In an effort to nip vision problems in the bud, the Association for the Blind & Visually Impaired Charleston embarked last week on its fourth year of its ReFocus on Children program.
For the next few months, staff and volunteer eye professionals will screen between 1,500 and 2,000 pre-kindergarten children in Early Headstart and Child Development programs in 24 Charleston County School District Title I schools.
If the outcome is similar to the previous three years, a quarter of those children will require a follow-up comprehensive eye exam, which includes the often daunting challenge of dilating eyes.
Ultimately, vision professionals will look for and try to head off the effects of strabismus (cross eyes), amblyopia (lazy eye), pediatric glaucoma or retinal diseases, or just correct routine vision problems.
Some children will get glasses. Some may require other treatments or surgeries. It can be a life-changer for a child.
The proof was apparent in the very first child the association screened in 2010, according to the association’s executive director, Mary Morrison.
“He was screaming bloody murder,” says Morrison. “We learned that he had been stabbed in the eye with a pair of scissors and the stitches in his eye had never been removed.”
Morrison says the association got him the help he needed and made sure he made his follow-up appointments.
“He’ll be in glasses his entire life, but he will see and be OK,” says Morrison. “Unfortunately, we have lots of stories like that and have found all sorts of eye diseases among these children.”
But just routine vision correction is similarly important, says Carly Oslin, an optometrist contracted part time by the association.
“For those who ... just need glasses because they can’t see the board, that’s important, too. They need to see in school or else they aren’t going to do well in school. If not, some of those children will be misdiagnosed with ADHD (attention deficit-hyperactivity disorder),” says Oslin.
Among those children last year was 4-year-old Skilah Colleton of McClellanville. Her mother, Sharila Smith, says she had no idea that Skilah needed glasses. She showed no signs of needing them.
Smith adds, “She loves her glasses.”
Needless to say, the outreach is a labor-intensive, time-consuming task, which costs $55,000. That figure does not include the estimated in-kind services, about the same amount, by generous local optometrists and ophthalmologists.
But in a growing theme of health care in America, it’s about prevention.
While the association’s efforts reach out to the underserved, the association urges all parents to take the vision of their children, especially within their first five years of life, very seriously.
“Every parent should have their child’s eyes examined at six months old, 3 years old and a year before they (the child) start kindergarten or first grade,” says Courtney Parades, the association’s program director. “Parents need to do it even if they aren’t noticing any problems because there’s no way of knowing without an exam.”
Parades noted that South Carolina is one of 16 states that doesn’t require eye exams at kindergarten.
Dr. Amber Sturges, pediatric ophthalmologist with Carolina Eye Care Physicians, is one of the association’s most dedicated volunteers and noted the critical need for children to be examined before first grade.
“In most kids, their brains finish developing their eyes, or visual potential, somewhere between (ages) 7 to 9,” says Sturges, noting the condition amblyopia, in which one eye is substantially dominant over the other.
“By catching it early, ideally by 3 or 4, you have plenty of time to play catch up and correct it by covering the good eye (with a patch) to give the brain one-on-one time with the bad eye ... Plus, when you catch it early, the vision isn’t that bad and takes less time to patch the eye.”
ReFocus on Children is evolving much as the association, a privately funded, nonprofit, has in serving the visually impaired in Charleston since 1936.
Though modeled after a program in Georgia, the association’s ReFocus on Children started small, screening 100 children in downtown Charleston schools the first year, and grew too fast. Staff and volunteers of the relatively small organization screened 3,000 children last school year. They didn’t wrap up until March.
“Last year, it grew faster than we were able to control, but we got through it,” says Parades. “To be honest, 3,000 was a bit much for us.”
“What I don’t want is to screen so many children that it takes too long to get back to do the exams and get them their glasses. We need to contain the program to help the most people we can well and then grow it as we can.”
Part of the strategy change, though, is requiring more work.
One problem they had with the program, Parades says, was getting permission slips back from parents allowing optometrists and ophthalmologists to perform the exams. The reasons run the gamut.
“I’ve heard back, from ‘My child is perfect and doesn’t need glasses’ to permission slips that never get out of the backpack,” says Parades.
So Parades and optometrist Carly Oslin attended school orientations to explain the importance of the exams and are trying to get permission slips signed up front.
Part of federal programming for Early Headstart and Headstart require vision screenings in the first 45 calendar days of school by program nurses, but the screenings are fairly rudimentary, using a child-appropriate Snellen chart, according to local Headstart nurses Julie McIntyre and Ali Hill.
They admit the shortcomings of the chart, which most people know as the chart that starts with a big “E.”
“I think a lot of the inaccuracy with the Snellen chart is the age,” says Hill. They are 3 or 4, maybe 5 years old. They are answering just to give you an answer. I think the association’s screenings are a lot more accurate than us doing the Snellen chart. But that’s the only thing we have to finish our screening and meet our requirements.”
The Headstart programs work with the association to help find those children who may slip through the cracks, says McIntyre.
“One child in particular that stands out was a child that we had no idea that there was anything was wrong. He was having behavior issues. The teacher noticed after the fact that he would get up right on a screen. When they (the association) checked him, he had a completely detached retina. He was almost blind and couldn’t see at all.
“Finding that out and getting him help made all the difference for him.”