Lions EYES Study References

SUPPORT OF REGULAR SCREENINGS FOR ALL CHILDREN

Source: American Academy of Pediatrics Volume 137, Issue 1 Procedures for the Evaluation of the Visual System by Pediatricians

“Vision screening is crucial for the detection of visual and systemic disorders. It should begin in the newborn nursery and continue throughout childhood. This clinical report provides details regarding methods for pediatricians to use for screening.”

Article is oriented toward various methods for physicians to check children for specific disorders. The relevancy is that the American Academy of Pediatrics recommends being checked throughout their childhood. The photorefractor checks for optical axis alignment, strabismus, amblyopia, and completes a vision screening and vision acuity for the eye optics.
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Source: School-Aged Vision – 6 to 18 years of Age, American Optometric Association

AOA promotes an annual comprehensive eye examination. We know that only a small percentage of the school-aged children receive an eye examination. Furthermore, “Undetected and untreated, vision problems can elicit some of the very same signs and symptoms commonly attributed to Attention Deficit Hyperactivity Disorder (ADHD), like hyperactivity and distractibility. Due to these similarities, children eliciting these symptoms should have a comprehensive vision exam with their Doctor of Optometry to avoid misdiagnosis.”

The article also states that vision screenings miss up to 75% of vision problems. And 61% that have been identified with problems never visit a doctor. The new photorefractor technology allows us to screen more children.
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Source: Evidence-Based Clinical Practice Guideline Comprehensive Pediatric Eye and Vision

An Epidemic of Undiagnosed Eye and Vision Problems

The traditional acuity chart screening may not catch those children that can work hard and focus for the duration of the exam. However, the objective nature of the Photorefractor measures the focal point of the eye and takes the ability of the child trying hard to focus out of the equation.

Seeing a Solution. Children 6 to 18 years should receive a comprehensive exam annually, but in the absence of an annual eye exam we need to screen every child every year. To do so we need to screen children faster and more objectively using a photorefractor.

SUPPORT FOR USE OF PHOTOREFRACTORS

Source: American Academy of Pediatrics Volume 130 Issue 5 11/2013

The Policy Statement opening paragraph states that the automated vision screening (use of a photorefractor) is especially useful in young children and can be used reliably in older children. Adoption is dependent on payment policies.

Further into the Article Section on Photoscreeners, Autorefractors and Other Instruments discusses instruments to objectively evaluate eye or visual systems … at present without a sufficient evidence base for recommendations.
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Source: Comparison of Photoscreening to Chart Methodology For Vision ScreeningL The Journal of School nursing

Study of young children 3-7 comparing a LEA visual acuity chart to a Plus Optics photorefractor on 127 children found the photorefractor superior to the chart in screening young children. Limitation is that the study had a limited population and there is little published data relating to US children 3-7 years old.

Note this study also supports the idea that further research and study with a broader age range and greater sample size is needed.

Also note the study protocol appears to be very similar to the protocol we have in place for our study.
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Source: Traditional and Instrument – Based Vision Screening in Third-Grade Students

Conclusion “Instrument-based vision screening is more time efficient than traditional screening and has a similar PPV (Positive Predictive Value) in third -grade students.

STUDY OF PUBLISHED DATA OR NEW STUDIES REGARDING EYES

Source: Technologies supporting vision screening: a protocol of a scoping review.

A proposed study to look at and review all published data on various vision screening methodologies. The study has not been completed.

The opening Introduction is a statement that vision problems affect academic performance, social and mental health. The assumption is that because of the impact vision has on society the study is warranted.
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Source: Eye health and quality of life- an umbrella review protocol

A study to determine two questions 1) what is the association of vision impairment and eye disease with quality of life? 2) What is the impact of ophthalmic interventions on quality of life.

