Marketing the InfantSEE Program at the Local Level

Miller 968By Jason Miller, OD, MBA – InfantSEE®, the American Optometric Association’s public health program to provide comprehensive eye assessments to infants in the first year of life at no cost, has firmly taken root since its introduction in the summer of 2005. How can optometrists best promote this public health program in their communities?

Fortunately, it is not difficult. The InfantSEE® public awareness campaign was designed from the start to be applicable at both the national and local levels. Read my column, InfantSEE in Optometry that was first published in 2007. The information remains current today.

Dr. Miller is a member of the Ohio Optometric Association and is the coordinator of the Central Ohio Optometric Association’s InfantSEE® program. He can be contacted at


Realeyes Starts Off Strong in 2014

Realeyes Westside Academy Jan 2014Realeyes staff and volunteer eye doctors have presented to more than 4,300 students in 38 Ohio schools so far in 2014.

In January, during presentations to pre-kindergarten, first, third and sixth grade classes at Edon Northwest Elementary School (Williams County), a third-grade student claimed the presentation was “better than recess!”

A week later, at multiple presentations at Westside Academy, Columbus (Franklin County), kindergarten students sang the tunes of “Sammy Safe-Eyes,” first-grade students participated in the penlight activity portion of “The Adventures of Rhet & Tina,” and third-grade students helped solve “The Case of Vinny Vision.”

Realeyes teaches students about the importance of vision health and eye safety and is presented at no charge by doctors in the community to pre-school through eighth-grade classes. Realeyes is funded by a grant from the Ohio Department of Health’s Save Our Sight Fund. Contact the Ohio Optometric Association for additional information at 800-874-9111; email:

Top Realeyes Presenters


Half-way through this school year, Realeyes presenters are scheduled to visit schools in 70 of 88 Ohio counties.

Realeyes is presented by Ohio optometrists in pre-school through eighth-grade classrooms in their communities to teach students about the importance of vision health and eye safety. Since its start in 2000, Realeyes has been presented to more than 700,000 students.


The top five Realeyes presenters so far this year (2013-14) are:

Dr Rambeau cropped


Dr. Renee Rambeau – 930 students in 36 presentations in Miami County




Dr Kristen Thompson


Dr. Kristen Thompson – 700 students in 17 presentations in Clark County



Dr. Stephen Sasala


Dr. Stephen Sasala – 620 students in 17 presentations in Cuyahoga County




Dr Brooke Bader cropped


Dr. Brooke Bader – 600 students in 11 presentations in Lorain County



Dr Susan Truitt


Dr. Susan Truitt – 500 students in 15 presentations in Union County



Realeyes is presented by Ohio optometrists in pre-school through eighth-grade classrooms in their communities to teach students about the importance of vision health and eye safety. Since its start in 2000, Realeyes has been presented to more than 700,000 students.

Realeyes is funded by a grant from the Ohio Department of Health’s Save Our Sight Fund. Contact the Ohio Optometric Association for additional information at 800-874-9111; email:

Vision and Students on Individualized Education Programs

Imagine strugglgirl new glassesing to determine the numbers on a clock, distinguish letters on a sign or see the number on a school bus. Imagine getting a headache when reading, doing homework or viewing the board in the classroom. For a student to be able to learn, he or she must be able to see. For students referred to an Individualized Education Program (IEP), this is even more important because vision is critical to improving performance in school.

Ohio law requires that students referred to an IEP must receive an eye exam from an eye doctor. Senator Randy Gardner of Bowling Green said, “Through my family’s experience, I know how important good vision is to the learning process. Correcting vision problems early on can help improve a child’s performance in school.”

Parents need to be informed of this requirement so they can schedule an appointment with an optometrist or ophthalmologist, and then ask the doctor to send a copy of the exam form to the school. Parents should schedule the appointment with the eye doctor within 90 days after the student is initially identified with learning disabilities. If the student had an eye exam during the previous nine months, the requirement is already met. Be sure to inform your school’s IEP coordinator about this state law.

