Download The Importance of Good Vision for Children

Seeing is Believing
The Importance of Good
Vision for Children
Dr. Teri Geist, OD
Nebraska Optometric Association
Good Vision Means
Better Learning
• Vision is a dominant process in growth, development and
daily performance of children
• Undetected, untreated vision problems can interfere with
students’ learning potential. Nearly 75% of the school day
is spent on visual activities.
• Vision disorders are 4th most common disability in U.S.
Courtesy of AOA Clinical Practice Guidelines on Pediatric Examination
Good Vision Means
Better Learning
• Only 15% of children have had an eye exam by age 5
• Only half of all children will have an eye examination
before completing high school
• 75,000 3-year-olds develop amblyopia each year
• Vision deficiencies in school age children are often
misidentified as behavior or social problems, which my
put the child into the wrong “treatment track”.
• More than 75% of juvenile offenders have undetected
and untreated vision problems.
Courtesy of AOA Clinical Practice Guidelines on Pediatric Examination
Statistics
• 60% of students identified as problem learners have
undetected vision problems.
• Based on that, as many as 4,500 Nebraska children
enter school each year with vision problems significant
enough to hinder their ability to learn!!
Statistics courtesy of AOA
Role of Vision In Learning
• Vision occurs in the brain, not in the eyes
• The eyes must see clearly, without double vision, and
with accurate focus control
• The brain must interpret the visual image from its
background, make assumptions as to its figure, and
integrate the information gathered from peripheral vision
and from other senses
• A child must have visual ability to learn to read prior to
reading to learn
Signs of a Visually Related
Learning Problem
Frequent rubbing of the eyes
Frequent blinking of the eyes
Short attention span or frequent daydreaming
Poor reading
Avoiding close work
Frequent headaches
A drop in scholastic or sports performance
Signs of a Visually Related
Learning Problem
Continued
Covering one eye
Tilting the head
Squinting one or both eyes
Placing head close to book or desk when reading or
writing
Difficulty remembering, identifying and reproducing
geometric forms
Poor eye-hand coordination skills
What is good vision?
Good vision includes:
– Visual acuity
– Eye health
– Eye teaming
– Eye focusing
– Eye motility
Vision Screenings
• Designed to identify gross visual problems and to
indicate the immediate need for an eye examination.
Parents must follow through on the referral.
• Most children who fail a vision screening will also fail
a diagnostic professional examination
Visual Acuity
How clearly one sees
– Near vision- the ability to see at 8 -16 inches
(reading a book)
– Intermediate vision- the ability to see at 16 -40
inches (computer distance)
– Distance vision- the ability to see at 10 feet or
more
– 20/20 indicates that you can see letters 3/8”
high at 20 feet
Components of Visual
Screenings
Distance Visual Acuity
– Purpose-To test for myopia, amblyopia,
astigmatism, and high hyperopia
– Equipment-Distance VA chart and Occluder
– Visual Acuity Charts Include:
• Snellen Chart
• Tumbling E chart
• Lea symbols
Snellen Chart & Tumbling E
Photos Courtesy of POA
Near Visual Acuity
• Purpose- To test for hyperopia, astigmatism,
amblyopia, and focusing problems
• Equipment- Near Acuity Cards and Occluder
• Near Acuity Cards include:
– Snellen
– Lighthouse acuity
– Lea Cards
– Tumbling E
Near point cards
Photos courtesy of POA
LEA Symbol Charts
Photos courtesy of POA
Eye Teaming
Ability of the eyes to:
• work properly together
• to coordinate and align both eyes to allow
brain to fuse a single image from the images
it receives from each eye
• to judge relative distances of objects and
have depth perception
• to converge on something near by turning
towards each other
Eye Focusing
• The ability of the eyes to focus and shift focus to
near and distant points accurately and efficiently
Eye Motility
• The ability of the eyes to move from one point to another
• The ability of the eyes to move across a page of print or
to follow a ball, etc…
Myopia (Nearsightedness)
• The inability to see distant things well
• The eye is too long for the normal focusing power of
the eye
• Symptoms include:
– Squints
– Gets close to the board
Hyperopia (farsightedness)
• The ability to see at all distances with additional focusing effort
• Eyeball is too short for normal focusing power of the eye
• In children the lens can focus and accommodate through this
error providing both clear distance and near vision, but much
effort must be used. This can cause headaches, fatigue, and
even crossed eyes.
• Symptoms Include:
– Rubs Eyes
– Has watery eyes
– Complains of blurred vision
Astigmatism
• Results from an irregular shape of the front surface of
the cornea.
