WASHINGTON—The American Academy of Ophthalmology today praised the findings of the second phase of the Vision in Preschoolers Phase II (VIP) study, which focused on the performance of nurses and lay screeners in administering preschool vision screening tests. The study, funded by the National Eye Institute and published in Investigative Ophthalmology & Visual Science, concluded that lay screeners, who are trained on vision screening tests, perform as well as professional nurses.

“The study affirms ophthalmology’s longstanding position that vision screening is effective when properly performed and that effective screenings can be done on a cost effective basis,” said Michael Repka, MD, president of the American Association for Pediatric Ophthalmology and Strabismus. “If costs are decreased, screenings will be more readily available and can be performed more often, leading to more frequent opportunities to detect vision problems.”

The study, which measured the accuracy of vision screenings in more than 1,400 three- to five-year-old Head Start preschoolers, also provides further evidence that vision screening is the most effective method of identifying children younger than six who have vision problems and need more in-depth follow-up care, rather than more expensive annual comprehensive eye examinations. This supports the Academy’s position that the mandatory comprehensive eye examinations, advocated by optical manufacturers and under consideration by some state legislatures to replace vision screenings, may not be the best approach.

The study authors conclude that “nurse screeners and lay screeners can achieve similar sensitivity for detecting preschool children” who need to be referred for a more comprehensive eye examination “with similar testing time, testability, and number of attempts to achieve readings of acceptable quality.”   

Another observation the Academy finds interesting is that two of the four screening tests used in the study, Retinomax Autorefractor and SureSight Vision Screener (both of which are new technologies), performed better than expected –  even better than traditional chart-based measures of visual acuity. In addition, the test times for both Retinomax and SureSight were one-third to one-half of those for the traditional methods.

“The study indicates that some of the new first-generation automated screening tools perform extremely well, when used either by lay volunteers or health care professionals,” said Sean Donahue, MD, PhD, associate professor of ophthalmology, pediatrics, and neurology at Vanderbilt University Medical Center. “The other bit of good news is that as these new technologies evolve and become more accurate and eventually more cost effective, more children will be able to be screened with better results. The next step will be to move the technology into the field, where it can be tested on large numbers of children not suspected to have any eye problem."

The Academy notes that preschool vision screening is only a part of the comprehensive health care model for monitoring children’s eye health developed by physicians treating children and children’s eyes. In particular, pediatricians and family practitioners play an important part in the monitoring process and are often in the best position to identify problems and refer children to pediatric ophthalmologists for follow-up treatment.