Kim Casier, Oral Health Manager, Oral Health Department
Each year, in Ontario approximately 3% to 5% of children (4000 to 7000) experience vision loss and left untreated can lead to poor performance in school. Effective September 2018, new requirements for the provision of vision screening for children in senior kindergarten (SK) were introduced in the Ontario Public Health Standards (OPHS). Vision screening under the Child Visual Health and Vision Screening Protocol, 2018 includes a short sequence of three tests that can detect risk factors for certain vision disorders. The screening does not diagnose vision disorders nor is it a replacement for a comprehensive eye examination conducted by an optometrist.
The vision screening tools that are currently utilized are the HOTV visual acuity chart with crowding bars; the Randot Preschool Stereotest; and an autorefractor.
- The HOTV visual acuity chart with crowding bars is a chart that tests visual acuity, otherwise known as the sharpness of one’s eyesight/clarity of vision. Visual acuity is expressed as a fraction, such as 20/20. In addition to visual acuity, this screening test is also designed to identify children at risk for the following vision disorders: amblyopia and refractive errors (e.g., myopia, anisometropia and astigmatism).
- The Randot Preschool Stereotest (Randot) is a vision test designed to detect reduced stereopsis/stereoacuity at near distances. Stereoacuity is the ability to visually recognize depth based on differences in the images presented to the two eyes.
- An autorefractor is a lightweight, portable, handheld screening device. It automatically screens for, and can identify the presence and size of some refractive errors, including near and farsightedness (myopia/hyperopia), astigmatism (asymmetrical focus), and anisometropia (unequal power between eyes).
In the fall of 2018, oral health staff received Ministry-specified training and completed their first school in November. In January 2019, dental staff began coordinating with all Windsor-Essex elementary schools to provide pre-screening notification for vision screening to occur simultaneously with dental screening.
Parents/guardians of children who are screened and identified in need of visual health services and/or treatment are provided with a post-screening notification and referral to an optometrist for further follow up. All other children receive a notification encouraging parents/guardians to book an appointment with an optometrist. Parent notification forms have been translated into Arabic and are also available in French and English.
To date 1400 senior kindergarten students attending 49 Windsor-Essex elementary schools have received vision screening. Of those screened, 34.29% (480) were referred to an optometrist for further follow up.
The vision screening has been conducted in conjunction with St. Clair College and second year nursing students from the Registered Practical Nurse (RPN) program. Nursing faculty viewed this opportunity as a “beneficial learning experience that would help to fulfil our mandate and provide the student with a rewarding community placement with children.” The RPN students received vision training/orientation at the College prior to the school assignment. A total of 136 RPN students (17 groups of 8 students) helped to complete 17 schools from January – April 2019. In addition, three BScN nursing students from the University of Windsor assisted with the vision screening.
Vision screening information has also been sent to Windsor–Essex community optometrists to increase awareness of the new vision-screening program. As well, a vision-screening pamphlet has been created for the community as well as program information has been posted on the WECHU website.
The 2018/2019 school year provided the WECHU oral health staff the opportunity to implement vision screening in a variety of school settings both with and without the assistance of nursing students. Currently an evaluation is being conducted to assess the best structure for full implementation of vision screening in all elementary schools starting fall of 2019. As well the WECHU has partnered with Sick Kids and McMaster to measure parental awareness and perceptions of vision screening.