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«Implementing an Evidence-Based Vision Screening Program-Tools and Tips for all Ages! Kelly Towey: Hello and welcome. Thank you for joining us today ...»

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Implementing an Evidence-Based Vision Screening Program-Tools and Tips for all Ages!

Kelly Towey: Hello and welcome. Thank you for joining us today for our webinar, "Implementing an

Evidence-Based Vision Screening Program -- Tools and Tips for All Ages!" This webinar is sponsored by

the Office of Head Start National Center on Health and the National Center for Children's Vision and Eye

Health at Prevent Blindness.

My name is Kelly Towey and I'm a consultant for the National Center on Health. Before we begin today's webinar, I'd like to highlight a few housekeeping items. First, if you're using wi-fi and are not hard-wired, you may experience greater lag time during the presentation. The slides will advance automatically throughout the presentation and attendees will not have control over the slides. All attendee lines are muted, but if you have a question, we encourage you to type it in the "Ask a Question" box on your screen. If time permits, there will be a short question and answer session at the end of the webinar.

If we don't have time to address your question during the webinar, we'll send you an answer directly via email over the next several weeks. If you're listening to the webinar by phone, you must click on the "Listen by Phone" button that is just above the "Ask a Question" box. To view the presentation in full screen, please click on the black button at the upper right-hand corner of the presentation slides.

Please note that after the webinar you'll be directed to an online evaluation. Please take some time to share your feedback on today's webinar. Only participants who complete the evaluation will receive a certificate of participation. If you're watching as a group, the person who logged into the webinar will receive an email with a link to the survey. Please share this link with the rest of your group so that they can complete the evaluation to receive their certificate, too.

If you need technical assistance during the webinar, please type your question in the "Ask a Question" box and our technical staff will assist you. At this point, I'll turn the webinar over to Kira Baldonado from Prevent Blindness.

Kira Baldonado: Thank you, Kelly, and thank you everyone out there for participating in the webinar today. We're pleased to be here with you today to talk about four key objectives. We're going to share with you some information about common vision disorders in children. We're going to talk a little bit today about key vision developmental milestones that you should be seeing in the first year of a child's life. We're going to talk about two evidence-based approaches to screening the vision of preschool-aged children. And then finally we're going to wrap up today by describing resources at Head Start that's going to support your Head Start and Early Head Start programs and improving your vision health program.

With us today to present is Dr. Kay Nottingham Chaplin, and we'lljust give a brief bio for Kay. Dr.

Chaplin is a member of the Advisory Committee for the National Center for Children's Vision and Eye Health which is at Prevent Blindness. In her work experience, she's helped Dr. Geoffrey Bradford who is a pediatric ophthalmologist at West Virginia University Institute to create the Vision Initiative for Children program that trains and equips individuals to screen the vision of preschoolers.

Dr. Chaplin has extensive experience with training and certification in vision screeners. She's conducted over 178 workshops and trained more than 1,600 individuals in vision screening which includes Head Start staff members to screen the vision in preschoolers. While working at West Virginia University, she also consulted about preschool vision screening for the Good-Lite company and since that time has continued to work for Good-Lite company and also serves as a Director of Vision and Eye Health Initiative at School Health Corporation.

Dr. Chaplin is a member of the West Virginia School Based Health Assemblies, School Health and Medical Service Team, and she also assists West Virginia Alliance Clubs in developing their statewide vision screening program. As a hobby, she studies eye chart history and design and is currently the Vision Eye Health Initiative's director for Good-Lite and School Health.

Also speaking today is myself, and I am Kira Baldonado. I am Director for the National Center for Children's Vision and Eye Health which is located at Prevent Blindness, and our national center is a partner organization in the Year of Children's Vision Initiative along with the American Association of Pediatric Ophthalmology and Strabismus, the American Optometric Academy of Optometry and also School Health and Good-Lite, and together we are working to provide new approaches, resources, and educational opportunities for Head Start and Early Head Start staff as they work to improve their vision health programs.

And we're pleased just to -- Dr. Chaplin and I are pleased to be able to be here with you today to talk a little bit about how healthy vision in children can contribute to improve school readiness, ability to learn, a child's self-esteem and confidence, athletic ability, and improved behavior. And your participation in the webinar today shows that you do truly care about having a strong vision health program. So, we hope that the information we provide will help you in that role. So, at this point in time, I'm going to turn it over to Dr. Chaplin to talk more about today's information.

Dr. Kay Chaplin: Okay, thanks, Kira. Hi, everybody. Thanks for joining us. And I'm going to go through this rather quickly because I have a lot of information to share with you. So, if you have questions, we will answer them, and I think you will have the opportunity to see this later.

So, I like stories, so I wanted to share with you; this is a story from a parent in West Virginia about the impact of learning that the child had after receiving prescription glasses. So, this child failed his vision screening. A subsequent eye exam indicated that he required prescription glasses, and according to mama, those glasses made an incredible difference in his life.

Previously, he would not sit still for reading time. Now, he sits in his mama's lap while she reads a book from start to finish. She said he would run around the room instead of watching TV with his brother, which was frustrating to his brother, but now he watches cartoons with his brother without running around the room.

And she said that at age four, he is achieving greater success at his daycare. Before the vision screening and the eyeglasses, he was up and moving during circle time. He was kind of a loner before. He would get bored, but now he sits and participates in group activities. So, you can see how this does have an impact on learning. So, there are four objectives. I'm going to start out with two common vision disorders in young children. And, okay, here we go.

Amblyopia, which is also known as lazy eye, and I will give an explanation or a definition of that in the next slide or two, but this is a common vision disorder in young children. Strabismus also called lazy eye, but that is where the eyes cross or drift, even when the child is tired, and here's an example at the bottom. Uncorrected abnormal refractive errors, and abnormal meaning to the degree that prescription glasses are needed.

