It is important to know
that a vision screening by a child's pediatrician or at his or her
school is not the same as a comprehensive eye and vision
examination by an optometrist.
Vision screenings are a limited process and can't be used to diagnose an eye or vision problem, but rather may indicate a potential need for further evaluation. They may miss as many as 60% of children with vision problems. Even if a vision screening does not identify a possible vision problem, a child may still have one.
Passing a vision screening can give parents a false sense of security. Many school vision screenings only assess one or two areas of vision. They may not evaluate how well the child can focus his or her eyes or how well the eyes work together. Generally color vision, which is important to the use of color coded learning materials, is not tested.
Recommendations for Infant and Pediatric Comprehensive Eye Exams
At about age 6-12 months, even if no eye or vision problems are apparent, parents should take their baby for his or her first thorough examination with an eye care professional. Things that Dr. Belill will test include:
- excessive or unequal amounts of nearsightedness, farsightedness, or astigmatism
- eye movement ability
- eye health problems
These problems are not common, but it is important to identify children who have them at this young age. Vision development and eye health problems are easier to correct if treatment begins early.
By age 3, your child should have a thorough optometric eye examination to make sure his or her vision is developing properly and there is no evidence of eye disease. If needed, Dr. Belill can prescribe treatment, including eyeglasses and/or vision therapy, to correct a vision development problem.
With today's diagnostic
equipment and tests, a child does not have to know the alphabet or
how to read to have his or her eyes examined. Here are several tips
to make your child's optometric examination a positive
- Make an appointment early in the day. Allow about one hour.
- Talk about the examination in advance and encourage your child's questions.
- Explain the examination in terms your child can understand, comparing the E chart to a puzzle and the instruments to tiny flashlights and a kaleidoscope.
Unless Dr. Belill advises otherwise, a child's next eye examination should be at age 5. By comparing test results of the two examinations, Dr. Belill can tell how well your child's vision is developing for the next major step into the school years.
Starting at age 6, Dr. Belill recommends children receive an eye exam every 12 months, even if they do not exhibit any obvious symptoms. Because vision may change frequently during the school years, regular eye and vision care is important. Dr. Belill not only evaluates vision, but also assesses for eye disease and/or signs of systemic disease. All parents want to see their children do well in school and most parents do all they can to provide them with the best educational opportunities. However, too often one important learning tool may be overlooked - a child's vision. A child may not tell you that he or she has a vision problem because they may think the way they see is the way everyone sees.
Below is more detailed information on pediatic vision based on age groups.
Infant Vision: Birth to 24 Months
Babies learn to see over a period of time, much like they learn to walk and talk. They are not born with all the visual abilities they need in life. The ability to focus their eyes, move them accurately, and use them together as a team must be learned. Also, they need to learn how to use the visual information the eyes send to their brain in order to understand the world around them and interact with it appropriately.
From birth, babies begin exploring the wonders in the world with their eyes. Even before they learn to reach and grab with their hands or crawl and sit-up, their eyes are providing information and stimulation important for their development. Healthy eyes and good vision play a critical role in how infants and children learn to see. It is important to detect any problems early to ensure babies have the opportunity to develop the visual abilities they need to grow and learn.
Eye and vision problems in infants can cause developmental delays. Parents play an important role in helping to assure their child's eyes and vision can develop properly. Steps that any parent should take include:
- Watching for signs of eye and vision problems.
- Seeking professional eye care starting with the first comprehensive vision assessment at 6-12 months of age.
- Helping their child develop his or her vision by engaging in age-appropriate activities.
The presence of eye and vision problems in infants is rare. Most babies begin life with healthy eyes and start to develop the visual abilities they will need throughout life without difficulty. But occasionally, eye health and vision problems can develop. Parents need to look for the following signs that may be indications of eye and vision problems:
- Excessive tearing - this may indicate blocked tear duct
- Red or encrusted eye lids - this could be a sign of an eye infection
- Constant eye turning - this may signal a problem with eye muscle control
- Extreme sensitivity to light - this may indicate an elevated pressure in the eye
- Appearance of a white pupil - this may indicate the presence of an eye cancer
The appearance of any of these
signs should require immediate attention by your pediatrician or
Preschool Vision: 2 to 5 Years of Age
Every experience a preschooler
has is an opportunity for growth and development. They use their
vision to guide other learning experiences. From ages 2 to 5, a
child will be fine-tuning the visual abilities gained during
infancy and developing new ones. Sacking building blocks, rolling a
ball back and forth, coloring, drawing, cutting, or assembling
lock-together toys all help improve important visual skills.
