Comprehensive Eye Exams: Important for Classroom Success

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
farsighted.

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?