Once identified, vision problems need to be corrected. This will not happen without deliberate emphasis on the follow-up to receive a comprehensive eye examination and recommended follow-up care. There is an ethical standard, see post to learn more, that guides against conducting screening programs unless follow-up care is available (American Academy of Pediatrics, 2004), but this appears to be commonly violated with respect to school-based children’s vision screening programs. Typically, a positive screening test results in a note being sent home to parents recommending that their child receive an eye examination by an optometrist or ophthalmologist; no further action may be taken. In some contexts, this approach suffices, but this is generally not the case in low-income families.
At least two broad approaches can help increase the chances that referred youth will receive an examination and recommended care. One is intensified outreach to parents to motivate, enable, and support them to use existing community-based eye care services. Interpersonal interaction is more likely to be effective than a one-way written communication. Parents should be informed about the nature of their children’s vision problem(s), about the potential importance, and about strategies to minimize adverse educational and health effects. Telephone outreach has proven effective in a variety of related applications and warrants consideration here. A second approach is a direct provision of services on-site within schools. Several examples of such school-based services have been reported and results are promising.
In one recent study in New York City, four of eight elementary schools were assigned randomly to receive a follow up program in which all students who “failed” the routine vision screening received a professional optometric screening and, where appropriate, two pairs of eyeglasses (one for classroom use and an extra one to be kept by the teacher). In addition, teachers encouraged eyeglass use as prescribed. Eyeglass use by children was assessed by direct observation prior to and after the optometric screening. At baseline, mean rates of eyeglass use for students in intervention and control groups at baseline were 22% and 19%, respectively (p > .10). At follow-up, eyeglass use rose to 47% in the intervention group whereas the control group’s rate remained consistent at 19% (p < .001). Significant differences persisted for boys and girls. These results demonstrate both the lack of follow up that can be expected subsequent to routine screening as well as the feasibility of increasing use of eyeglasses in an elementary school setting.