There was a time when students at the University’s Pennsylvania College of Optometry (PCO) weren’t being exposed to a certain group of patients, specifically the preschool three-to five-year-old age group, where potential eye issues could be detected prior to starting school.

But the PCO brain trust figured out decades ago that working with the Head Start program in the Philadelphia School District could be beneficial for a couple of reasons: One, it would indeed expose PCO students to working with that age group of youngsters, and two, it would be connected with, and giving something back, to the community.

Head Start patient 1The national Head Start program, an office of the Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services (HHS), promotes school readiness of children from birth to age five from low-income families through agencies in their local communities. Head Start services include early learning, health and family well-being.

PCO was one of the few institutions at the time to add early vision screenings into the Head Start mix.

“That was part of our outreach initiative, to expose our students to this age group,” said Satya Verma, OD, ’75, FAAO, FNAP, Diplomate, director of Externship Programs at PCO, who initiated contact with the Head Start program in the Philadelphia School District in the early 1980s. “We contacted Head Start in the district and we had school nurses who were very happy to have us. Nobody was doing anything for Head Start schools at that time.”

According to Dr. Verma, nurses were conducting some screenings, but “they were also glad that somebody else was going to take care of it because they didn’t feel well-equipped. And, at the same time, it was time-consuming because they didn’t have the time, especially when funding for the nurses was scattered. They would have one nurse attending to three or four schools. They couldn’t really do that. And, here we were coming in and doing those things.”

Head Start patient 2PCO students up to that point had little exposure to preschool children, so the opportunity to work with Head Start and conduct vision screenings was a win-win. Providing care to this younger age group was also a benefit to the community.

Part of the challenge from those early years – which still exists to this day – was that in the inner city school system, securing follow-ups for the screenings was difficult.

“The nurses would do their part, and we would provide a letter telling them when a child had failed the screenings,” said Dr. Verma. “But some parents ignored it, didn’t do the follow-up, or didn’t have the time or resources.”

By 1983, there were about 20 Head Start sites in the Philadelphia School District, and that’s when Gale Orlansky, OD, MEd, assistant professor at PCO, began working with Head Start, a role she would serve in for more than 30 years. 

“Dr. Verma needed someone to go out and do vision screenings and I said yes,” said Dr. Orlansky. “At the time, I was doing vision screenings for the homebound (another community initiative by PCO) and then at the same time doing Head Start.”

According to Dr. Orlansky, there was a teaching purpose and a community purpose for working with the program. It was also the first exposure with vision care that many of the children were receiving.

“There was no area in our student’s clinical experience that you could see 30 children in a morning and actually do tests including retinoscopy and color vision and have a doctor supervising get immediate feedback,” she said. “The experience for the students, from the feedback that I got, was that this was the best. It was an invaluable experience. Also, if the students were doing something wrong technically, I could go and say, ‘Let’s sit down and let’s work this through together.’ On the spot. It was a little bit different than working in their comfort zone of being in a clinic compared to being out in the field and working in a classroom or a hallway, and showing that you can be adaptable.”

PCO added yet another aspect to its connection with Head Start in 1994 when, parallel to what Dr. Orlansky was doing with the screenings, Elise Ciner, OD, FAAO, PCO professor and co-director of the Special Populations Assessment and Rehabilitation Center, became involved with the Vision in Preschoolers Study, funded through the National Institutes of Health – National Eye Institute (NIH-NEI).  The framework for the study originated at a summer invitational research symposium sponsored by the American Academy of Optometry and the American Optometric Association.

The purpose of the study was to research the best methods for screening preschool children for vision disorders. 

“We actually looked at every single state in the country. We surveyed and reported on what their current requirements were for preschool screening,” said Dr. Ciner. “What we found was that there was a very wide variation of what each state required or didn’t require. There were some states that did not require any screening of their young children. There was no uniform policy, approach or technique. Everybody was doing something different.”

Head Start patient 3Five clinical centers around the country — in Philadelphia; Boston; Tahlequah, Okla.; Berkeley, Calif.; and Columbus, Ohio — were funded to research the best screening methods able to detect preschool children at risk for the most common and correctable vision disorders in this population. This included NIH-NEI funding for the purchase of five identical 38-foot mobile units in order for study visits to be conducted on-site at the child’s school, which would allow more children to participate throughout each city. A follow-up NIH-NEI study from 2011-2016, “Vision in Preschoolers – Hyperopia in Preschoolers,” found a relationship between uncorrected moderate farsightedness and early literacy in preschool children. Members of the Vision in Preschoolers Study group including Dr. Ciner continue to be active at the local and national levels on behalf of children’s vision.

“We were also looking to empower communities, because even though at Salus University and in Philadelphia we had Dr. Orlansky going out performing these wonderful screenings, there weren’t optometry schools in most cities. And, many practitioners don’t have the time to go out and do a lot of screenings,” said Dr. Ciner. “So we were looking to see which tools would work best, and then which tools would work best in the hands of nurses and lay screeners from within each community.”

After years of work, Drs. Ciner, Orlansky and Verma all believe their involvement with local Head Start programs has been important for PCO and Salus University. 

“I think it puts a great face on Salus. When I go to the Head Start healthcare advisory committee meetings, I’m representing Salus, and people know us and appreciate what we do for children in Philadelphia. It’s very important for us to have a seat at the table. There are more than 7,000 children enrolled in Head Start throughout Philadelphia, and many of them become our patients as do their siblings and families,” said Dr. Ciner.

Dr. Orlansky, who isn’t out in the field these days, said her many years working with Head Start and the young patients has meant a great deal to her.

“Honestly, those children became my babies, and I treated them as if they were my children because we wanted to pick up anything and everything with respect to visual problems and refer them out to any one of several referral sources,” she said.

Working in conjunction for many years, the two made a great team.

“I applaud Dr. Ciner for what’s she doing, because she is the follow-up,” said Dr. Orlansky. “She has done the studies that I have been part of. She trusts my findings from all these screenings, which enables her to proceed with her findings on her studies and research. We’ve had a good working relationship.”

Dr. Verma agreed about the mutual benefit to the institution. 

“PCO was one of the few places that was doing Head Start screenings early on,” said Dr. Verma. “We couldn’t have provided that experience for our students, we couldn’t have created it any other way.”