Identification of School-age Eye conditions Evaluation (ISEE)

Significant vision problems (SVP), such as significant uncorrected refractive error, amblyopia, and strabismus are common in school-age children and may impede learning. Vision screening, a key public health tool to identify school-age children at risk for SVP, is mandated in 41 states, however it is not known which currently used screening test(s) effectively identify at-risk school-age children. Timely, appropriate eye care for children who are identified through screenings can improve quality of life, facilitate learning, and decrease the burden of lifelong vision problems, and its attendant economic costs. Currently there is great variation in state vision screening requirements and in approaches adopted among organizations involved in screenings. There is a need for evidence-based school-age vision screening guidelines and policies, however this will require much more robust data on the effectiveness of screening tests than are currently available. Effective screening tests must have high sensitivity and specificity to accurately identify those at risk for SVP while avoiding undue and costly over-referrals. Lay and nurse screeners also must be able to successfully administer the screening tests to children, interpret findings and make appropriate referrals. Limitations of prior screening studies in school-age children include: 1) examining only those referred, leaving the percentage with missed SVP unknown; 2) evaluating only 1-2 instruments without comparing available screening approaches concurrently; 3) including a wide age range, without subgroup analysis in the school-age population; 4) small sample size with limited range of SVP included; 4) not evaluating sensitivity to detect each type of SVP; 5) using definitions of targeted SVP that vary and may miss visually significant refractive error in school-age children; 6) not including newer technologies. Thus, valid full-scale, side-by-side comparisons between alternative screening tests are vital. There is also a paucity of information on how SVP affect quality of life in school-age children. Considering disparities in access to eye care after vision screening referral, greater understanding of the facilitators as well as barriers for obtaining needed care after screening referral is also urgently needed. This proposal aims to show the feasibility of a full-scale, multi-center, multidisciplinary study to compare the effectiveness of using traditional (visual acuity and stereoacuity) and technology-based vision screening tests for identification of school-age children at risk for SVP and in need of an eye exam. Before conducting the full- scale study, we must show the feasibility of enrolling children at each site, completing vision screening testing, and collecting eye exam results. We will also refine study procedures (e.g. training, certification, testing, data collection, data management, and analysis) and develop a Manual of Procedures and Protocol for the planned, full-scale UG1 study. We also will seek input from key organizations involved in conducting or setting standards for children’s vision screening to ensure that crucial questions, including equitable access to care, will be addressed in the full-scale study. The findings will help inform future screening guidelines and policies.