Research project focuses on recommended screenings and barriers to vision care
Since 2022, ACHF has partnered each spring term with the Oregon Health & Science University (OHSU) at Ashland Nursing Program to explore public health topics together. The ACHF team was pleased to be paired with OHSU Accelerated BSN student, Heather Daylene Ayers*, with support from OHSU Nursing Instructor, Rachel Boney.
This year’s project idea originated months before ACHF staff and Ayers’ first meeting. In early 2026, a generous donor established the Kids in Focus – Vision Endowment at ACHF. The endowment will provide ongoing support, through investment earnings, to improve vision outcomes for young children in Southern Oregon, especially for those in the infant to preschool years.
To better understand the vision-related needs of the community and gaps in care, Ayers began the project by conducting a community assessment. Using methods such as comprehensive literature review, consultation with a research librarian, data collection, and expert and stakeholder interviews, Ayers gathered critical insights about how families with young children identify, navigate, and experience vision challenges, diagnoses, and treatment.
Ayers found that vision disorders in early childhood, such as amblyopia (lazy eye), strabismus (eye misalignment), and refractive errors, affect up to 6% of children under age six. These disorders can be more serious than expected. For example, amblyopia can cause permanent vision loss if untreated. Yet only about 63.5% of children aged three to five have been vision-screened by a health care professional. This gap represents missed opportunities to intervene during a crucial stage of development.
Early childhood is a period of rapid brain growth, and healthy vision is essential to that process. Although national guidelines recommend screening at least once between ages three and five, Ayers noted that many children are screened late or not at all. Disparities persist, with lower screening rates among Hispanic children, the uninsured, and lower-income children (Black et al., 2019).
Ayers discovered that, even when screening occurs, follow-up is inconsistent. About 30% of screened children require a referral for further evaluation, but many do not complete the process. Challenges with referral and care coordination limit the effectiveness of early detection. Without timely treatment, preventable vision problems can continue into later childhood and beyond.
Untreated vision disorders affect more than eyesight. Visual impairment is linked to delays in coordination, balance, and fine motor skills. It also impacts learning; reduced visual acuity upon entering school is associated with lower literacy scores. Social and emotional effects are documented as well, including stigma and reduced peer acceptance for children with visible eye conditions.
Despite clear screening guidelines, implementation remains uneven. Incomplete screening rates, disparities in access, and gaps in follow-up show that current systems are not reaching all children equitably. Strengthening early screening and referral pathways is essential to prevent long-term developmental, academic, and psychosocial consequences.
After in-depth research and discussions with doctors, vision screeners, parents, and others, Ayers developed a set of recommendations for addressing barriers and disparities. Some strategies include:
- taking screening services directly to children in community settings, like preschools, libraries, community centers, and family fairs
- establishing referral pathways with local optometrists and ophthalmologists
- providing caregiver education on early vision screening
- partnering with schools, health care organizations, and community agencies
For more details, you can view Ayers’ project documents as follows:
*This blog is based on a report by Heather Daylene Ayers. Ayers will graduate from OHSU with her BSN in September 2026 and begin the OHSU FNP program right away. She is a 2025 recipient of ACHF’s William G. and Ruth T. Evans Endowed Nursing Scholarship.
