We take our kids to the pediatrician every month when they’re born, and at least every year as they get older. Many public schools require that we take our kids to the dentist at least once a year too. Yet despite the fact that vision problems are just as common in young kids as cavities, most of us don’t take our kids to get professional eye exams until they show signs of a problem. The American Academy of Pediatrics recommends that children get a professional eye exam as an infant, at the start of school, and every 2-3 years after. Here’s why:
This mom’s ignorant mistake
My daughter, Addie, is 4. During the vision screening at her last well visit, her pediatrician asked her to read an eye chart. She struggled to name the shapes they asked her to identify, and she didn’t pass the test. But we all attributed that to the fact that her excited little eyes were looking everywhere BUT the chart. The pediatrician didn’t recommend a professional eye exam.
Kids Peel and Stick 11”x17” Eye Test Chart (EyeWalls)
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Fast forward a few months, and I get a letter from the school nurse: “We have detected a potential vision issue in your daughter during our routine vision screening. We recommend a follow-up with a doctor”. Cue momma’s antennae, right? Wrong!
Even though this was the second piece of evidence that my daughter was having vision issues, I still approached it with skepticism. I was in the room when she rambled through the pediatrician’s eye chart and it really seemed that she was just too young to pay attention. How could they possibly tell anything from a highly distractable 4yo trying to identify shapes she barely knows? Sometimes she even sees far away birds that no one else can make out. So, we went on with our lives.
Luckily, our school nurse treats these tests as more than just a county requirement, and when Addie didn’t show up with glasses, the nurse gave me a call. I explained my skepticism about the eye test, and she informed me that they stopped using those, and instead use an instrument called a Spot™ Vision Screener.
What is a Spot™ Vision Screener?
This screener helps to identify potential vision issues in children who are too young or are otherwise unable to identify and communicate the symbols on a classic eye chart test. This tool came out on the market in 2016, and many schools are using them now. The child sits in a chair about 3ft from the device, and the screen displays flashy lights and sounds to keep your child’s attention. Within 2 seconds, it takes several measurements of your child’s eyes, assessing the alignment of both eyes, the sizes of the pupils, and the ocular refraction, which is basically the way the image focuses in the eye.
These are expensive pieces of equipment ( they cost about $7,000), but our school system shares one among its 7 schools. If yours doesn’t have one, I highly recommend suggesting to your school board that they purchase one. The visual assessment showed an abnormality in Addie’s eyes that could indicate a problem with her vision. Studies show that when these screeners detect a problem, they are correct over 70% of the time. So, off to the doctor Addie goes, and off to the literature I went to get more informed about why we need to get our kids routine eye exams. Here’s what I found:
Finding #1: Most parents don’t follow up on school eye exams
At first, I felt like a terrible mom for just shrugging off Addie’s failed eye tests. But as I did research on this, I found that my reaction is quite common. In fact, one study showed that when children fail visual exams at school, less than 40% of those children get follow-up screening! As a result, vision problems often go unrecognized and undiagnosed in young children.
Most of us don’t get our kids professional eye exams for one of four reasons:
- We think our kids are too young for accurate eye exams. Many times, this is true. However, with the new technology described above, it is now possible to screen for potential vision problems even in newborns!
- Many believe that eye problems don’t really happen until later in life. This is because most of us who have glasses or other vision issues found out about them later in childhood. But this doesn’t mean that those problems developed later in childhood. We just didn’t screen as much or as accurately back then. One study testing the eyes of young children from kindergarten to 5th grade found vision difficulties in 33% of students, while only a fraction of these had eye exams before.
- Kids with eye problems don’t know that they can’t see, because they’ve never seen the world any differently! I got glasses when I was in the 6th grade. We only realized that I needed them because I happened to comment on a line of street lights that looked like a straight line of light to me. When I got those glasses, it was the first time I realized that you were supposed to be able to see the leaves on the trees. I was absolutely shocked, because I had never been able to see them in my life. If our kids don’t know that they should be able to see the board or a soccer ball in the field, they don’t alert us of a problem, and we tend not to take them to get checked.
