Amblyopia is a disease that affects vision development in 3% of all children. It is caused by uncorrected refractive error (a need for glasses), strabismus (eye misalignment), or other conditions that deprive the eye of the normal images needed for eyesight development.
“If the brain doesn’t get adequate visual input from the eyes it never learns to see well, even if the eyes are otherwise healthy,” Dr. Greninger says. Unfortunately, children with amblyopia often do not display symptoms, and if the condition is not identified and treated before age 7 their vision loss may be permanent.
When Dr. Greninger launched his ambitious “20/20 by 2020” program in 2017, only half of all amblyopia diagnoses were made before the critical age of 7, and less than half of the region’s 160,000 children between ages 3 and 6 had their eyes screened appropriately. By 2021, screening rates for children 3 to 6 years old had jumped to 90% across KP Northern California.
“His vision was very clear,” says Angela Wong, MD, The Permanente Medical Group chair of pediatrics chiefs. “He wanted us to have the best preventive eye care program in the United States.
In collaboration with pediatric leaders, Dr. Greninger led the region in switching from wall “E-chart” vision tests to an age appropriate, computerized screening system, which is now embedded in KP HealthConnect and administered by pediatric medical assistants. Further, he worked with TPMG Consulting Services to develop e-consults to allow easy referrals to further testing and evaluation with an eye doctor and a regional dashboard for tracking performance in pediatric eye screening.
“We can identify those sites which may not be screening at as high rates as other sites, and give them some extra help and training,” Dr. Greninger says. “We can also identify best performers and try to learn from them.”
Nancy Goler, MD, TPMG associate executive director (2016-2022), says, “Dr. Greninger saw a problem and recognized that we could solve it. With vision, strategy, and collaboration across specialties, we now are screening more effectively and preventing childhood blindness and other visual impairment.”