Summer Intern Blogs, 2022

The National Center for Children’s Vision and Eye Health 2022 summer interns wrote blog posts on the presentations during the Forum on Children’s Vision at the 2022 Focus on Eye Health Summit.

Leveraging Data Sources to Tell the Children’s Vision Story

By Jessica Bartman, MPH Candidate, The Ohio State University

Megan E. Collins, MD, MPH, is an associate professor of Ophthalmology in the Wilmer Eye Institute of Johns Hopkins School of Medicine. She is also the Co-Director for the Johns Hopkins Consortium for School-Based Solutions. Dr. Collins spoke about how data can be used to enact change in school vision and eye health programs. She has investigated the impact of eye care on children’s health, academic achievement, and well-being, as well as disparities and gaps in eye care. She uses her study findings to promote the use of data for making informed decisions about children’s vision and eye health practices, vision health systems, and health policy. She has investigated available data on state vision screening requirements and how screening leads to treatment. She has also investigated data on pediatric vision disorders, insurance status, and social determinants of health and their connection to education outcomes. Learn more about Dr. Collins here.

Dr. Collins offered recommendations on improving the collection of data on children’s vision and eye health:

1. To uniformly collect and subsequently assess children’s vision data on a national level, a consistent and evidence-based strategy is required.
2. A national data collection system would allow more complete studies of eye care, lead to more efficient vision treatment for children, and allow states to more easily isolate areas where care is lacking and help those states more directly.
3. A data collection system could help more children access eye care if they do not pass vision screening, and access treatment (contributing to academic success).
4. Review other state and national systems for health monitoring (hearing, dental, immunizations, etc.) as examples for how vision monitoring systems could operate.
5. Review available data and create your own system so that when the time comes when better state and national vision data systems are available, you can merge the systems.

The School Factor: Focusing on the Roles of Education and Eye Health

By Michaela Turturro, MPH Candidate, University of Illinois at Chicago

Presciliana Olayo, Vision Care Services Coordinator at the Fort Worth Independent School District (the District) presented The School Factor: Focusing on the Roles of Education and Eye Health. Ms. Olayo has worked in the Public Education (K-12) system for 20 years in program management of federal, state, and local grant funds. In her current role as the Vision Care Services Coordinator, Ms. Olayo collaborates with local community partners, including the Alcon Foundation, to address student vision needs that are essential to their well-being and academic readiness. Long-term goals of the District’s children’s vision screening program are to build family support systems, implement efficient and effective expansion of vision care services (screening to eye examinations to eyeglasses), develop data tracking systems, and strengthen communication to increase vision care awareness for students, parents, school nurses, and administrators. Learn more about Ms. Olayo’s background here.

In conversation with the session moderator, Stacy A. Lyons, OD, FAAO, New England College of Optometry, Ms. Olayo discussed the vision and eye health services offered by the District:

• The children’s vision program in the District provides professional eye care services to underserved children, including screening for visual acuity and eye conditions throughout elementary school and in 7^th Students who do not pass the screening are referred for eye examinations, which are offered (along with prescription glasses) at the school-based eye care center that is open to all students in the District. The school-based eye care center is run in partnership with the Alcon Foundation.
• The Vision Care Services program works closely with District administration to improve awareness of the need for vision services and understanding of the opportunity to provide school-based care where many families are underinsured. Engaging student support services, school leadership, principals, the technology department, facilities, school nurses, and aides in the development of school vision services was instrumental for success, along with communicating with families.
• Tools and resources helpful in implementing the long-term goals are partnerships with community organizations, foundations, and local hospitals. Once partnerships are solidified, the program matches partners’ areas of expertise to the appropriate age groups. A key component is communication to families that is understandable, available in multiple languages, and uses simple formats and language.

Several key lessons learned were shared:

• The success of this vision and eye health program is attributed to the entire community working together as a team.
• Vision care must meet the individual needs of students and each student must be seen as unique. A common shared program goal is necessary but the services and strategies to implement the goal need to be tailored to each school. It is critical to consider the racial, financial, and cultural factors impacting students and their families. Programs must establish positive relationships with the community, schools, and families.
• Strategies to decrease barriers must be tailored to each school community. It is essential to work with each family to understand their priorities and collaborate to educate on the importance of eye care including the long-term impact of vision health on academic achievement.

Concluding the discussion, Ms. Olayo recommended the following actionable steps to school-based vision care services:

1. Start by determining the needs in your district and establish the available capacity to meet those needs.
2. Bring stakeholders into the conversation and work collaboratively.
3. Establish long-term goals with small actionable steps that can be modified along the journey.
4. Consider student diversity (race and ethnicity, finances, and culture) when implementing specific vision and eye health strategies.

Equitable Engagement and Practices for Children’s Vision Research

By Emely Melendez, MPH Candidate, George Mason University

Barbara Bierer, MD, presented “Equitable Engagement and Practices for Children’s Vision Research” during the Forum on Children’s Vision at the 2022 Focus on Eye Health National Summit.  Dr. Bierer, a professor of medicine at Harvard Medical School, founded and currently runs the Multi-Regional Clinical Trials Center (MRCT). Learn more about Dr. Bierer here.

The focal point of the presentation was the importance of diversity and inclusion in clinical research and the importance of acknowledging multi-dimensional diversity, as each person is made up of unique characteristics and needs that encompass several dimensions. The multiple dimensions include, but are not limited to, race, sex, ethnicity, gender identity, age, abilities, LGBTQIA+, socio-economic levels, etc. Dr. Brier stressed the importance of understanding the multiple dimensions of individuals’ identities so that researchers can ensure better representation of children and families who have been underrepresented in past clinical research. Dr. Bierer pointed out there have only been 205 clinical research studies conducted for children with vision disorders in the last 10 years (according to ClinicalTrials.gov.) From a global perspective, most of those studies were conducted in the U.S. with regional disparities.

Dr. Bierer offered a number of ways to improve and achieve diversity, inclusion, and equity in clinical research applicable to children. She issued a “Call to Action” which included prioritizing participant engagement, following best practices, and holding yourself accountable. Dr. Bierer provided the following suggestions to help reach this goal:

1. Utilize the guidance toolkit developed by the MRCT. This tool kit provides solutions that remove many, if not all, barriers to inclusion related to institutions, investigators, staff, patients, advocates, communities, data collection, and data analysis.
2. Develop patient and community engagement strategies to support diverse participation: Form relationships, provide training and support, and identify shared goals.
3. Consider family structure, which can influence the level to which a participant will be involved in a study.
4. Communicate clearly with understandable, plain language that children and adults will understand, so they can easily absorb the information being presented during all stages of the study.
5. Consider how data are presented, visualized, and shared to ensure your communications are culturally competent.
6. Clinical research with children can be promoted by shifting the perspective from being protective to appropriately inclusive, considering global differences in law, health care, cultures, and processes.
7. Most important, listen to the children and parents involved clinical research to find ways that will improve engagement and practices by giving them a seat at the table and a voice.

The link to the recording of the full Forum on Children’s Vision, including the presentations and patient testimonials, can be found here.