Profile: Denise Chamblee, VP of Children's Eye Foundation

Denise Chamblee, MD, describes the Children's Eye Foundation See by Three program.

Add amblyopia and strabismus to the long list of diseases and conditions found in children that could be caught during a standard pediatric well visit. These ocular problems, if left untreated, could turn into legal blindness.

"In amblyopia, the eyes do not learn how to see," said Virginia ophthalmologist Denise Chamblee, MD. "The brain says, 'This eye sees well, this one does not: I'll ignore everything that comes from the other eye.'" And once the brain wires itself to not take input from an eye, it's very hard to get it rewired.

How early? The CEF's See By Three campaign is trying to make it before age 5, and ideally (as the name infers) before age 3. But the trickier questions are who should be screening, and how? After all, only a fraction of all children see pediatricians for well visits. And a physician's time during those visits, between immunizations and everything else, is already at a premium.

Testing the sight of the toddler set presents a natural problem: many can't yet recognize the capital letters that make up standard eye charts. The See By Three program is using the four Lea Symbols: a circle, square, apple, and house. With fuzzy vision, the apple and circle look similar, as do the house and square. Clear vision makes the four shapes appear distinct.

The specifics of the program-how many minutes it will take, what charts will be used, what 800 numbers and Web sites will be given to screeners for assistance-are being field tested in two locations. Pediatricians in the Jacksonville, Fla. area, and statewide in West Virginia, are the initial trial subjects. CEF estimates that half of all the pediatricians in West Virginia-and most all of their staff-will be trained in the screening.

"From this program, we'll learn what works and how we can improve...We'll take the best model to other cites and states," Chamblee said.

And pediatricians aren't the only ones being asked to shoulder responsibility for looking into kids' eyes. The See by Three program trains both physicians and nurses in the pediatrics office. Family physicians and school nurses are getting rounded up for the effort as well.