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2015-18 report

2015-18 report supplement (parents' questionnaires)

Conference presentations

Checking the Vision of Preschool Children: A Role for Public Health? (Ontario Public Health Conference, 2016)

Access to Vision Health Services amongst Vulnerable Populations in Canada: A Scoping Review (Canadian Association for Health Services and Policy Research, 2017)

Factors Influencing Vision Care Access amongst Aboriginal Children in Canada: A Conceptual Framework (Canadian Association for Health Services and Policy Research, 2017)

Evaluation of a School-Based Visual Screening for Kindergarten Children (Association for Research in Vision and Ophthalmology, 2017; Canadian Association for Health Services and Policy Research, 2017; Canadian Amblyopia Network, 2017)

A School-Based Program for Checking Kindergarten Children's Vision (Ontario Public Health Conference, 2017)

The Cost-Effectiveness of a Public Health Nurse Program to Screen for Amblyopia in Ontario (International Society for Pharmacoeconomics and Outcomes Research, 2018)

The Cost-Effectiveness of a School-Based Vision Screening Program to Detect Amblyopia and Refractive Errors in Young Children Compared to Usual Care Screening in Ontario, Canada: An Economic Analysis (American Academy of Optometry and 3rd World Congress of Optometry Joint Meeting, 2019)

A Randomized Clustered Clinical Trial to Assess the Efficacy of Vision Screening in Children Aged 3-6 Years. (Canadian Ophthalmological Society, 2018)

Checking Vision in Senior Kindergarten: Background Research (Ontario Public Health Conference, 2019)

Economic Evaluations of Vision Screening Interventions for Children: A Systematic Review (Canadian Association for Health Services and Policy Research, 2019)

The Cost-Effectiveness of School and Clinic-Based Vision Testing Programs to Detect Amblyopia in Young Children in an Urban North American City (Association for Research in Vision and Ophthalmology, 2020)

Visual Screening of Children in Kindergarten (Association for Public Policy Analysis and Management, 2020)

Cluster-Randomized Controlled Trial of School-Based Visual Screening for Kindergarten Children (Association for Research in Vision and Ophthalmology, 2021)

Material Deprivation and Eye Exams in Young Children in Ontario, Canada: A Population-based Cohort Study (Pediatric Academic Societies Conference, 2021; and Association for Research in Vision and Ophthalmology, 2021)

Peer-reviewed papers

Asare, A.O., Wong, A., Maurer, D., & Nishimura, M. Access to Vision Services by Vulnerable Populations in Canada: A Scoping Review. Journal of Health Care for the Poor and Underserved, 2019, 30, 6-27.

Nishimura, M., Wong, A., Cohen, A., Thorpe, K.E. & Maurer, D. Choosing Appropriate Tools and Referral Criteria for Visual Screening of 4- and 5-Year-Old Children in Canada: A Quantitative Analysis. BMJ Open 2019;9:e032138. doi:10.1136/ bmjopen-2019-032138.

*Nishimura, M., Wong, A., Dimaris, H., & Maurer, D. Feasibility of a School-Based Vision Screening Program to Detect Undiagnosed Visual Problems in Kindergarten Children in Ontario. Canadian Medical Association Journal, 2020, 192(29), E822-E831. CMAJ 2020 July 20;192:E822-31. doi: 10.1503/cmaj.191085

Asare, A.O., Maurer, D., Wong, A.M.F., Ungar, W. J., & Saunders, N. Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study. The Journal of Pediatrics, 2021. doi: 10.1016/j.jpeds.2021.10.020.

Asare, A.O., Wong, A.M.F., Maurer, D., Kulandaivelu, Y., Saunders., N., & Ungar, W. J. Economic evaluations of vision screening to detect amblyopia and refractive errors in children: a systematic review. Canadian Journal of Public Health, 2021. doi: 0.17269/s41997-021-00572-x.

Asare, A.O, Maurer, D., Wong, A.M.F., Saunders, N., & Ungar, W.J. Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada". JAMA Network Open. 2023;6(1):e2249384. doi:10.1001/jamanetworkopen.2022.49384

*Main points of this paper

  • Screening found for the first time in their lives that 7% of kindergarten children had an eye problem that could lead to blindness in one eye unless treatment began by age seven. Treatment started immediately, usually in the form of a pair of free glasses.

  • Most schools, teachers, and parents support vision screening in schools, and children say they enjoy the vision "games."

  • Screening takes 15 to 20 minutes per child and can be conducted for $10, including the cost of the equipment.

  • When parents received a letter permitting them to opt out of screening, 4% did so. When parents were required to opt in, 30% did not.

  • Referral rates to optometrists averaged 53% for children in junior kindergarten and 34% for children in senior kindergarten. Screening a child in both junior as well as senior kindergarten added no value.

  • Fifteen percent of the children we referred did not see our optometrist because they were already seeing another. Of the remaining children, 70% were taken by parents to the follow-up appointment we scheduled for them, no matter whether that appointment was in school or at the optometrist's office. The remaining 30% had parents who did not reply to our letter, or refused the appointment without giving a reason, or did not show up.

  • School-based vision screening can identify a large number of kindergarten children with treatable eye problems, but successful treatment depends on the parents' awareness of the importance of eye exams and glasses, their knowledge that eye exams are covered by OHIP, and the ready availability of free glasses if parents cannot pay for them.

    Interview with Dr. Nishimura about these points at MedicalResearch.com.