July 24, 1998

Lions Club screening program producing eye-opening results

Lions Club screening program producing eye-opening results

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The Tennessee Lions Eye Center's statewide child vision screening program is showing strong results. At a training session at VUMC last year, Lions outreach directory Tammy Johnson (left) helped Lions Club members Margene Stack (center) and Carol Cannon learn how to use the novel vision screening equipment. (Photo by Donna Jones Bailey)

About 6,000 pre-literate children across Tennessee have been screened for vision disorders during the past nine months through the Tennessee Lions Eye Center Outreach Program, part of the Tennessee Lions Eye Center at Vanderbilt Children¹s Hospital.

By October, the program¹s one-year anniversary, nearly 10,000 children are expected to have been screened.

And these numbers aren¹t the only impressive part of the program.

The screenings ‹ conducted using hand-held cameras operated by trained members of the Tennessee Lions Clubs ‹ are proving to be even more accurate than predicted.

In a paper presented at the Association for Research in Vision and Ophthalmology (ARVO) in Ft. Lauderdale, Fla., in May, the results of 2,500 screenings were presented by Dr. Sean P. Donahue, assistant professor of Ophthalmology and Visual Sciences, Tammy Johnson, director of outreach for the Tennessee Lions Eye Center (TLEC) and second-year medical students John Parrott and Carolyn Quinn.

Parrott and Quinn participated in the program, first through the medical school¹s summer Community Scholars Program, then continued their participation as an elective.

The accuracy of the testing has been impressive. Of the 2,500 children screened statewide, about 7 percent failed the test, indicating a potential vision abnormality. Of these, 80 percent were confirmed to have a vision abnormality in follow-up visits to an optometrist or ophthalmologist.

"The percentage who fail is lower than we would expect," Donahue said. "We would have expected an 8-10 percent failure rate, and about 50 percent of those to have an actual eye problem. The 80 percent figure is very reassuring though. It shows that the screening is working wonderfully."

The Vanderbilt group also presented a poster on the organizational structure of the outreach screening program and the process of teaching the Lions Clubs members to conduct the screenings.

The goal of the Tennessee Lions Eye Center Outreach Program is to prevent childhood blindness through early detection and treatment of the most common vision disorders that can lead to blindness.

Most of the children screened are between six months and four years of age. The screenings have been held across the state at day care centers, preschools, Sunday schools and upon request at organized sites. Johnson, the TLEC¹s outreach director, trains the Lions Clubs members.

It is important to discover these problems when the children are young because they are easier to correct early in life, Johnson said.

The outreach "clinic without walls" uses a high-tech camera called a PhotoScreener to photograph a child¹s eyes. The camera makes use of the eyes¹ light reflex when flash photographs are taken, one with the flash in the vertical position and one in the horizontal position, which enables estimation of refractive error.

The black and white photographs are then sent back to the Vanderbilt Reading Center at VUMC to be evaluated. There, examiners are on the lookout for a host of vision problems, including: amblyopia (lazy eye); strabismus (misaligned eyes); cataracts; hyperopia (farsightedness); myopia (nearsightedness); astigmatism; and anisometropia (a difference of refractive error between the eyes).

After they are evaluated, the results are sent from Vanderbilt to the testing sites for distribution, along with a list of ophthalmologists and optometrists in the area who will see children. Follow-up phone calls are made to assure that the patient has seen an ophthalmologist or optometrist and results from the doctors¹ visits are sent back to Vanderbilt and compared to the screening diagnosis.

"The program is full circle from planning to screening to making sure the child sees a doctor, to making sure our diagnosis is correct," Johnson said.

Lately, the TLEC has been gaining national attention for its screening program.

Donahue and Johnson have been invited to be among 20 participants in a National Institutes of Health-sponsored forum on vision screening in Bethesda, Md. in September. The goal of the conference is to establish policy for vision screenings in children.

"It¹s a huge step, just being invited to participate in something like this," Johnson said. "Just the fact that they¹re having it is important."

In June, representatives of the Lions Clubs International Foundation visited the TLEC to learn more about the screening program in hopes of making it a model for Lions Clubs to emulate throughout the world.

The program is successful in several areas, Donahue said.

"The obvious success is that we¹re finding children who have eye problems who wouldn¹t seek care otherwise and are getting them into the health care system," he said. "It¹s also successful for the Lions, helping them build their organization by attracting new members."

The program is also giving the TLEC much-needed information on amblyopia.

"The research and epidemiology of amblyopia has been very lacking," Donahue said.