Lions EYES History…Evaluating Youth Eyesight Study
In 2013 The Lions District 27-B2 in Northeast Wisconsin embarked on a mission to improve vision screening and started researching new techniques to quickly evaluate youth eyesight. After much research the District decided to purchase 10 photorefractors to assist in screening young children.
After thorough training, the photorefractors were deployed to various clubs for usage. Vision screening was hugely successful. The school screenings were much faster, required less resources, and produced about the same number of referrals as the manual acuity charts. Screening reports were submitted to the school nurses for their records and dispersal to the affected parents. Parents and Optometrists loved the report which provided more detail explaining why the child failed the screening.
However, schools started receiving push back from the Department of Public Instruction that the photorefractors were not approved for screening children over 6 years old. We were informed that for a new device to be approved it must be supported by a research study to determine the effectiveness of the device.
Numerous professional publications stressed the need to have annual vision checks for all children including adolescents up to adulthood. Working with local optometrists, we received confirmation that children of all ages need more frequent screenings. The optometrists explained that as the child grows their entire body changes including the eyes and many children may have undetected vision issues.
The frustration from being stopped from using the device on older children lead us to start looking into the feasibility of developing a research study. We brought our story to both the Door and Brown County Health Departments vision screening personnel who did vision and hearing checks. We asked if we could assist them and if they would like to compare the photorefractor to the manually administered acuity charts. After months of comparisons they were impressed, and we asked for their support in helping us develop a study.
The Green Bay campus of the Medical College of Wisconsin, which is an essential engine for medical research, patient care, and scientific education in Wisconsin, listened to our story, and they asked to partner with us. We then solicited the Door County Superintendents of schools, two Optometrists and CESA-7 (Cooperative Educational Service Agencies) to discuss the feasibility of developing a study and what would be involved.
Upon confirming that a study was feasible, and that we had supporters, the Lions Club of Dyckesville Foundation 501(c)(3) was created for the task of pursuing and evaluating new vision screening techniques and developing the needed scientific evidence regarding these instruments.
It was decided this could only be done by performing a comparative analysis and measuring the results of the various vision screening methods. The Foundation has created a community of support to conduct the necessary comparative analysis. Our goal is to generate evidence-based knowledge to optimize school-based vision screenings. Currently only select grades are chosen with only about 20% of the school age population actually being screened. We believe every child should be screened every year. If we can improve the vision screening process and reduce the cost and time, it will have relevance across Wisconsin and the Nation.
Formally pursuing this goal, the Medical College of Wisconsin, the Brown and Door County Public Health Departments here in Wisconsin, CESA-7, and the participating Brown and Door County Schools agreed to join in the task of finding a better way.
Team Development
The Medical College of Wisconsin took the lead in bringing the study together. A professional researcher was hired, and a study protocol was developed. A pilot was established, and two additional players were included. Prevea Health provided optometrists to validate vision screening results and Strategic Research Institute would provide the data analysis. The plan was submitted to the Institutional Review Board to certify its integrity and when approved we started moving forward.
Study Protocol
We decided to develop a study based on the protocols for the screenings and data reporting practices currently in existence. This approach capitalizes on the existing knowledge and experience of the local educational and health departments and minimizes the disruption to the health programs and relationships between the schools and the children.
The Plan and Action
During the academic calendar year 2018-19, this vision-screening was piloted in Door County schools, screening 2,564 students. In year 2020 a capital campaign was launched to obtain funding to support the study and out-of- pocket expenses for the pilot. The field phase was scheduled to be conducted in the 2020-2021 school year screening an anticipated 12,500 students including a substantial number of children with diverse ethnic and economic backgrounds.
2020 Covid 19 Declaration of the Pandemic proved disastrous. Our capital campaign was shut down, Health Departments turned their attention to the pandemic and schools were either shut down or closed to anything but strict school activities.
2022 The Dyckesville Lions Foundation is starting where we left off and launching a funding drive. Once our funding is sufficient, we will open discussions with the principal players to determine if they are still open to participating in the study. If for whatever reason they are unable or unwilling to commit resources to the study, we are aware of other interested parties who would take their place.
Screening Protocols
Each student was screened using two different chart-based vision acuity tests (the Snellen and the Critical Line charts) and the SpotTM photorefractor. Additionally, the intention was to capture samples of exam times for the different screening methods. The samples were used to discuss and compare the time efficiency of the different methods. The students who failed either the chart acuity tests or the instrument-based screening continued to be followed by the Public Health Departments according to their current routine, which includes sending a letter home to the parents recommending that the child visit an optometrist for a complete diagnostic vision exam. The Public Health Departments also have a standard practice for following up on whether the child visits the optometrist and if the family needs assistance in accessing the exam or eyeglasses.
Also, the students who failed any part of the screening underwent an instrument verification test with a Prevea Health Optometrist from the study. These exams took place in the schools during school time, and the Optometrist was not aware of the child’s initial screening result and reported the findings of the verification exam to the research coordinator.
Evaluation and Reporting
The data from the pilot was collected by the Medical College of Wisconsin and provided to Strategic Research Institute to dissect and evaluate. All findings are being held in confidence following research guidelines. No findings have been shared. Upon completion of the study, the results will be made available for peer review, and will later be published for various interest groups. The following associations / journals will be targeted: Public Health Departments, Pediatrics, Optometry, and Education.
Study Results
When the study is complete, the findings may be utilized by the Public Health Departments and the Lions Foundation for planning and implementing the most effective and efficient vision screenings and to provide the local communities with up-to-date and relevant information regarding this important intervention.
Publication in peer-reviewed academic journals should contribute to advancing public health knowledge and intervention practices related to school-based vision screening.
Process at a glance:
- Publish
- Peer review
- Bring to the public
- Look at new technology as it develops.