Preschoolers are eager to draw and look at pictures. Also, reading to young children is important to help them develop strong visualization skills as they "picture" the story in their minds. Preschoolers depend on their vision to learn tasks that will prepare them for school. They are developing the visually-guided eye-hand-body coordination, fine motor skills and visual perceptual abilities necessary to learn to read and write.
According to the American Public Health Association, about 10% of preschoolers have eye or vision problems. However, children this age generally will not voice complaints about their eyes.
Parents should watch for signs that may indicate a vision problem, including:
- Sitting close to the TV or holding a book too close
- Tilting their head
- Frequently rubbing their eyes
- Short attention span for the child's age
- Turning of an eye in or out
- Sensitivity to light
- Difficulty with eye-hand-body coordination when playing ball or bike riding
- Avoiding coloring activities, puzzles and other detailed activities
This is also the time when parents need to be alert for the presence of vision problems like crossed eyes or lazy eye. These conditions often develop at this age. Crossed eyes or strabismus involves one or both eyes turning inward or outward. Amblyopia, commonly known as lazy eye, is a lack of clear vision in one eye, which can't be fully corrected with eyeglasses. Lazy eye often develops as a result of crossed eyes, but may occur without noticeable signs.
School-aged Vision: 6 to 18 Years of Age
It has been estimated that as much as 80% of the learning a child does occurs through his or her eyes. Reading, writing, chalkboard work, and using computers are among the visual tasks students perform daily. A child's eyes are constantly in use in the classroom and at play. When his or her vision is not functioning properly, education and participation in sports can suffer.
As children progress in school, they face increasing demands on their visual abilities. The size of print in schoolbooks becomes smaller and the amount of time spent reading and studying increases significantly. Increased class work and homework place significant demands on the child's eyes. Unfortunately, the visual abilities of some students aren't performing up to the task.
Vision is more than just the ability to see clearly, or having 20/20 eyesight. It is also the ability to understand and respond to what is seen. Basic visual skills include the ability to focus the eyes, use both eyes together as a team, and move them effectively. Every child needs to have the following vision skills for effective reading and learning:
- Visual acuity - the ability to see clearly in the distance for viewing the chalkboard, at an intermediate distance for the computer, and up close for reading a book.
- Eye Focusing - the ability to quickly and accurately maintain clear vision as the distance from objects change, such as when looking from the chalkboard to a paper on the desk and back. Eye focusing allows the child to easily maintain clear vision over time like when reading a book or writing a report.
- Eye tracking - the ability to keep the eyes on target when looking from one object to another, moving the eyes along a printed page, or following a moving object like a thrown ball.
- Eye teaming - the ability to coordinate and use both eyes together when moving the eyes along a printed page, and to be able to judge distances and see depth for class work and sports.
- Eye-hand coordination - the ability to use visual information to monitor and direct the hands when drawing a picture or trying to hit a ball.
- Visual perception - the ability to organize images on a printed page into letters, words and ideas and to understand and remember what is read.
If any of these visual skills are lacking or not functioning properly, a child will have to work harder. This can lead to headaches, fatigue and other eyestrain problems. Parents and teachers need to be alert for symptoms that may indicate a child has a vision problem. When certain visual skills have not developed, or are poorly developed, learning is difficult and stressful, and children will typically:
- Experience discomfort, fatigue and a short attention span.
- Avoiding reading and other close activities
- Attempt to do the work anyway, but with a lowered level of comprehension or efficiency.
- Frequent headaches, eye rubbing or blinking
- Covering one eye or tilting the head to one side
- Holding reading materials close to the face
- An eye turning in or out
- Seeing double
- Losing place when reading and difficulty remembering what he or she read
Some children with learning difficulties exhibit specific behaviors of hyperactivity and distractibility. These children are often labeled as having "Attention Deficit Hyperactivity Disorder" (ADHD). However, undetected and untreated vision problems can elicit some of the very same signs and symptoms commonly attributed to ADHD. Due to these similarities, some children may be mislabeled as having ADHD when, in fact, they have an undetected vision problem.
The most common vision problem is nearsightedness or myopia. However, some children have other forms of refractive error like farsightedness and astigmatism. In addition, the existence of eye focusing, eye tracking and eye coordination problems may affect school and sports performance. Eyeglasses or contact lenses may provide the needed correction for many vision problems. However, a program of vision therapy may also be needed to help develop or enhance vision skills.