

140

160

180

200

# Sites

Number of Sites Screened

2015 2016 2017

Research Focus on Access to Care

Phone Follow up After Vision Screening

Geoinformatics for driving distances to care

Geoinformatics for targeting at risk children

How can repeat screening improve screening sensitivity and specificity?

Insights from Repeat Vision Screening

Insights from Repeat Vision Screening

Insights from Repeat Vision Screening

Insights from Repeat Vision Screening

Conclusions:

Astigmatism readings prompting referral with the SPOT

photoscreener are stable between annual screenings.

Compliance with follow up should be emphasized in children

with cylindrical error who fail repeat vision screening

Improving follow up after vision

screening

Phone call data

Connect family to a child-friendly provider in their local community

Optometrists to evaluate for glasses and pathology

Pediatric Ophthalmologists as needed

Vision Screening Follow up Data

No Follow-up N=1206

By 1st Call N=792

By 2nd Call N=684

By 3rd Call N=452

Had Follow-up N=1928

Graph 1: Completed Follow-up Distribution by Call Attempt

Vision Screening Follow up Data

41.08% n=792 35.48%

n=684

23.44% n=452

By 1st Call By 2nd Call By 3rd Call

Proportion Completed Follow-up by Call

Total Patients: 1928

How to Promote a Child-Friendly Culture

of Vision Care in our Area?

GeoInformatics software

ARCGIS (ESRI Redlands, CA)

Open Street Map (ESRI Redlands, CA)

What is Geoinformatics?

“Geoinformatics might be referred to the academic discipline or career of

working with geo-data for better understanding and interpretation of human

interaction” –IGI Global

Access to Pediatric Eye Care Following

Vision Screening

Screening sites from our database

Logged distances to nearest participating optometrist

Logged distances to nearest pediatric ophthalmologist

Analyzed Driving Distances Using Open Street Map (ESRI Redlands, CA)

Coordinated with Socioeconomic and Population data from 2010 Census using

ArcGis (EsRI Redlands, CA)

Driving Distance Map

Driving Times

Driving Time Access to Care

Public Transportation

Conclusions

5 minutes to nearest optometrist

25 minutes to nearest pediatric ophthalmologist

How to reach them all?

How best to use vision screening resources?

Geoinformatics software

State of CA licensed preschool data

Novel ranking system

Prioritizes low-income and high-volume preschools

Heat Map Directs Vision Screening

Resources

MHI

($55,775)

PL ($25,100)

0

1

2

+ 100

50

3

2

1

SOCIOECONOMIC

SCORE ($)

CAPACITY SCORE

(# of Children)

=

COMPOUND

SCORE

Figure 1. Facility scoring system to optimize selection of

low-income, high-capacity facilities

MHI = US Median Household

Income

PL = Poverty Line

Maroon Text = Point Values

X

What is on the Horizon?

Smart-Phone based Vision Screening

Go Check Kids (Gobiquity Inc. Aliso Viejo, CA)

Specially adapted I phone with appropriate lens/light to evaluate red reflex

WiFi

No Screening for Astigmatism

No downloading mass data

A Dream for the Future

Parents Understand Amblyopia like Bike Helmets!

Conclusions

Community-based photoscreening is an efficient way to reach children

Educating parents regarding the importance of follow up may require several

phone calls

Most of the communities in our area have providers close to screening sites.

Follow-up with providers in the local community helps at-risk children to

develop a relationship with a provider near their home

Geoinformatics is a tool that can help screening programs to reach the most

vulnerable children efficiently

Sincere Gratitude

Cheng Family Foundation

Program coordinators

Judy McGuire

Ronela Tavoc (2015-2017)

Loma Linda University Eye Institute

Michael Rauser MD

Leila Khazaeni MD

Fatima Esmail MD

Tim Winter MD

Stephanie Terrill MD

LLU Volunteers

Mary Beth Morris

Loma Linda University School of Medicine

Walter McPherson Society

Chase Atiga

Connie Oh

Richard Ulangca

Michael Chung

Matthew Fukuda

Benjamin Robinson

Loma Linda University Foundation

Michael Bautista

Ronald McDonald Foundation

Riverside Community Foundation

Any many others!

Sincere Gratitude

Lions Clubs of District 4-L5

Rob and Lucy Manning