Introduction: Quotes an estimated 36 million people were blind in 2015, 217 million had moderate or severe vision impairment, and more than a billion people have near-vision impairment.
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Source: Why Nearsightedness is on the rise in children

Nearsightedness (myopia) in the United States has increased from 25% in 1970s to nearly 42% in three decades and the World Health Organization estimates that half the world’s population may be myopic by 2050.
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Source: Progression of Myopia in School – Aged Children after Covid -19 Home Confinement

Home confinement due to coronavirus disease 2019 appeared to be associated with substantial myopic shift in children; younger (6-8) children’s refractive status may be more sensitive to environmental changes than older children, given that they are in an important period for the development of myopia.
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Source: Types of Pediatric Vision Screening American Academy of Ophthalmology

Types of subjective versus objective vision screening.
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Source: Children’s Eye Foundation & AAPOS Educational Brochure

All Children See program to provide eye exams for children under 18
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Source: PreventBlindness.org

In 2018 4.3 million children do not have any health insurance coverage. 2% of children under age 18 are blind or visually impaired. 5% of young children are at risk for vision loss, 5-10% of preschoolers and 25% of school age children have visions problems. 80% of learning is visual.
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Source: Children’s Vision Screening Requirements by State:PreventBlindness.org

The US has inconsistent requirements for childhood vision requirements. Only a few states require eye health examination prior to entering school, 27 States (54%) require vision screening for preschool-age children, and 11 states (22%) have no requirements. To say we have a comprehensive and consistent system to ensure our children’s sight would be difficult.
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Source: Common Children’s Vision Problems: PreventBlindness.org

There are a significant number of children that have vision issues ranging from complete vision loss to blurry vision at any distance. Many people think that if we take care of the very young children, older children do not need vision screening. Children ages 5 to 17 are growing and along with that growth their body and vision continue to change. As an example, in that age group 9% are affected by Myopia, 13% have Hyperopia, and 15-28% have Astigmatism. This emphasizes the need to continue screening the child’s vision all the way to age 18.

The absence of a standardized approach to the determination of vision screening rates means that the United States lacks reliable data to track national progress toward vision screening goals or to compare rates of vision screening across states and regions.
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Source: Children’s Vision Screening and Intervention: PreventBlindness.org

Any possible problem identified by vision screening must be followed up with a comprehensive eye examination. Together, vision screening and eye examinations are complementary and essential elements of a strong public health approach to vision and eye health.

Economic Burden

Source: Economic Burden of Vision Loss and Eye Disorders in the United States

The US cost associated with vision loss and eye disorders is astronomical. It is estimated that the cost was $139 billion in 2013, which translates to a cost of about $450 for each US Citizen. This emphasizes the need to improve diagnosis and management of future eye disorders. The Lions EYES study is designed to identify and test new tools to screen children and reduce the economic and social cost and consequences of impaired vision by catching problems early. Moreover, eye loss is more costly than three of the top seven major chronic illness including heart disease, Alzheimer’s, diabetes, and cancer.
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Source: The Economic Burden of Vision Loss and Eye Disorders among the United States Population Younger than 40 Years

When we think about the cost of eye related disorders we often forget two indirect costs. The first is a social cost which is the loss of quality of life for the individual who has the disorder. The second is the loss of that individual’s contribution to society. In this study they estimate a productivity loss of $12.2 billion annually for just productivity loss. And the cost of quality of life is unmeasurable. Emphasizing the need to identify better tools to help us identify vision issues early, and provide a continued quality of life experience to those issues, is paramount.

Hormones can affect eyes and vision

Source: How Hormones Can Can Affect Eyes and Vision

As a child grows through puberty and their body rages with hormones, everything changes from the size, and strength to the shape of their eyes. As we experience the surge in hormones, everything changes, like one’s voice seems to change overnight. The same with vision. The change is both rapid and evolving and emphasizes the need for additional vision screening to make sure children identify that their eyes are changing along with their sight. Unfortunately, most vision screening programs are focused on the very young and many states and schools stop checking vision. Approximately 55+ % of the states stop screening students before 7th grade, and only 28% of the states screen above 8th grade. That leaves a lot of Children passing through their puberty years that may not realize that their vision is changing. Like any eye disease, as the shape of your eye changes through puberty you can experience a loss of vision which can go unnoticed.

Source: Vision Loss Can Go Unnoticed

Many eye diseases progress so slowly that you adapt to changes in your vision without even realizing it. It’s only when you visit your ophthalmologist for an eye exam that the full extent of the damage becomes clear.

Several diseases can cause gradual vision loss. Chief among them is glaucoma. Glaucoma is often called the sneak thief of sight because it can slowly steal vision without you being aware of what’s happening. With open-angle glaucoma, the most common form, there are virtually no symptoms.

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