Why is an eye exam required for students referred to special education programs?

Since 80 percent of learning is through vision, a comprehensive eye exam by an eye doctor—optometrist or ophthalmologist—can detect and correct vision problems, which could improve the child’s performance in school. Although one in four school-aged children have a vision disorder, about 70 percent of students on an IEP have an undiagnosed vision disorder. Eliminating or correcting vision problems is the first step to helping these students.

If the eye exam is not done within 90 days of identification for IEP, can the student attend school?

The goal is to help students. Students will not be kept out of school if the eye exam requirement is not met.

Why is an eye exam needed?

While school nurses may detect a vision problem through a vision screening, vision screenings never diagnose or treat a vision disorder. A comprehensive eye exam is a detailed assessment of the overall eye and vision health including measuring for distance vision, eye alignment, focusing, eye shape, depth perception, and more. Eye doctors are trained to make a definitive diagnosis and prescribe treatment such as glasses, contact lenses and medication.

One aspect of learning preparation that is often overlooked is good vision, which is essential for a child to learn. A trip to an eye doctor can help students. Teachers are in a unique position to help students and parents understand the importance of regular eye exams.

“Healthy eyes and clear vision can make all the difference in how a child learns and preforms in the classroom,” said Karla Zadnik, OD, PhD, Associate Dean at The Ohio State University College of Optometry and medical director of Realeyes. “Poor vision makes a child work harder in the classroom, which can result in lower grades. A comprehensive eye exam by an eye doctor is the best way to ensure vision is not holding a child back.”

In this season of giving, consider donating to the Ohio Optometric Foundation

Dr. JacksonDuring this busy holiday season, we’re asking all Ohio optometrists to make a generous donation to the Ohio Optometric Foundation, which was created to help Ohio eye doctors make a difference in the lives of others in their communities.

One-hundred percent of your donations go to programs to help children obtain quality eye care, as well as to fund scholarships for optometry students. The foundation also funds grants and programs to promote public awareness of the importance of comprehensive vision care.

Over the years, the foundation has made a difference in the lives of many Ohioans, thanks to the generosity of our donors. Some examples include:

- Providing free eye exams and glasses to students in Individualized Education Programs who are required to have an eye exam, but who don’t have the financial ability to pay for the exam or lenses.

- A foundation grant helped a clinic in Toledo buy vital equipment, which is used by volunteer eye doctors to provide eye examinations to low-income residents.

- More than $100,000 in scholarships awarded to students in Ohio optometry schools, many of whom have earned advanced degrees beyond their doctor of optometry degree. Other students dedicated themselves to research or service projects to help give back to the communities.

Donations to the Ohio Optometric Foundation are tax deductible, and it’s a great way to support our vital mission to promote the importance of a lifetime of vision care for the residents of Ohio.

You can mail your donation to:

Ohio Optometric Foundation
P.O. Box 6036
Worthington, OH 43085

OOA/AOA Warning: Misleading Campaign Promoting Vision Screening

OOA/AOA Warning Parents about Misleading Campaign Promoting Vision Screening

Beginning January 1, nearly all children in the U.S. will have coverage for annual eye examinations, follow-up care, and treatments, such as eyeglasses, from their local doctor of optometry. For many families, the coverage will be embedded within their basic medical insurance, not as a stand-alone benefits as has typically been the case. Sadly, even though many children currently have this vision care coverage and millions more will soon gain new access to this vision care coverage through an Optometric Care ACA Children’s Health Benefit, deemed essential to a child’s overall health, a group of specialty surgeons is attempting to mislead the public and steer families away from the primary eye and vision care that they need.

Through a nationwide campaign called “Choosing Wisely”, a group of special-interest surgeons has released recommendations urging parents not to bother with annual comprehensive eye examinations provided by doctors of optometry unless the child is already identified as having a vision problem. The problem with that recommendation is that there is no valid screening method to identify most kids with vision problems.

The OOA/AOA is rapidly taking steps to counteract this potentially harmful suggestion.

