Article taken from Spring 2011 ICO Matters: Download here
With a gentle hand, third-year ICO student Birva Kadakia guides a young boy into a folding chair and helps him focus on the lighted dot inside the autorefraction machine. She coaxes him along with a quiet “good job” and “almost done” as she conducts his exam, then sends the 8-year-old along to the next testing station.
This isn’t a typical optometrist’s office. In fact, it’s not an office at all. It’s the new Illinois Eye Institute clinic at the Chicago Public Schools (CPS). This one-of-a-kind clinic opened Jan. 4 to provide eye exams for CPS students. They have been identified during previous vision screening or by their teachers as needing a complete eye exam.
CPS estimates as many as 60,000 of its students fail their vision screening each year, and the IEI Clinic, located at Princeton Elementary School, is hoping to provide care to many of these children. The clinic is funded by a combination of private grants and state reimbursement, and is part of a broader initiative known as Chicago Vision Outreach. This community-based program is the first known model to deliver eye care services year round within a school system.
After spending just a few hours at the clinic, Kadakia said the benefits to both her and the CPS students were obvious. “This is such good experience because we don’t get pediatrics at ICO until our fourth year,” she says. “So far it has been going very well. I am learning to talk to [the young patients] a little differently than I do older patients. I ask them how school is going or about something else to keep them still.”
That kind of experience is exactly why the IEI Clinic at CPS is so valuable, says Sandra Block, OD ’81, MEd, the ICO professor who is directing the clinic. She says ICO students are perfecting their clinical skill base and becoming familiar with the common problems facing young patients.
“Our students will work with kids who are healthy and have significant uncorrected refractive error, amblyopia or strabismus, as well as eye health and other problems,” she says. “We will provide primary eye care up front, and if they need vision therapy, we’ll refer them back to the Pediatric/Binocular Vision Service at IEI. Our goal is to grow this clinic to provide whatever vision services kids need.”
The Chicago Public Schools System is the third-largest public school system in the nation, with more than 400,000 students from preschool through high school. Of those, 86 percent live below the poverty line. Many parents or guardians are not aware of state-funded services or cannot find a doctor accepting new Medicaid patients.
“I have witnessed children in clinics who can’t read a basic word in the largest font and don’t even realize it’s a problem” says Jaime Dirksen, coordinated school health manager for CPS. “Once they have an opportunity to see, it’s amazing. They are just floored that they’ve been going around with this horrible vision. It’s very sad, but it’s also the reality. It’s hard enough for parents to keep up with food, housing and getting the kids to school every day, without having to take care of vision problems, too.”
The entire clinic experience is constructed to put the students at ease. There are two pre-testing rooms and four full exam rooms, and a place for students to wait while their eyes are dilated. Eventually, as many as 100 students could be seen each of the five days per week the clinic is open. Each individual school decides which students need to be seen and how urgent their need is.
“We’re thrilled to be able to improve delivery of eye care for our students,” says Tariq Butt, MD, a member of the Chicago Board of Education. “This program serves as an illustration of a partnership that can vastly improve the quality of education for the students who can see better as a result of improved care.” Dr. Butt accompanied ICO President Arol Augsburger, OD, and other members of the ICO senior management team on a tour of the clinic. "This program serves as an illustration of a partnership that can vastly improve the quality of education for the students who can see better as a result of improved care."
“This new clinic could only be possible in partnership with the Chicago Public Schools and a plethora of funders who care deeply about making quality eye and vision care accessible,” Dr. Augsburger says. “ICO and IEI already are well known for fostering collaborative partnerships. Because of this latest effort, 10,000 untreated eye- and vision-care issues for CPS children can be solved this year.”
Lessons for the Real World
On a recent morning at the CPS clinic, ICO pediatric resident Erica Zeiders, OD ’10, kept a steady stream of third- and fourth-grade students moving through each step of the clinic. She answered questions from third- and fourth-year ICO students administering the vision tests, reviewed each of the CPS student’s results, and made sure the atmosphere stayed welcoming for the youngsters.
Dr. Zeiders says every patient encounter is a chance for her and the rest of the ICO team to learn valuable skills for their future outside school. The patient load can be heavy, and the ICO students have to move at a quick pace. Then there are the challenges of working with children.
“You have to be more creative and make sure they look at you and do what you need them to do,” she says. For example, one of the screens was showing the popular animated movie “Finding Nemo” as a way to check distance vision.
Once the exam is completed, children who need glasses are able to pick out frames onsite and they will hopefully arrive in about four to six weeks. The glasses are billed to Medicaid or Illinois’ All Kids program, if the child is enrolled; there is grant funding available for those not eligible under those programs.
Those who have a more significant problem or something that cannot be addressed with glasses are referred to IEI or for a follow-up visit to the clinic that will include their parents or guardians.
During a quick break between young patients, third-year ICO student Wei Han reflected that even after just two four-hour shifts at the clinic, he already can see the benefits to being there. He says he’s learning to be thorough while also being efficient.“It’s always fun,” he says. “You can’t have enough experience.”