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Making Sight Right

Early screening can help prevent
damaging vision problems

By Caralee J. Adams - Pittsburgh Post-Gazette - Children's Health
Tuesday, November 24, 1998

Many parents assume that their child's vision is fine if a pediatrician or a school nurse doesn't flag a problem. However, optometrists say that these screenings are not adequate to detect many vision problems that can interfere with a child's development.

The American Optometric Association recommends that a child have a comprehensive vision exam at 6 months and again at ages 3 and 5. After that, children should have exams every two years.

"You can't necessarily look at your child and tell if they have a vision problem," says Susan Cotter, doctor of optometry and professor at Southern California College of Optometry in Fullerton, Calif. "The only way to know for sure is to have an eye exam by an optometrist. A pediatrician is only able to detect big problems."

New research supports the need to detect eye problems at an early age, Cotter says. In the past 15 years, equipment and techniques, such as modified tests using picture cards, have been developed that make it easier to evaluate a child's vision.

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"You can't necessarily look at your child and tell if they have a vision problem."
Susan Cotter optometry professor
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For example, eye care professionals can evaluate a child's vision using retinoscopy in which an optometrist uses a special instrument to observe the way light moves through the eye. From this, they can determine the type and degree of refractive error — near-sightedness or farsightedness — and make a prescription.

Yet despite the available technology, only a third of children between ages of 6 and 16 are likely to have had an eye and vision exam in the past year, and just 14 percent of children under 6, according to the AOA. It estimates that 25 percent of school-age children have vision problems.

Hans Lessmann, a Swissvale optometrist who specializes in treating children, says failure to catch vision problems at an early age can hinder a child's development and ability to learn. Young children rarely complain of headaches and they can't tell you if things are blurry because they don't know any different.

Children may have nothing wrong with their eyes, yet might have a vision problem because of how they have learned to use their eyes.

Sight is the capacity to see clearly, Lessmann says. Vision is the capacity to use your visual sense to accurately direct action and derive meaning. Vision is a learned process and, therefore, it is trainable. But vision can also be confused and learned in an inappropriate way.

In infants, Cotter says, an optometrist can spot hidden problems, such as anisometropia, meaning the eyes have different vision strengths. If that condition is not caught early, the child may rely on the good eye and the eye that is out of focus may not develop adequately. Also, some babies around 3 or 4 months develop an eye that turns inward or is crossed. An exam at 6 months can catch this disorder.

By examining children at ages 3 or 4, an optometrist can rule out vision problems before any academic introduction, Lessmann says. As soon as children are exposed to letters, it is important to have their eyes checked.

Vision screening programs for school children are limited because they are designed to identify children who may have a vision problem and need further care, but they are not diagnostic nor are children always referred for further attention, according to the AOA. Unfortunately, Lessmann says, "the public views that as an exam."

While most optometrists can evaluate children, parents can ask if a practice specializes in children's eye care. A comprehensive vision exam for children should include tests for eye health, visual acuity, eye alignment, and refractive assessment (to determine if the child needs corrective lenses).

To prepare children, consider taking them along on a visit with a parent or older sibling first. Cotter encourages parents to talk to children about the exam in advance and to be positive. For some children, the eye drops are unsettling. Parents can practice at home first with artificial tears to alleviate the apprehension. Schedule the visit during a time that the child is alert and usually in a good mood.

Children may be referred to an ophthalmologist if they have problems such as infections of the eye, droopy eye lids or a blocked tear duct.

Indicators of a vision problem

Crossed or turned eyes.

• Reddened, watering, or itching eyes; encrusted eyelids, frequent sties.
• Turning or tilting head to use one eye only; or closing or covering one eye.
• Placing head close to book or desk when reading or writing.
• Frowning or scowling while reading, writing or doing chalkboard work.
• Excessive blinking or rubbing of eyes.
• Losing place while reading and using finger or marker to guide eyes.
• Spidery, excessively sloppy or hard-to-read handwriting.

Related to behavior:

• Short attention span for the child's age.
• Nervousness, restlessness or unusual fatigue after visual concentration.
• Displaying evidence of developmental or emotional immaturity.
• Low frustration level; withdrawn, has difficulty getting along with other children.
• Headaches, nausea and dizziness.
• Complaints of blurring vision or of double vision at any time.

Related to classroom work:

• Saying words aloud or lip reading.
• Difficulty remembering what is read.
• Omitting, repeating and miscalling words or confusion of similar words-.
• Persistent word reversals after the second grade.\
• Difficulty remembering, identifying and reproducing basic geometric forms.
• Difficulty following verbal instructions.
• Poor eye-hand coordination.

Source: "The Suddenly Successful Student. A Guide to Overcoming Learning and Behavior Problems. How Behavioral Optometry Helps," by Hazel Dawkins and Drs. Ellis Edelman and Constantine Forkiotis (The Writing Team, 1990).

Common vision disorders
These disorders are representative in a clinical population of children 6 months to 18 years.

• Hyperopia (farsightedness) — 25 percent
• Astigmatism — 23 percent
• Myopia (nearsighted) —18 per­cent
• Nonstrabismic binocular disorders (focusing problems, poor eye teaming and eyetracking) —14 percent
• Strabismus (misaligned eye) — 12 percent
• Amblyopia (blurred vision even though proper correction ) —7 percent
• Accommodative disorders (focusing problems) — 6 percent
• Peripheral retinal abnormalities requiring referral or follow-up care — 2 percent

Source: AOA. Findings based on specialized clinical population and may not be representative of vision problems in the general population.