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Letter From Dr. Salvatore

Salvatore L. Stella, M.D.
Director, B.V.C. Foundation, Medical Advisory Committee

Board of Supervisors, County of San Diego

During the nearly 30 years I was engaged in the practice of Pediatric and Adolescent Ophthalmology, the saddest and most disappointing experience followed the discovery of an older child with amblyopia who failed to respond to treatment. Success in amblyopia is realized with the greatest frequency in those youngsters in whom amblyopia is detected and treatment is instituted during the pre-verbal years.
The vision screening techniques of the past that rely mainly on the subjective responses of the individual, do not lend themselves to the very young child. However, utilization of objective techniques made possible through improved technology now allows successful screening of the preverbal child. Through such techniques, timely detection and treatment have nearly eliminated amblyopia among children in Sweden.

The impact of eliminating and/or significantly reducing the incidence of amblyopia will result in direct and indirect benefits to society. Based on the data provided by others, it is estimated that early detection cost savings per one thousand (1,000) children, would result in savings of $60,000 in the case of amblyopia, and an additional $35,000 in the case of strabismus. Sizable savings in indirect costs would be realized arising out of a significantly smaller number of youngsters requiring special service programs and other special needs in school. Exact dollar cost savings realized are not immediately available, however, the consensus is that over time this figure would be significant.

Throughout life, individuals with amblyopia negatively impact the community in a number of circumstances that do not lend themselves to easy quantification. For instance, the lack of two good eyes limit one’s opportunities in the business and job market sectors, contributes to higher job-related accidents and lower individual productivity. In the area of work-related injuries, review of the literature reveals that individuals with amblyopia are more than twice as likely as the general populations to sustain the injury in the healthy eye. The loss of spatial depth localization may predispose the amblyopic individual to increased accidents. The same disability of faulty or absent depth appreciation precludes amblyopes from qualifying and performing in many vision-dependent career activities. In short, the result is underperformance and low productivity. To further underscore the impact of amblyopia on society, among adults 20-70 years of age, preventable amblyopia ranks as the leading cause of monocular blindness, ahead of such conditions as glaucoma and macular degeneration.

Speaking as a concerned citizen, I, for one, would favor the passage of legislation mandating visual screening of all children as a prerequisite for admission to pre-school, similar to the requirement of childhood inoculations.

Better Vision for Children Foundation (B.V.C.), is committed to the implementation of a vision screening program for pre-school children employing state-of-the-art technology. I have a vision that San Diego may very well become the first major metropolitan area in this country to conduct mass vision screening of the preverbal-preschool child. Aside from providing the necessary leadership, San Diego could serve as the model that other communities will clamor to emulate. B.V.C. Foundation, and the County of San Diego, in joint partnership, could make this vision a reality and a first in the nation.

Finally, the money savings realized as a direct result of supporting the proposed program of childhood visual screening for the early detection and treatment of amblyopia, would over time translate into more available monies to the County, which could be used to fund other pressing community needs.

Salvatore L. Stella, M.D.
Diplomate, American Board of Ophthalmology
Charter Mem. American Association for Pediatric Ophthalmology

Adolescent Ophthalmology Medical – Surgical Group of San Diego