- The cost of professional vision care can be daunting. This was definitely one of my considerations. The average cost of a professional eye exam is around $100! The cost of an exam is usually divided into two parts: the eye health exam and the refraction exam. The eye health exam is usually covered by health insurance, but the refraction portion (where they determine your prescription for glasses is not).
Here’s a good post about what is covered for eye care, and what is not. Despite the costs, vision is critical for our daily lives. An eye exam could prevent a lifelong and preventable loss of vision in your child.
Finding #2: There are four major eye problems that are most common in children
When we think of vision problems in our kids, we tend think “they can’t see the board”. But it’s not always as simple as that. Some eye problems in kids can be much more serious, even resulting in vision loss. Most of these are treatable, but only during young ages when the problems are new. Here are the most common problems that visual screenings find in young kids:
Amblyopia with or without Strabismus
Amblyopia, or lazy eye, is a condition that usually begins in infancy and early childhood, and progresses as a child grows. About 2-4% of people have this, and it is the leading cause for vision loss in children. When we think of lazy eye, we tend to think of an associated condition called Strabismus. This is when the eyes point in different directions.
But amblyopia, itself, actually means that one of the eyes did not develop properly, and is unable to focus on an image, even with corrective lenses. Amblyopia can be caused by strabismus because the brain has to choose one eye for focusing, or it can cause strabismus, because one eye doesn’t function properly and that eye then isn’t used to focus on objects. This can actually even be present in both eyes.
What that means is that your child can have progressive amblyopia even if his/her eyes even if the position of the eyes are not yet abnormal. What’s more, this condition is treatable early in life using relatively simple methods, but if it progresses too far, your child could experience permanent, irreversible vision loss in one or both eyes. For these reasons, it is worth getting some routine eye tests for your child.
Myopia
Myopia is what we also call “nearsightedness”. Images we see are made up of light that is reflected from the objects we are looking at. Normally, the reflected light passes through the pupil and the lens focuses the image on the retina at the back of the eye. The image actually gets flipped upside down due to the curvature of the eye, and the brain then interprets it and turns it right-side up. When you have myopia, your eyeball is too long, so images that are close to you don’t quite make it to the retina. This results in an image that is blurry. When you have this condition, you can still see far away objects just fine, because the reflective angle is different. Normally, corrective lenses can help to fix this problem in both kids and adults.
Hyperopia
Hyperopia is often called “farsightedness”. People with this condition have the opposite problem as those with myopia. One or both of their eyeballs are too short. Because you need a longer reflective distance to focus on objects that are far away, the image is not yet focuses when it gets to the retina in a shorter eyeball. As a result, far away objects appear blurry, while near objects focus just fine. This condition can also be fixed with corrective lenses most of the time.
Astigmatism
Astigmatisms result in blurry vision when focusing on both near and far objects. They happen because clear layer on the front of the eye, the cornea, is shaped like a football, rather than, say, a volleyball. This causes the reflections from an object to split as they pass through the cornea. The object then focuses in multiple places on the retina, which can make it difficult for the brain to interpret the image. Corrective lenses can also help this condition.
The important thing to note is that myopia, hyperopia, and astigmatism, if left untreated, can lead to amblyopia and later vision loss. So it is important to indentify the issue early on.
What’s the Take-Home?
As parents, we tend to be proactive when it comes to conditions in our kids that cause them pain or discomfort. Unlike colds or cavities, the symptoms of vision problems are often a lot less noticeable, especially in young kids. We often think that because our kids aren’t having problems writing their names or catching a ball, that their vision is fine. Yet they could be experiencing problems that are shaping the way they learn and interact in their daily lives. Routine eye exams are just as important as routine well visits and dentist appointments. I now wonder whether Addie can see those leaves that I missed myself for so many years. We’ll find out next week.
