Schools work to improve vision health

December 7, 2014
Girl looking into eye vision scanner machine

A San Jose student receives an eye exam from Vision to Learn.

It was a good week for the 90 students at Merritt Trace Elementary School in San Jose who climbed into a mobile eye exam van and emerged with the promise of a free pair of eyeglasses. But for thousands of students across the state who need glasses but don’t have them, it was another blurry week of not seeing the blackboard or the letters in a book.

Effective Jan. 1, two new state laws will clarify and expand the protocol for mandatory vision screening of students, but they don’t address the crux of a major children’s health conundrum: ensuring that students who fail the vision test actually get eyeglasses.

As many as 1 in 4 students in kindergarten through 12th grade has a vision problem, according to the American Public Health Association, but in some California schools, the majority of students in need of glasses don’t receive them, researchers said. In a 2011 study of 11,000 low-income 1st-graders in Southern California, published in the Journal of Public Health Management and Practice, 95 percent of students who needed eyeglasses didn’t have them, one year after their mandatory kindergarten vision screening.

“You would hope that the problems would have been caught,” said Dr. Anne Coleman, a co-author of the study and an ophthalmologist at UCLA’s Jules Stein Eye Institute.

But bridging the gap between a failed vision test and a student with glasses on – ready to see the math problem on the board, the words in the book and the baseball coming over the plate – has been a difficult task. Increasingly, schools and nonprofit organizations are working together to go beyond mandatory vision screening to help low-income students obtain the glasses they need to succeed.

“What we need is a systematic approach,” Coleman said.

Screening of student vision is mandatory in California schools and the new law, Senate Bill 1172, authored by state Sen. Darrell Steinberg, D-Sacramento, adds the requirement that a student’s near vision be tested, in addition to far vision. The law also makes plain that vision screening is required in kindergarten, or when a student first enters a school district, and in 2nd, 5th and 8th grades – a change from the previous language that required vision testing upon entry and thereafter “at least every three years.”

“What we need is a systematic approach,” said Dr. Anne Coleman, an ophthalmologist at UCLA’s Jules Stein Eye Institute.

The second new law, Assembly Bill 1840, authored by state Assemblywoman Nora Campos, D-San Jose, allows the use of “photoscreening” – a handheld device that detects vision issues – as well as the use of an eye chart in a student vision screening. The device costs about $7,000.

Research has shown that the consequences of impaired vision are far-reaching for students, including underachievement, disengagement and behavior problems, said Charles Basch, professor of health and education at Teachers College of Columbia University. Because most learning occurs visually, and low-income students are at greater risk of “underdiagnosis and undertreatement” of vision problems, getting glasses on students needs to be part of school reform efforts to improve academic outcomes, said Basch, author of the research brief “Healthier Students are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap.”

Unlike dental decay and asthma, vision problems are not associated with student absences and the correlating loss in revenue for school districts, which receive funding based on Average Daily Attendance.

“It’s a need that has a pretty simple solution to it,” said Nancy Prail, director of ChildSight, a program of Helen Keller International, a New York-based nonprofit organization that in 2013-14 performed vision screenings and eye exams on 16,800 middle school students in the Los Angeles area, with 2,543 pairs of eyeglasses provided.

After a student fails to read the eye chart in a vision screening conducted by a school nurse, a letter is typically sent home informing the family of the results and stating that the child needs a more in-depth eye examination. In low-income families, following through on that referral is often difficult, Prail said.

“There’s a whole stew that gets stirred up,” Prail said, including a family’s difficulty in finding a provider that will accept Medi-Cal and the inability to take time off work to bring a child to an appointment.

Bringing clinicians to schools is a way to overcome those barriers, Prail said. Some school-based health centers provide the exams and several nonprofit organizations are working with school districts to send optometrists and mobile eye exam vans to schools in California, including ChildSight, Vision to Learn, See Well to Learn and VisionFirst.

In the San Jose Unified School District, a new partnership with Vision to Learn, a Los Angeles-based nonprofit organization that provides free eye exams and free glasses to children in low-income communities, has simplified the process of getting glasses on students, said Melinda Landau, manager of the Health and Family Support Programs at the district.

For four rainy days last week, the 15-foot Vision to Learn mobile eye exam van was parked outside a portable classroom at Trace Elementary while a parent volunteer shepherded groups of three or four students across the tarmac and into the world of eye examination machines and best of all, a display case of red, purple, blue and black eyeglass frames from which to choose.

Credit: Jane Meredith Adams/EdSource Today

The Vision to Learn mobile eye exam van at Trace Elementary in San Jose. Credit: Jane Meredith Adams/EdSource Today

“I lost my glasses in 1st grade,” said Camielle Toscano, a 2nd-grader at Trace Elementary, who sat in rain boots and a rain jacket waiting for an eye exam in the van.

At the back of the van, optometrist Dr. Chris Low slid lenses of various magnification strengths into a machine as Keiasia Johnson, a 1st-grader, looked through the lenses and read an eye chart.

Pleased by the ability to see that the test lenses gave her, Keiasia said, “They look fine when I have my glasses on.” Stepping to the other end of the van, Keiasia tried on a variety of eyeglass frames with the help of optician Lisa Nguyen before settling on pink. Nguyen will return to Trace Elementary to deliver and fit the eyeglasses on students in two to three weeks.

Because school partnerships with nonprofit organizations are dependent upon philanthropic fundraising and priorities, the search for sustainable vision care for students is ongoing. With more California children entitled to pediatric vision services through the Affordable Care Act and the expansion of Medi-Cal, one strategy is to bill insurance for the care that is provided at the school site. Gov. Jerry Brown authorized grants that total about $1.5 million available Jan. 1 in Los Angeles County to pilot test the creation of a database system to connect student on-site vision care with insurance billing, said Gaye Williams, executive director of Vision to Learn, which plans to apply for a grant.

In the San Jose Unified School District, a  five-year “Putting Healthcare Back into Schools” Nurse Demonstration Project through the Stanford University School of Medicine School found that the presence of a full-time school nurse increased the number of students receiving follow-up eye exams and eye glasses. The rate of follow-up was “almost 100 percent in schools, if they had a full-time nurse,” Landau said.

Full-time school nurses see the families, know the students and work with the teachers to ensure that appointments are made, glasses obtained and glasses worn in class. The nurses also act as a liaison with groups, such as the service organization the Lions Club, that provide vouchers for free eye exams and glasses. “There was time and attention put on it,” Landau said.

Now Landau is working to collect data on the impact of glasses. “We need to track these kids to find out — do we see improvement in academics?” she said.


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