So, we're talking about myopia, nearsightedness; hyperopia, farsightedness; astigmatism;

anisometropia, which may or may not be a new term for you, but that is a difference of refraction of the eyes. For example, I am nearsighted in one eye, farsighted in the other. And early detection is very, very critical for preventing permanent vision impairment. And many times, many times and probably the majority of times parents are completely unaware that their child has a vision disorder because Johnny is not going to come up to mama and hold one hand over an eye and say, "Oh, mama, I think I might be 20/50 in this eye and 20/32 in this eye, and I need an eye exam." So, that is not going to happen.

What happens usually is one eye will compensate for the other eye and the child just thinks however he or she is seeing the world is how everybody else sees the world. Again, children are unaware. So, parents and children are typically unaware. Unless it's an eye that crosses all the time, most of the time vision impairments are silent, if you will. It's not something like a boo-boo that needs a Band-Aid.

So, here's an example: David did not pass his kindergarten vision screening, and afterwards, when his mother asked why he did not tell her that he had problems seeing, his response was, "I didn't know."

Now he can see more clearly and he loves his new blue glasses and blue case. So, amblyopia defined.

Amblyopia, again called lazy eye, is a brain issue defined as loss of vision when the nerve cells in the visual part of the brain -- here's an example, the picture. You can see the optic nerve, another part of the visual pathway, and the primary visual cortex. So, the nerve cells in the visual part of the brain are not receiving sufficient use while the sense of sight is developing. Amblyopia can be the result of uncorrected refractive errors. It can be the result of strabismus or crossed eyes. It can be something blocking the vision, such as cataract. And early detection and treatment, preferably before age five years, will improve the likelihood that that vision can be restored to normal if not at least as much better than what it is.

So -- ooh, happy -- here we go. Y'all bear with me because sometimes I get a little crazy here with the next button.

So, uncorrected refractive errors, hyperopia, farsightedness, that's difficult -- and most of you guys may know this already, so treat this as a refresher. So, difficulty seeing objects up close. Here's an example.

Myopia, nearsightedness, difficulty seeing objects far away. Here is an example. Astigmatism, and astigmatism will affect both near and distance, so it could be like this example. And then again anisometropia, the difference between the two eyes. So, strabismus, here's an example. Misaligned eyes, another example. Uncorrected refractive errors and strabismus can lead to amblyopia and it needs to be detected and treated early in a child's life for the best outcomes.

So, importance of detecting amblyopia early is to prepare children for kindergarten and learning and to prevent permanent vision impairment and also to impact vision disorders as the child grows into older adulthood and develops older adults' vision disorders.

So, now we're going to talk about four key vision developmental milestones, during the first year of a child's life. So, the first key vision milestone occurs around eight weeks, by six weeks, no later than eight weeks, and this will be a primary interest for anybody on here who works with young children like Early Head Start. So, what you want to look at here is eye contact. And you can see in this photo we have really good eye contact, excellent eye contact in the second photo.

So, you want to know: Does the infant have good eye contact with parents? When the two are looking at each other, is the baby looking at the parent? And some of these milestones you will already be looking at in terms of just overall development, but what I would like you to do is to look at these in relationship to vision. So, not just overall development but in relationship to vision.

And so does the infant already copy facial expressions? Now, you can see in the picture on the bottom right-hand side that mama is pursing her lips there and the baby is responding. So we're copying facial expressions. Here is another example of great contact. Here is excellent contact. Look how that baby is smiling. So, eye contact with parents is essential to developing bonding and communication.

And again, this is something you know, but I want you to please think about it from the perspective of vision. Lack of eye contact can interfere with early emotional and general development. Early intervention should begin immediately if you're not seeing good eye contact. And you also would want to help parents receive assistance in helping the infant develop communication through all the senses if vision is becoming a problem or you think that vision is a problem, so the infant should receive an eye exam from an eye doctor without delay if you don't see good eye contact.

If you could advance the first – [Video playing in foreign language] Dr. Chaplin: If you noticed in that video, no matter what mama was doing, the baby would not have direct eye contact with mama. Now, watch what happens after some special glasses are placed on the child. If you will advance -Video begins] [Women speaking in a foreign language] [Video ends] Dr. Chaplin: So, normally when I show that, at the conclusion of that video, I would get an "aww" or some wonderful reaction from the group, because when that baby locks on mama and can see mama, what a difference.

So, now let's talk about the vision milestone at age 12 weeks, and this is enjoyable visual interaction. So here we can see in the bottom photo that the interaction appears incredibly enjoyable. So, what you want to know is: Does the infant have a social smile? And as you can tell on this one, baby definitely has a social smile and is very happy. When the parent smiles at the infant, does the infant respond with a smile? Does the baby show interest in objects hanging over the crib such as these little animals, the bugs? So, here you can see this baby is very happy. So, a social smile means the brain is maturing, the infant can see short distances, and the infant is making sense of an object. That social smile boosts bonding and is one of the cornerstones of communication between infant and parent.

So, vision milestone at age three to four months, awareness of and exploration of the hands. Here's an example, hands at midline, baby exploring this object with hands. So, what you want to know is does the infant watch her hands? Does the infant bring his hands to midline and to his mouth? And you want to know: Does the infant hit toys hanging above her? So, here's an example, this infant exploring a necklace. Awareness of hands leads to exploring the hands with the mouth, which leads to using the hands to explore the world, and exploration with hands gives concrete information about abstract objects, including size, form, surface quality, and weight. And that concrete information about an


object will be stored in the infant's brain to combine with the visual concept of each object.

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