Screening for Amblyogenic Factors in a Rural State: Implementing a Statewide Childhood Vision Project

Wyoming is the least populated state in the United States, with approximately 582,000 people living in a geographic area of 97,093 square miles. Wyoming's sparsely populated cities and towns struggle to support an optimal level of primary and specialist health care (Gantenbein, Robinson, Wolverton, & Earls, 2011). Limited availability of primary care for children presents a barrier to the provision of screening services for potentially correctable conditions such as amblyopia (Kemper & Clark, 2006). Amblyopia is the most common form of unilateral blindness in children, with an estimated prevalence of 1-5% (Holmes & Clarke, 2006). To address the need for vision screening services in areas where primary care is limited, the Lions Clubs of Tennessee established a network of lay screeners who were trained to follow a standardized screening protocol (Donahue, Johnson, & Leonard-Martin, 2000). The success of the Tennessee program led the Lions Clubs International Foundation (LCIF) to incorporate vision screening into its Core Four sight preservation initiatives and provide matching funds for Lions Clubs in various states, including Wyoming, to initiate vision screening programs (see Donahue et al., 2006, for a review). THE PROGRAM The Wyoming Lions Early Childhood Vision Program (WLECVP) provides children aged 6 months to 6 years with free annual vision screening, administered by trained lay persons from the community. In a state where vision screening is not mandated and where public schools do not begin vision screening until a child registers for kindergarten, WLECVP affords Wyoming children access to modern vision screening services well before they enter school. Similar to the Tennessee Lions Vision Screening Project, WLECVP utilizes trained Lions volunteers to set up and conduct screenings throughout the state, but WLECVP utilizes the services of Lions volunteers to a much lesser extent. What makes WLECVP unique is its use of 14 regional Child Development Centers and their staff members to conduct vision screenings in 46 sites. The Child Development Centers are state-supported entities that provide education and related services to children with developmental delays and disabilities from birth through 5 years of age. To meet children's needs, the centers work in conjunction with other early child care and education sites such as Head Start programs, developmental preschools, and private childcare settings. Child Development Centers were chosen by WLECVP as primary screening sites for several reasons. First, they serve children with developmental delays--a population with higher rates of vision problems than the general population (Sandfeld-Nielsen, Skov, & Jensen, 2007). Second, their staff members have regular contact with the children being screened, which provides more consistent and secure lines of communication with the parents or guardians of a child who has failed a screening activity. Third, their staff members are specially trained to work with children and families and may be more adept in attaining the cooperation of children who are difficult to screen, such as those with developmental delays. Finally, given their location in population centers throughout the state, they provide readily accessible developmental screening services for the entire population of children from birth to five years of age. At the outset of the program in 2001, the WLECVP project coordinators assembled an advisory team made up of optometrists, ophthalmologists, teachers of visually impaired students, early childhood special education teachers, and specialists in early childhood education to develop a vision-screening protocol for that could be administered by lay screeners. At the time, no single tool had been developed that was capable of reliably identifying amblyopia risk factors. Therefore, the team decided on a battery of five different vision screening tools that took into consideration the particular strengths of each tool in detecting specific amblyopia risk factors. …