January 9, 1998

Lions Eye Center screenings target pre-verbal children

Lions Eye Center screenings target pre-verbal children

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Tammy Wiedenfeld (left), director of outreach for the Tennessee Lions Eye Center, trains Cheatham County Lions Club members Margene Stack (center) and Carol Cannon on the use of vision screening equipment. (Photo by Donna Jones Bailey).

During the next 11 months 10,000 pre-literate children in Tennessee will be screened for vision disorders, thanks to the Tennessee Lions Eye Center Outreach Program, part of the Tennessee Lions Eye Center at Vanderbilt Children's Hospital.

The program, which began in November, has already provided screening for more than 1,000 children across the state. The screenings are aimed at detecting eye problems that may go unnoticed at such an early age, when children can't verbally express a problem or read an eye chart.

Most of the children being screened are between six months and four years of age. The screenings, held at day care centers, preschools, Sunday schools and upon request at organized sites, are being conducted by members of the Tennessee Lions Clubs, who are being trained by Tammy Wiedenfeld, Director of Outreach for the TLEC.

A group of 22 Lions Clubs members were trained last week at VUMC.

"The Lions are just incredible," Wiedenfeld said. "They are enthusiastic, committed to this project and incredibly well-organized. They are very easy to work with in this program."

The Lions Clubs are divided into five districts throughout the state, with a total of 250 clubs and 6,500 members. Each district has a coordinator who works with Wiedenfeld.

The TLEC celebrated its official grand opening in August. The outreach "clinic without walls" uses a high-tech camera, called a PhotoScreener, to photograph a child's eyes. The PhotoScreener is a camera that makes use of the eyes' light reflex when a flash photograph is taken. Two pictures are taken, one with the flash in the vertical position, 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 here at VUMC to be evaluated. The photographs are examined for vision problems that cause amblyopia (lazy eye). Other vision problems detected include: strabismus (misaligned eyes); cataracts; hyperopia (farsightedness); myopia (nearsightedness); astigmatism; and anisometropia (a difference of refractive error between the eyes). The camera is believed to be about 90 percent sensitive and specific in showing a vision problem.

There are 1.5 million children in the state and only 10 pediatric ophthalmologists ‹ three of whom are in Nashville. Approximately 3 percent of these children have serious eye problems. 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.

Wiedenfeld said it is important to discover these problems before age six because they are easier to correct early in life.

It takes three Lions Clubs members to perform the tests. One operates the PhotoScreener, one escorts the children to the screening site and one is needed to complete the required paperwork and consent process.

The outreach program doesn't end with the diagnosis. The results of the screenings are sent from Vanderbilt to the testing sites for distribution. Follow-ups will be made to ensure that children with a potential problem visit with a local ophthalmologist or optometrist.

By using a computer data bank of all of the state's ophthalmologists and optometrists, Wiedenfeld is able to recommend followup care in the child's hometown.

prior to a screening, a letter will be sent to each ophthalmologist and optometrist in the community explaining the outreach screening program, and the physicians are being asked if they are available for referrals for children in their area. The eye care professionals are also asked to indicate the types of insurance they accept.

"We try to refer children with vision problems to the closest ophthalmologist or optometrist in order to make it convenient," Wiedenfeld said. "We want to make sure they actually see a doctor."

Two weeks after the parents receive the results of the screening, those who require followup care are contacted by VUMC to see if they have scheduled an appointment. When the screening results are taken to the appointment, a form is enclosed so the results of the followup appointment can be forwarded back to Vanderbilt.

"That's what is so important about this program, it's full circle from planning the screening, to making sure that the child sees a doctor, to making sure our diagnosis is correct," she said.

The followup information is already coming in, she said.

"One of the first screenings I did was on a little boy from the Kingsport area. He was myopic, couldn't see distances very well, but you couldn't tell by looking at him. He was one of the most active children in the room," Wiedenfeld said.

"He was three and had no idea that he was supposed to be seeing better than he was. His parents called me after the referrals were sent out and said they didn't know he had a problem. They said, 'he's in sports, how could he have a problem?' But he was in gymnastics and was little. He could see the floor with no problem. He could tumble. I told them just to make sure nobody threw a baseball at him. He's not going to be able to see it."

Wiedenfeld said she recently received the evaluation back from the child's doctor confirming the seriousness of his myopia.