Back to School - ALREADY!? It's that time of year to remind parents that good vision is critical for many classroom tasks - from reading books or seeing a whiteboard to viewing a computer screen. Visual function is one predictor of academic performance, and incredibly important for academic success. Without healthy vision, students can face unnecessary challenges not only in the classroom, but also to their mental, physical, social and emotional well being.
A comprehensive eye examination for students is one of the most important “to-dos” as children head back to school, and yet it is often overlooked. Without an eye exam, many children will suffer from undetected vision problems, and some may even be misdiagnosed as having a learning disorder. The signs and symptoms of visual disorders can be very similar to attention deficit and hyperactivity.
Children often do not complain of poor vision because they do not realize that they see differently than others. Children usually have difficulty expressing the symptoms associated with vision problems. Yet, millions of school children in America have vision conditions that can negatively affect learning. While many parents rely on vision screenings in school to check for eye problems, it often isn’t enough. Comprehensive eye exams are necessary to detect problems that a simple screening can miss, such as problems with eye coordination, and moderate amounts of farsightedness and astigmatism.
According to the American Optometric Association (AOA), vision screenings are not diagnostic, and therefore, typically identify only a small portion of the vision problems in children. During a comprehensive eye exam, a doctor of optometry will check not just the child’s visual acuity, but how well the eyes work together as a team, focusing ability, visual alignment, eye tracking skills, and color vision, as well as the overall health of the eyes. We know that more than 1 in 5 preschool aged children have a vision problem, and less than 15% of preschool aged children are getting eye exams.
How early and how often should children receive comprehensive eye exams?
Infants should receive a baseline eye exam between the ages of 6 and 12 months, immediately after the critical period when the eye undergoes rapid and profound changes and is therefore most vulnerable to interference with normal development. I am enthusiastic about initial infant exams, and a participating provider in the InfantSEE® public health program. Under this program, participating optometrists provide a comprehensive infant eye assessment between 6 and 12 months of age as a no-cost public service. Visit Infantsee.org to find out more.
A baseline eye exam at a young age is an important part of your child's wellness care. Family history and patient history will be reviewed to assess the risk for current or future eye problems. Such risk factors include a family history of eye disease, premature birth, low birth weight or the use of oxygen at birth, maternal infection in pregnancy, as well as drug and alcohol use or smoking during pregnancy.
If no problems are detected in infancy, a second comprehensive eye exam is recommended between the ages of 3 and 5 years. Preschoolers should receive at least one in-person comprehensive eye exam to prevent or diagnose any condition that may have long-term effects. Children aged 6 to 18 years should receive a comprehensive exam prior to entering the first grade and annually thereafter.
Early detection and treatment provide the very best opportunity to treat and correct vision problems to help children see clearly. Good vision doesn't always just happen - a child's brain has to learn how to use their eyes to see. The longer a vision problem goes undiagnosed and untreated, the more a child's brain has to overcompensate to live with the vision problem, instead of developing and learning normally.
Common Eye Problems in Children
Refractive Error: The light entering the eye does not come into focus on the retina (at the back of the eye), resulting in an out-of-focus image. Vision will be blurry. Myopia, Hyperopia, and Astigmatism are common in children. Refractive error is correctable with glasses or contact lenses
Myopia (Nearsighted): Light entering the eye focuses in front of the retina. Vision will be clear when viewing close objects, but distant objects are blurry. You may notice your child pulling objects close to their face to view them. They may be having difficulty from the back of the classroom. Your child may squint or rub their eyes a lot.
Hyperopia (Farsighted): Light entering the eye focuses behind the retina. Vision will will often be clear when viewing distant objects, but can be blurry when viewing near objects. You may notice your child having difficulty with reading and near tasks. They may complain of headaches or tired eyes.
Astigmatism: The curve of the cornea (the front of the eye) or the curve of the lens inside the eye are irregularly shaped. The light entering the eye is therefore out-of-focus. Objects could be blurry at all distances and may appear warped. Your child may show symptoms similarly to being nearsighted or
Strabismus (Eye turn): An eye muscle weakness that causes one eye to turn inward or outward. Strabismus is sometimes visibly noticeable, but mild cases of strabismus may not be detected by a nonprofessional. Strabismus can cause double vision, but may be asymptomatic. Strabismus will often lead to blindness of the turned eye due to improper development if left untreated. Children with strabismus have poor depth perception.
Amblyopia (Lazy Eye): Poor vision, usually only in one eye, that results from underdeveloped vision. The most common causes of amblyopia are strabismus and high refractive error in one or both eyes. Amblyopia in one eye may be asymptomatic. Amblyopia must be treated in childhood while the eyes are still developing in order to correct vision.
Color Deficiency: The inability to discern between different shades of color. Severity can range from mild to severe. Colorblindess in children is usually congenital, so there will often be a family history of colorblindness. The most common inheritence pattern is from your maternal grandfather. It is important for your child's educators to know if your child has a color deficiency, as they may need special accomodations in the classroom.
Conjunctivitis (Pink Eye): inflammation of the conjunctiva, the outer tissues of the eye. Conjunctivitis is most commonly caused by allergies and eye infections. Children often contract viral conjunctivis, which is highly contagious. To avoid “pink eye” make sure to wash your hands regularly, refrain from rubbing your eyes, and do not share towels.
