Focusing on a Bright Future

When her daughter’s daycare offered free vision screening for children through Impact America, Cacy Rice signed up. Kaylynn was only 4, but Cacy wore contact lenses and she wondered if Kaylynn might someday need glasses, too. 

That screening, Cacy says, helped identify a serious vision problem that could have led to long-term challenges for her daughter. Through early diagnosis and treatment, Kaylynn was able to get the help she needed to protect her vision from irreversible damage or loss. 

It was our first warning sign of a problem that would have been much more difficult to treat later on,” Cacy said from the family’s home in Belton, South Carolina. When Kaylynn put on her first pair of glasses she said, So this is what it’s like to see.’”

With support from The Duke Endowment, Impact America is expanding vision screening in Head Start centers, daycares and pre‑K programs across the Carolinas. Of the more than 67,600 preschoolers in North Carolina and South Carolina who have participated since 2016, about 10 percent have had vision abnormalities detected. The nonprofit Sight Savers America coordinates follow-up care, provided free of charge, to make sure treatment needs are met.

We want to give families access to timely and important care and make sure children can begin school ready to learn and thrive,” says Channing Kennedy Bethke, Impact America’s national program director.

When Kaylynn put on her first pair of glasses she said, So this is what it’s like to see.’”

A Camera Called Spot

Impact America was founded in 2004 to address the consequences of poverty through health, economic, and education-based initiatives. It works in seven states across the Southeast, including North Carolina and South Carolina. Along with the vision screening — called FocusFirst — initiatives include SaveFirst, which provides free income tax preparation services, and SpeakFirst, which empowers teens through competitive debating.

As an AmeriCorps Program, Impact America’s field team includes recent college graduates who commit to a year of service learning.

Ellie Bisese signed on as FocusFirst Team Lead for the Carolinas after graduating from Furman University this past May. She plans to go to medical school but felt called to this unique opportunity.

Through eight hours of training and practice sessions with more experienced team members, she learned to use a high-tech digital camera — called Spot — that photographs a child’s eyes and analyzes the results. Spot produces an immediate pass” when no problems are detected, or fail” for potential issues such as nearsightedness, farsightedness or amblyopia, a degenerative vision problem that’s often called lazy eye.”

Many conditions can easily be treated with glasses — but if they aren’t caught and corrected early, they could lead to long-term vision impairment. Several clinical and research studies have shown that undetected problems often cause children to struggle in the classroom and might slow social development.

Just one month into her job, Bisese was visiting a preschool in South Carolina when a teacher shared a concern about a child who became fidgety and disruptive whenever the class whiteboard was used for a lesson. The screening found severe astigmatism, which meant the little girl had been struggling to see clearly at a distance.

As the teacher suspected, her acting out may have been triggered by frustration,” Bisese says. It felt good knowing that we were able to get her back off to a good start.”

The Biggest E’

Since beginning work in South Carolina with a pilot in 2015, Impact America is now screening nearly statewide. It expanded to North Carolina in 2018 and reaches 21 counties there.

Many states provide vision tests for students when they reach kindergarten and first grade; by targeting ages 6 months to 5 years, Impact America reaches children before many untreated problems become complicated.

After Kaylynn Rice’s screening, Cacy Rice remembers her first office visit with a pediatric ophthalmologist the next week. With only her left eye uncovered, Kaylynn couldn’t see the biggest E” on the eye chart. The ophthalmologist diagnosed amblyopia and the 4‑year-old began receiving extensive vision therapy.

Today, Kaylynn has grown from a shy little girl into a precocious 8‑year-old who loves to read and write. Her eyesight is much improved, and Cacy gives all the credit to early detection.

From everything I’ve learned about amblyopia, you want to get it diagnosed while visual pathways are still growing because it can result in permanent blindness if left untreated,” she says. I’ll be forever grateful to Impact America for saving my daughter’s vision.


  • FocusFirst is a free vision screening initiative of Impact America, serving preschools, Head Starts and daycares in Alabama, Tennessee, North Carolina and South Carolina. 
  • Since 2006, it has screened more than 715,000 children. Of those screened, about 10 percent had undetected vision problems.
  • Common issues include astigmatism (trouble focusing), hyperopia (farsightedness), myopia (nearsightedness) and amblyopia (“lazy eye”). 
  • If a child has a potential vision problem, FocusFirst will connect the family to Sight Savers America.
  • Sight Savers will contact parents to determine if they need assistance in locating, scheduling, and/​or paying for follow up care. They will also connect parents with optometrists and ophthalmologists who can provide necessary professional examination, diagnosis, and treatment (including glasses, other vision aids or surgery). 
  • Of the children referred for care, more than 80 percent complete the follow-up. 
  • To measure impact, program leaders track the number of children screened, the number who fail the screenings, the reason for failing, and the number of children referred to Sight Savers America. A Sight Savers report tracks children who received vision aids, surgery or other treatment.
Focusing on a Bright Future03

Vision to Learn

In 2019, The Duke Endowment also awarded a grant to Novant Health Presbyterian Medical Center Foundation in Charlotte to engage Vision To Learn, a national nonprofit that uses mobile vision clinics to provide free screenings, eye exams and glasses to economically disadvantaged students. The support will serve students in Charlotte-Mecklenburg Schools. 

Vision to Learn partners with school districts in a program that begins with vision screenings for all students in the school. After the initial evaluation, Vision To Learn coordinates with schools to schedule one or more visits by the mobile vision clinic staff. Students who require glasses can choose frames onboard the mobile vision clinic. 

Two weeks after exam day, Vision To Learn’s optician returns to the school to deliver new glasses, provide individual glasses fittings and educate students on proper care and cleaning. 

The organization serves children in 13 states and more than 400 cities.

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