  • First, AOA has prepared a statement for parents (member log-in required) that you can use in giving your own expert advice to parents and other in your community who care about children’s health.
  • AOA has prepared a public referenced article: Health Reform Offers Better Children’s Vision Care in the U.S.
  • In the coming weeks, the AOA will conduct PR outreach to both medical-health media and consumer media to correct the record about the problems with vision screenings and the benefits and accessibility of comprehensive eye exams for children. Materials will also be provided for you and affiliates to use with the media and other public health stakeholders.

Only comprehensive eye exams fully identify eye problems, provide diagnosis, and ensure a linkage to treatment for all of the vision and eye health issues that can impact a child’s ability to meet important developmental and educational milestones while routine vision screenings miss up to three-quarters of learning-related eye and vision problems.

Once missed by vision screening, children are often misdirected toward Individualized Education Plans (IEPs) and/or Attention Deficit Hyperactivity Disorder (ADHD) treatments without ever receiving the vision care they actually need. But, not surprisingly, these vision screenings are predominantly effective at finding those rare kids in need of eye surgery and have been shown to detect little else that relates to a child’s success or failure in school.

Vision screenings miss more problems than they find. A study funded by the National Eye Institute found that even the most highly trained vision screeners using the the top-of-the-line screening equipment will miss one-third of all learning-related eye and vision problems in children. Children should never have to suffer a lifetime of visual and learning problems because a vision screening missed their vision or eye health issue.

School Nurse Symposium November 18

Do you know a school nurse that would be interested in attending the OOA School Nurse Symposium? November 18, 9:00 AM – 1:45 PM at the Northeast Conference Center in Westerville, OH. Free CE! Lunch included! Visit to register.

Quotes from school nurses about previous School Nurse Symposia:

“I’ve been a school nurse for over20 years. This was the most informative vision workshop I have ever attended.”


“No matter how often I attend, I always learn new things. These session improve my efficiency.”


“Excellent presentations! I especially liked having an OD at our table to respond to our questions and I loved the eye emergency portion.”


Foundation Golf Outing Wrap-Up

PrintThe annual Golf Outing to raise funds for the Ohio Optometric Foundation (OOF) was held August 7 at Scioto Reserve Golf Course in Powell. Thirty-one foursomes participated in the event that also included a silent auction, raffle and putting contest.

OOF Golf Outing Winner

Dr. Doug McCloy was the OOF 2013 Golf Outing winner. Winner of the Zone Optic Cup was the Zone 3 foursome of Dr. Brian Mathie, Dr. Braden Kail, Dr. Tom Scullion, and Dr. Ted Rath.

Special thanks to the sponsors:

IMG_0243Gold Sponsor: Interstate Optical, Silver Sponsor: Toledo Optical, Bronze Sponsors: Classic Optical, HOYA

Hole Sponsors:HoleSponsor1HoleSponsor4 HoleSponsor2


Essential Tests for the Essential Benefit

by Michael J. Earley, OD, PhD and Marjean Taylor Kulp, OD, MS

Currently, under the Affordable Care Act, a yearly comprehensive eye exam for all children under 18 years old is defined as an “Essential Benefit”. This provides optometry with a tremendous opportunity to truly make a significant impact in the lives of these children.  Kids coming in for comprehensive vision exams provide an essential opportunity to identify Child Photo Glasseschildren who have significant vision problems which may impact their performance in school and/or sports, and subsequently their overall self esteem. Of course, this gain cannot be achieved unless the testing performed at the vision exam is sufficient to uncover the visual conditions that can serve as barriers to success. We are all aware of testing that constitutes a “comprehensive exam”.  Below are six essential tests (yes – essential testing for the essential benefit) that should be completed on ALL children who are seen for comprehensive vision exams. This list is not intended to be exhaustive and certainly many other tests could be added.  Our goal is to show that running a few simple tests ACCURATELY can make a big difference in identifying versus missing a visual issue in your pediatric patients.  Simply performing these tests is, of course, not enough. You have to follow up on treatment or make the appropriate referral if a child does show deficits on these tests. A complete sensorimotor examination should be recommended for children with suspected binocular vision problems.