Is your child due for an eye exam?
People are bothered by bright lights on a regular basis, whether it be from the backlit screens on our devices, glare from oncoming car headlights, fluorescent lighting overhead, or direct sunlight. These bright-light situations result in tired eyes and suboptimal vision. We often resort to compensating behaviors like squinting, shielding our eyes with our hands, and dimming overhead lights or computer screens. I often recommend anti-reflective coatings, tints, and polarized lenses for glasses wearers. Another option has recently entered the marketplace for contact lens wearers.
A Johnson & Johnson company, Vistakon, has released a new contact lens that darkens in response to the changing light levels in your environment. Acuvue Oasys with Transitions Light Intelligence Technology was designed to reduce squinting, help eyes recover faster when subjected to bright light, and reduce halos and starburst at night. Their goal was to improve comfort and enhance vision in bright-lighting situations.
Oasys with Transitions is a 2-week replacement lens, meaning you can wear it daily for two weeks before disposal.
The lens blocks high-energy blue light ranging from 380-460nm wavelengths which you may encounter from screens and outdoors. It also absorbs >99% UVB and >90% UVA. The higher the levels of light exposure, the darker the lenses will get, maxing out at about 70% outdoor light filtration. In comparison, most general purpose sunglasses filter between 60-92% of light.
The lenses take less than one minute to activate when exposed to an increased light level, and can take up to 90 seconds to clear when light exposure is reduced, like when returning indoors. Even in their clearest state, these lenses are filtering about 15% of light. This low level of light filtration allows for indoor use and nighttime driving, while reducing glare from car headlights and indoor light sources. The company cites that people ages 40-65 will be most likely to notice improved vision indoors and with night driving with the inactivated lenses.
Review of Lens Performance
When wearing these lenses indoors, I didn't notice any adverse effect on my vision. Knowing they are filtering light even in their inactivated state, I wondered if they would feel too dark while indoors. This was not the case. In fact, I was surprised that I noticed the slight increase in contrast resulting in a mild improvement in vision compared to my clear contact lenses.
I did not notice any benefit or detriment to my vision during computer use, but if you are someone who finds relief from blue-blocking spectacles on the computer, you should theoretically gain a similar benefit from these lenses.
I wore these contacts outdoors on a bright sunny day and the lenses did begin to change fairly immediately. They didn't seem to get to their absolute darkest until closer to that one-minute mark. As they darkened, I felt a definite improvement in my eye comfort and less squinting compared to my clear contact lenses.
In the direct sun, these activated lenses definitely felt better than nothing, but as expected, I still wanted my sunglasses and hat for maximum comfort and best vision. Vistakon has clearly stated that it does not intend for these contact lenses to replace sunglasses. The lens only covers a small area of the eye, extending only slightly beyond the cornea. While this protects the cornea and the inside of the eye, sunglasses will be needed to protect the sclera (white part of the eye) and eyelids (a common area for skin cancers) from UV exposure.
I felt these lenses shined in times of indirect outdoor light exposure. For example, I found I was much more comfortable while outdoors in the shade (where I was getting fairly heavy UV exposure but not direct sunlight) than my clear-lens-wearing husband.
When returning inside, I found the transition from the activated state to clear lenses to be seamless. They didn't feel overly dark when initially going back inside and the gradual lightening of the lens was not disruptive or noticeable.
These lenses will activate in the car, although it will be limited by the fact that car windshields blocks nearly 100% of UV light. You do get some UV exposure from the side windows, but I found the contacts to be basically inactivated in the car and therefore of limited benefit for driving in the bright sun.
Nighttime driving was mildly improved, although fortunately for me, I do not struggle with nighttime glare on a regular basis, therefore I look forward to hearing more reviews from my patients.
Appearance on the Eye
The lenses were designed to minimize change to the eyes appearance, but I found them to be pretty noticeable on my lighter colored eyes. This may not be as dramatic on people with darker irises, but because the contact lens extends beyond the iris, it does have the unusual appearance of large irises. Of course this was not very noticeable when the lenses were inactivated and much more noticeable when darkened.
The comfort of these lenses were good enough. I have worn the regular clear Oasys lenses in the past and find them more comfortable than Oasys with Transitions, but I was able to wear these all day without problems. They did seem to become dry for me at the end of the day when I began feeling the edges of the lens. Of course, just like all contact lenses, these lenses should be prescribed by a professional to ensure adequate fit which results in better comfort and safety. They may not be for every one.
They will not and should not replace sunglasses, but would be beneficial for those that have general light sensitivity, want enhanced contrast, or are in bright lighting situations where sunglasses are inappropriate or impractical. Depending on the lighting of my environment, these lenses ranged from no impact on my vision to a noticeable improvement in my vision. I never felt they were detrimental to my vision at any point. The comfort was only moderately good for me (but I do have sensitive eyes) and I was not a huge fan of their appearance in my eyes when fully activated. Overall, I enjoyed wearing these lenses.
Are you wondering if these lenses could work for you? We would be happy to schedule your consultation: Call 330-343-8863.