Paulette Tattersall is the Northeast Director of Prevent Blindness, a national organization whose mission is to prevent blindness and preserve sight. She is also Co-Chair of Children’s Vision Massachusetts (CVMA), a 70-member coalition of parents, health professionals, educators and organizations who work together towards building a statewide systematic approach to vision care for Massachusetts children.

How did you begin your career in early childhood?

My public health career started as a pharmacist in New Zealand. After coming to the United States, I worked as a clinical coordinator for children’s vision research studies at the New England College of Optometry, which brought me to early childhood in a more focused way. The research developed into my next position as Pediatric Program Director of Massachusetts’ first mobile vision clinic. The program visited underserved schools and preschools providing eye exams and free eyeglasses to children throughout the state. I learned firsthand the barriers to eye care families face, and the kinds of assistance early educators and parents need in order to make sure a child’s vision is working well. At Prevent Blindness we raise awareness about these needs through advocacy, provision of vision screening training and free resources including webinars and presentations to parents and professionals. The work of Children’s Vision Massachusetts(CVMA) is supported by Prevent Blindness and the National Center for Children’s Vision and Eye Health (NCCVEH) and contributes to and implements their recommended evidence-based best practices at the state level.

What efforts have you been involved in to improve the quality of early childhood programs and services?

My work is focused on improving children’s vision by reducing the barriers that prevent a child from receiving eye care. This can be as simple as parent/caregiver information, or more complex like research investigating effective screening approaches by age. Vision research results are used to set screening guidelines in target populations, and improve the quality of vision-related activities such as screening in the field. A partnership with the Massachusetts Department of Early Intervention led to the addition of vision questions to the Massachusetts Individualized Family Service Plan (IFSP) eligibility form, and a list of the signs and symptoms of vision problems in the IFSP Appendix. We also created an informational leaflet: Is My Child Seeing Clearly? – A Vision Guide for Parents of Children in Early Intervention, which is downloadable and available in English, Spanish, Brazilian Portuguese, Haitian Creole, Vietnamese, Chinese and Arabic.

What are some of the challenges you have experienced in your work and what strategies have you tried to overcome them?

Most of us do not appreciate the fundamental role good quality visual input plays in a child’s development. When a child’s vision does not develop normally, usually it is not obvious to adults -there’s no emergency, no pain, and a young child rarely complains of trouble seeing because they don’t know what clear vision is. However, untreated vision problems can impair a child’s progress towards meeting developmental milestones, socialization and learning. Some children, including children with special health care needs, are at higher risk of developing a vision disorder and should have regular visits with an eye doctor (ophthalmologist or optometrist).

Some parents or caregivers may think it is OK to wait until the young child is older before taking them to an eye doctor when they do not pass a vision screening or there are symptoms. Only an eye doctor can diagnose a vision or eye health problem if there is one, and waiting can have consequences. Apart from milestones not reached, or reading or learning struggles that may occur, some vision disorders are only effectively treatable in early childhood, with permanent poor adult vision outcomes if left untreated, or treated inconsistently.

In order to raise awareness about the importance of vision care for children of all ages, Prevent Blindness, NCCVEH and CVMA create information for parents, caregivers, and early childhood providers which are easily downloadable, accessible, in English and Spanish and several other languages, and can be widely distributed. Educators have a crucial role in children’s lives, and we also seek to empower them to support a child’s optimal vision for best outcomes. Helping parents and early childhood providers recognize vision disorders and take action is our job and we embrace it eagerly!

There are many barriers that families face that can interrupt a child receiving eye care or staying in eye care, but sometimes families are unaware that eye care may be covered by their child’s health insurance. We work with our coalition partners to find solutions on behalf of providers and all families, and partner with programs to offer free assistance for eye exams and eyeglasses for qualifying families.

What suggestions do you have for others interested in improving early childhood services and programs?

We, the adults that surround a child on a daily basis, can be “detectives.” Think of vision — be aware of the repeated signs and symptoms that may indicate a possible untreated vision disorder in babies, preschoolers or school-aged children, and which children should be under the regular care of an eye doctor. If vision screenings are performed, ensure they are done to the highest standard using age-appropriate, evidence-based tests.

Intervene in a timely way if a vision problem is suspected, or kids that need eye care are not receiving it. Intervention could mean a myriad of different approaches – a vision screening, discussing next steps with the parent or caregiver if the child does not pass the screening, raising concerns with the family and suggesting for them to speak with their primary care provider, or determining if there are barriers to care for the family such as not realizing the importance of vision care, what to do after a referral from a vision screening, or how to find an eye doctor who treats children. Having the child receive and stay in eye care, when required, is the goal.

Regular communication and coordination of the child’s care among teachers, parents, school nurses or health managers, primary care providers and eye doctors is essential. After an eye doctor visit, understand how each child’s prescribed treatment should be used in the classroom, and used appropriately, making note of recommended classroom modifications. Ask questions and follow through if the child repeatedly attends school/preschool without their prescribed vision treatment.

Supporting families and caregivers to overcome barriers to care, to access and stay in eye care, will give the best opportunity for their child’s good health, optimal development, learning, and high quality of life.

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