Tests that may be done by a technician or doctor depending on practice flow:

1. Symptom Survey

Children are terrible historians and do not typically enter the exam room with a chief complaint in mind. Myopes who currently wear glasses will tell you that “far away is not as clear as it was”.  Kids with binocular vision problems, however,  will not typically present with “I suffer from asthenopia after 25 minutes of sustained near work.” They often don’t realize that the symptoms with near work (e.g. headache) are secondary to a vision problem. Therefore, we have to directly ask about specific symptoms to elicit a significant finding. The Convergence Insufficiency Symptom Survey (CISS) is one possible survey that can be a useful tool to help identify kids ages 9 and up with significant near work symptoms. It has been extensively studied and validated in clinical trials and is extremely easy to use.  Normal children without binocular vision or accommodative problems have an average score of 9 on the CISS.  A reliable cut-off to indicate symptomatic convergence insufficiency is a score of 16 or more. It is important to run the survey as directed (i.e. with lapcard answer key, reading questions verbatim, and limiting patient to responses on card). Download Form: CISS Form

2. Visual Acuity

Snellen acuity is fine for older kids but single, crowded LEA symbols or HOTV should be used in young children.  Single optotypes with crowding bars have been shown to be effective in identifying amblyopia and to give more repeatable outcomes.  Optotypes that do not blur out equally, such as Allen Figures, should be avoided.  A lap card which shows the optotype choices is essential to improve testability in young children because the child can point to(match) or name the symbol.  Studies have shown that 99% of 3-year-old children can complete visual acuity testing when using LEA or HOTV and a lap card.

With young kids, do not use a cover paddle to occlude when testing acuity. Instead use an adhesive occlusive patch or Blenderm tape when testing acuity and watch carefully for peaking.  Amblyopic children are experts at peaking and will often try to peak because they want to do well for you. Many clinicians have missed decreased acuity in one eye due to a transient subtle head turn around the cover paddle.  Kids think the goal is to get the letters right – not to individually test the resolution limitations of the two eyes independently!

Remember that kids often remember letters that have been presented so letters/symbols should be changed between presentations (e.g. right and left eye) or have the child read the optotypes in a different order (e.g. backwards) when testing the second eye if you are unable to change the letters/symbols on your chart.

NEVER EVER put decreased monocular acuity off to amblyopia in the absence of a TRUE amblyogenic factor. Always order necessary tests and/or make appropriate referrals to rule out other underlying causes.

3. Motor/Sensory Fusion – As in the other categories, not all tests are equally effective so it’s essential to use a test that young children can complete and that performs well in identifying children with problems.

School-aged children

Near Point of Convergence (NPC) is another easy quick test that can be very diagnostic IF performed correctly. It’s important to use an ACCOMMODATIVE target (e.g. a fixation stick with a vertical row of 20/30 letters) and to bring the target SLOWLY towards the child (1-2cm/second) in order to make sure the child has time to let you know as soon as he/she sees double.  It’s also important to WATCH for either eye to turn out; if a loss of fusion is seen that should be recorded as the break value. Many kids with intermittent strabismus will suppress when their tropia manifests, therefore they may never report that the target doubles.  A normal NPC should be closer than 6cm. A NPC break of 5.75cm or beyond has been shown to have a sensitivity of 87% and specificity of 67% for identifying school-aged children with convergence insufficiency or binocular dysfunction. Yes, this quick, simple test, when run as stated above, can help pick up most kids with CI with a low false positive outcome.

Preschool ChildrenChild Photo Double Rings

Random Dot Stereoacuity is a quick, easy test for preschool children. Testability is excellent and children generally have fun with this test. Effective tests include the Preschool Assessment of Stereopsis with a Smile(PASS) or the Randot Preschool.  The PASS can be run like a hide and seek game (find smiley!) and the Preschool Randot can be run in a matching fashion.  It is important to use one of these random dot tests (you can’t see the picture without the Polarized glasses) because reduced performance on these tests has been shown to be associated with significant vision problems (e.g. strabismus, amblyopia, significant refractive error) in preschool children.  Tests that do not have random dot shapes such as Stereofly should be avoided. Subnormal performance is achieving worse than 400” for 3-year-olds and achieving worse than 200” for 4- to 5-year-olds on the Randot Preschool or achieving worse than 120” on the PASS.

