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Vision Screening for Children: Early Detection Means Better Treatment

Eye problems in healthy children can be a silent disease. Vision problems often go undetected by both kids and their parents leading to permanent eye damage. Dr. Pamela Gallin, a pediatric ophthalmologist talks about vision care for young children.

Kids across the country are back in the classroom. It's a time of year when the American Optometric Association likes to remind parents to schedule an eye exam for their children. Good vision is a must for children to succeed in school and at play.

Dr. Pamela Gallin, a pediatric ophthalmologist and the director of Pediatric Ophthalmology at Babies and Children's Hospital of New York at Columbia Presbyterian Hospital, advises when a child should have his or her first eye exam, and how parents can recognize symptoms of vision problems and a child's first pair of contact lenses.

Children with uncorrected vision conditions or eye health problems face many barriers in life, academically, socially, and athletically. According to eye care professionals, high-quality eye care can break down these barriers and help enable your children to reach their highest potential.

According to the United States Center for Health Statistics, only 14% of American children under the age five have received a comprehensive eye exam. The American Optometric Association (AOA) suggests that children receive a complete eye examination at six months of age, again at age three, and another one before starting kindergarten. Many optometrists suggest yearly or more frequent examinations for at-risk patients.

Early Care

At about age six months, parents should take their baby to a doctor of optometry for his or her first thorough eye examination. Things that the optometrist will test for include excessive or unequal amounts of nearsightedness, farsightedness, or astigmatism and eye movement ability as well as eye health problems. These problems are not common, but it is important to identify children who have them at this stage. Vision development and eye health problems can be more easily corrected if treatment begins early.













Early Care Follow-Up

Unless you notice a need, or your doctor of optometry advises you otherwise, your child's next examination should be around age three, and then again before he or she enters school.

















Toddler Years

Parents should watch for signs that may indicate a vision development problem, including a short attention span for the child's age; difficulty with eye-hand-body coordination in ball play and bike riding; avoidance of coloring and puzzles and other detailed activities.

There are everyday things that you can do at home to help your preschooler's vision develop as it should. These activities include reading aloud to your child and letting him or her see what you are reading; providing a chalkboard, finger paints and different shaped blocks and showing your child how to use them in imaginative play.












School Aged Children

The basic vision skills needed for school usare:

  1. Near vision. The ability to see clearly and comfortably at 10-13 inches.

  2. Distance vision. The ability to see clearly and comfortably beyond arm's reach.

  3. Binocular coordination. The ability to use both eyes together.

  4. Eye movement skills. The ability to aim the eyes accurately, move them smoothly across a page and shift them quickly and accurately from one object to another.

  5. Focusing skills. The ability to keep both eyes accurately focused at the proper distance to see clearly and to change focus quickly.

  6. Peripheral awareness. The ability to be aware of things located to the side while looking straight ahead.

  7. Eye/hand coordination. The ability to use the eyes and hands together.






Watch for Symptoms

If any of these or other vision skills is lacking or not functioning properly, a child will have to work harder. This can lead to headaches, fatigue and other eyestrain problems. As a parent, be alert for symptoms that may indicate your child has a vision or visual-processing problem. Be sure to tell your optometrist if your child frequently:

  1. Loses their place while reading.
  2. Avoids close work.
  3. Holds reading material closer than normal.
  4. Tends to rub their eyes.
  5. Has headaches.
  6. Turns or tilts head to use one eye only.
  7. Makes frequent reversals when reading or writing.
  8. Uses finger to maintain place when reading.
  9. Omits or confuses small words when reading and consistently performs below potential.

Since vision changes can occur without you or your child noticing them, your child should visit the optometrist at least every two years, or more frequently, if specific problems or risk factors exist. If needed, the doctor can prescribe treatment including eyeglasses, contact lenses o vision therapy. It's very important to note, a school vision or pediatrician's screening is not a substitute for a thorough eye examination.





Treatment Options

Eyeglasses are an option for most children-even infants. Contact lenses should be purchased for children that are mature enough to handle them. Because the eye continues to develop until around age 18, laser vision correction is not optimal for children. Vision therapy might also be prescribed to help conditions that cannot be treated with glasses or contacts alone.















Why do you call vision problem a silent disease

Vision loss is a silent disease because you don't know your child has it. You can't see it. It's estimated that 2% to 5% of children suffer some vision loss. Newborn screening can pick up problems but after that it's up to the family. Most of the time children don't know they can't see. Many times, they can only see in one eye. So, they're able to function normally and the only way to pick up on it is a vision screening. Kids are great at faking it.














How is vision screening different from an eye exam

An exam tells you 100% whether your eye is normal and whether both eyes are the same in their ability to focus. You cannot always determine that from a screening, they can be very unrliable. Usually a nurse or clerk in busy office does the exam and kids read letters or play a testing game. The office phones are ringing, things are hectic, and the kids run out of steam, and the end result isn't always accurate.

In an exam, an ophthalmologist checks your vision. They do a dilated exam and that tells the doctor a measurement. It checks the focusing power of the eye and the power of the lenses. But, the real test is whether the eyes are equal, to see if you have a matched set.











When should parents take their children to the doctor

Parents should go to the doctor whenever they suspect a problem. Like I said, go to the doctor because most people don't reach that point where they notice a problem. Parents seem to always dout themselves. If you think your child cannot see, that's reason enough.
















Is there anything parent can do at home to test a child's vision

Yes, cover one eye with the palm of your hand and ask your child to read a poster. If he or she cannot, you've got a problem. Kids will tell you when they cannot see, put them in a situation where they cannot function and they're very good at telling you.

Children's bodies are growing and changing, how frequently should a child have his or her eyes checked?

It depends on what the doctor sees the first time. If there are no problems, parents should have eyes checked during a child's annual exam in their pediatrician's office. However, anytime you suspect a problem you should call the doctor.












Are school screenings reliable

No, but they are all that most people have. There is even a false sense of security in the optometrist office. They don't realize that the optics of child's eyes are different from an adult's. If you want a good exam you need to see an ophthalmologist .

















Are most vision problems first discovered when a child enters school

I'd say many are discovered during infancy, the premature or newborn baby age if there was a trauma. But again, it's the silent disease. Most kids and parents don't know there's a problem. It's very common for kids to have one good eye and one bad eye, and that's like running a race with two different sized shoes. You can run but as a matched set your feet don't function together and that's the problem. The unevenness of vision is the problem.

What about contact lenses. Nowadays glasses are a fashion statement. They're lighter with stylish frames but at what age can a child be fitted with contact lenses?

We usually say it's ok for teens. It's easier now because contacts are disposable and have a high water content. As long as they have parental consent, teens can wear contacts. Also, contacts are great for kids who are into sports. They can be safer and it gives them better vision for sports.

Has the popularity of video games like playstation and the smaller hand-held gameboys had any impact on children's vision?

NObut hey could go brain dead.

What about sitting too close to the television set?

It's not a problem. Some parents don't want it, so if they tell, I usually say with a grin that kids shouldn't sit close to the TV, but the kids see me.

Are some vision problems reversible?

Yes, if you pick them up early, many are. After age nine it gets harder. The brain is like a cake and it sets. So, parents need to take their children to the doctor if they suspect a problem. I always tell parents, they don't need to make the diagnosis, just going to the doctor is enough.

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