• The eye is more football shaped rather than round
• Causes blurred vision for distant and close-up things
• Symptoms include:
– Rubs eyes
– Has watery eyes
– Complains of blurred vision
Strabismus
• Occurs when the eyes are not aligned when viewing
an object
• The eye may turn inward toward the nose (esotropia)
or outward toward the side (exotropia)
• This is usually caused by poor muscle control
• An eye turn can happen constantly or occasionally
Esotropia
Exotropia
Symptoms of Strabismus
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Intermittent double vision
Closes or covers one eye
Says letters or words appear to move
Loses place
Is Inattentive
Rubs eyes
Has watery eyes
Complains of blurred vision
Has poor reading comprehension
Accommodative & Binocular
Disorders
• Accommodative- The eyes cannot focus well
• The inability to contract or relax the eyes’ focusing
muscles efficiently
• Binocular – The eyes do not work well as a team; for
example, the eyes cannot converge for up-close
reading
Accommodative Symptoms
– Headaches
– Tired at the end of the day
– Has blurred vision when looking from board to
book or book to board
– Holds things very close
– Is Inattentive
– Rubs eyes
– Has watery eyes
– Complains of blurred vision
– Has poor reading comprehension
Binocular Disorder Symptoms
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Headaches
Fatigue
Double vision
Blurriness
Watery eyes
Rubs Eyes
Is Inattentive
Loses place
Says Letters or words appear to move
Amblyopia
• Also known as “lazy eye”
• Reduced vision in an eye that was not stimulated in
early childhood
• Can result from strabismus or misaligned eyes or a
difference in clarity between the two eyes
• One eye is focusing better than the other one
• One eye becomes stronger from its use and the
other eye is suppressed and not worked hard
enough
Color Vision Test
• Detects difficulty in ability to recognize color
• Children with color deficit are not actually blind to
color, but simply have difficulty identifying and
distinguishing between different colors
• Color Deficiencies are usually hereditary and affect 1
in 12 boys but only 1 in 200 girls
Color Vision Tests
Photos courtesy of POA
Color Vision Test
• Equipment:
– Occluder
– Pseudo-Isochromatic
Test Plates
• Referral Criteria
– Student fails if does
not correctly identify
the image on the
card
Photos courtesy of POA
Convex Lens Test
• Detects large amounts of hyperopia
• Equipment
– Age-appropriate distance acuity charts
– Occluder
– Pair of +2.25 Spherical Lens (ages 5-8)
– Pair of +1.75 Spherical Lens(>age 8)
Convex Lens Test Referral Criteria
• If the student cannot read the 20/40 line while
wearing the lenses then he/she has passed
the test
• If the student can read the 20/40 line while
wearing the lenses then the student has
failed and should be referred.
Stereo/Depth Test
• Tests for amblyopia, strabismus, and binocularity
• Equipment
– Random Dot E
– Stereofly
– Random Dot Stereotest
Stereotests
Photos courtesy of POA
Random Dot E & Polarized Glasses
Photos courtesy of POA
Cover Test
• Tests for ocular alignment disorders, strabismus, and
binocular problems
• Done both at distance and near
• Unilateral cover test
– Movement on Unilateral cover test = strabismus
– No movement on unilateral cover test = normal
• Alternate Cover Test
– Movement on Alternate cover test = Strabismus or
binocular problem, depending on severity
– No movement on alternate cover test = normal
Near Point of Convergence
• Tests the ability of the
eyes to converge for upclose tasks
• If the eyes cannot
effectively converge for
near vision tasks, then
the patient has
convergence
insufficiency
• Equipment
– Near Point fixation stick
– Tape Measure
Photos courtesy of POA
Symptoms of Children Struggling
in the Classroom
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Trouble finishing written assignments
Losing their place when reading
Having a short attention span when doing close work
Skipping words when reading
Making errors when copying from the board
Underperforming
Eye Health
• The absence of anomaly or
disease
• If not diagnosed or treated, eye
disease can lead to vision loss or
impaired vision
• Ocular health is evaluated by
external ocular examination with
a biomicroscope, eye pressure
evaluation, and a retina exam
The Current Law
www.NECHILDRENSVISION.org
• Took effect in 2006-07 school
year
• Within 6 months of enrollment
• Distance and Near Acuity
• Amblyopia/Strabismus
• External and Internal Eye Health
Cost of Neglecting the Problem
Increased school failure and drop out rates
Inappropriate learning disability referrals
Loss of self esteem and motivation
Increased behavior problems
Long term increase in illiteracy, joblessness
and crime
Learning Preparedness
If a child cannot see,
a child cannot read,
and if a child cannot read,
a child cannot learn.
Good Vision =
Good Education
nechildrensvision.org