Tests that should be done by a doctor:

4. Retinoscopy

In kids, retinoscopy is not just a test to “get close to Rx”, it often determines the Rx. At the child’s initial exam, determination of refractive error should include cycloplegia with cyclopentolate (we use 1% cyclopentolate/1% tropicamide) after all near testing is complete. Uncovering the full amount of hyperopia will play an important role in deciding how to treat any other binocular vision issue that is uncovered.  Very young children should typically be hyperopic with at most a low amount of astigmatism. Emmetropization causes this hyperopia to decrease rapidly in the first year of life and then gradually over the next few years.  An average refractive error for a preschool child is +1.25.  A general rule of thumb that we use is that if a child is still 3D hyperopic at 3 years of age, then the process of emmetropization did not work and the child will typically stay hyperopic. This rule of thumb comes in handy when a parent asks if the child will always need glasses.

5. Ocular Alignment

Cover Test

Cover test is essential to identify any strabismus or significant phoria, however, again this is a test that MUST be run accurately to have any value.  The cover should be held over each eye for 2-3 seconds on unilateral cover testing and for 1 second on alternate cover testing. It is ESSENTIAL to use prism neutralization and a small accommodative target for testing (e.g. 20/30 target or a target just above threshold for the patient). For example, a patient with convergence excess will typically try to focus slightly behind the target (lag of accommodation).  With a 20/200 near target, the patient can have a lag of over a full diopter and still “see” the letter.  This can cause you to underestimate the near esophoria by 10 or more prism diopters!  To maintain attention, engage the child by asking questions about the target and change the target if the child loses interest.  It generally takes about 20 seconds for the phoria to reach a stable position on cover testing (e.g. to find the prism which results in SUSTAINED reversal [5 reversals]).  Binocular vision problems often result in significant symptoms; your patient deserves that minute of your time to do cover testing!


Use an interesting target and watch carefully for any over action or restriction. A number of binocular issues only present in secondary/tertiary gaze positions and show alignment in primary gaze.

6. Ocular Health

Ocular health assessment in a child is the same as an adult, including a dilated fundus examination.  One important point to always remember is that amblyopia is not typically associated with an afferent pupillary defect so an APD requires follow up.

Again, this list is not intended to be exhaustive. It is meant to remind all of us that spending a few extra minutes running these tests accurately can greatly change the lives of many children.  Amblyopia is of course a condition that MUST be detected and treated.  Other binocular issues like CI, CE, accommodative issues, etc. DO have significant impacts on educational success. A COMPREHENSIVE vision exam is the essential benefit because the federal legislature was convinced that these issues need to be uncovered and treated early on in a child’s educational life.  They have done their part – now we have the responsibility and opportunity to do ours!

Realeyes at Health Fairs

OOA staff presented the Realeyes exhibit at 10 to 15 health fairs and conferences throughout the summer months. In order to attract students to the booth so they can learn about the value of taking care of their eyes, games and prizes dealing with vision are offered.

cornholeFirst, they are engaged in an activity such as cornhole or the football toss game while wearing glasses that simulate vision conditions followed up by a discussion about the importance of seeing as good as you can see and visiting the eye doctor who can diagnose and treat vision disorders.994837_166695736843608_458002876_n

Second, they visit a table where they are asked to name ways to protect their eyes (swimming goggles, protective batting helmets, eating foods that can help prevent eye diseases).



Third, they play Plinko to win “protection for their eyes” (UV sunglasses/hats/foods that prevent eye diseases).

table setupFourth, they receive take-home handouts that provide information about eye and vision care.

If you would like to help Realeyes at a future health fair, please send an email to