• Elias I Traboulsi, Heather Cimino, Constance Mash, Rhonda Wilson, Susan Crowe, and Hilel Lewis.
• Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
• Trans Am Ophthalmol Soc. 2008 Jan 1; 106: 179-85; discussion 185-6.

PurposeThe Vision First program began in the fall of 2002 as a community outreach initiative by the Cleveland Clinic Cole Eye Institute in partnership with the Cleveland Metropolitan School District. It was designed to provide free eye examinations to all prekindergarten, kindergarten, and first grade students enrolled in Cleveland City public schools in order to diagnose refractive errors, amblyopia, and strabismus, so that treatment is instituted and the best possible visual outcome attained.MethodsExaminations are performed in 2 lanes of a specially outfitted recreational vehicle. All children undergo monocular visual acuity testing at distance and near, stereopsis testing, cover testing at distance and near, testing of versions, and external ocular inspection. If a child fails any part of this examination according to the guidelines set by the American Academy of Pediatrics, cycloplegic drops are instilled and an optometrist refracts the child on location and performs indirect ophthalmoscopy. Glasses are prescribed and follow-up with a pediatric ophthamologist is arranged.ResultsDuring the first 4 years of the program, 22,988 examinations were performed. Seven percent of children had errors of refraction that necessitated optical correction, about 2.1% had strabismus, and 1.7% had amblyopia. The cost per student per year was around $23 excluding glasses.ConclusionsAbout 10% of 5- and 6-year-old schoolchildren have eye problems that require either glasses or treatment for strabismus or amblyopia. The Vision First model brings eye care professionals to the schools and provides effective comprehensive screening of all children, as well as detailed examination and referral of those with significant eye problems.

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