Undetected Eye Problems
Hamper Student Learning

Although legions of children started school this year with new notebooks, pens, and pencil cases, many were missing a critical learning tool: eyeglasses. Few children get comprehensive eye exams before age 5 -- reading an eye chart in the school nurses’ offices does not qualify as an eye exam -- and many who are unable to see clearly develop academic and behavior problems.

Optometrist Dr. Pamela Lowe talked with Education World about the importance of early eye exams, and outlined some of the behaviors that could signal vision problems. She recommends that teachers keep an eye out for those behaviors.

Dr. Pamela Lowe

Education World: At what age should children have their first eye exam?

Dr. Pamela Lowe: A child’s first eye exam should be in the first year of life between the ages of 6-12 months. That is when the visual system is rapidly developing and focusing. [Evaluating] eye-teaming skills along with doing a thorough eye health assessment are important to ensure babies’ eyes are developing appropriately.

EW: What are some of the most common vision problems detected in young children?

Lowe: Unfortunately, some of the most common vision problems go undetected in young children due to the fact that parents and caregivers are unaware of when a child should have their eyes examined. Only 30 percent of children entering school have had a comprehensive eye examination, so many kids fall through the cracks and are not seeing and learning to their highest potential.

Children who can’t see well don’t necessarily complain about vision problems because they think the way they see is how everybody must see. They have no frame of reference to gauge vision because they don’t have the visual demands of an adult -- such as driving or needing to see clearly to perform a job efficiently -- to know what normal vision is. One of the most common undetected visual disorders is far-sightedness or hyperopia. Children with this condition do “see clearly” but their eyes have to work much harder to “see clearly” and it can significantly impact near tasks, such as reading.

EW: What is the difference between school eye screenings and a comprehensive eye exam?

Lowe: The difference between a school eye screening and a comprehensive eye exam is that a screening just scratches the surface of what a comprehensive exam reveals. A screening is testing whether the eyes can see letters clearly or not, mainly at distance; it does a poor job of determining if children are suffering from the more subtle visual disorders that often go undetected. A comprehensive eye exam not only determines the need for spectacle correction, but also more thoroughly tests eye-teaming skills, or binocular vision. And of course, the health of the front and back of the eyes is assessed; school eye screenings do not determine the health of a child’s eyes.

EW: What are some of the indicators of vision problems in children that teachers should watch for?

Lowe: Children who have vision problems might squint, turn or tilt their heads to see, rub their eyes frequently, avoid tasks that require close work, lose their place while reading, or act out in class.

Just think if you were a student struggling to see clearly -- you would avoid the many visual tasks of the classroom, and turn to acting out and distracting others by inappropriate behavior. Often, however, kids at risk for eye conditions do not have symptoms; that’s why a comprehensive eye exam is important for all children entering school full time, and every year or two throughout their schooling.

EW: How might vision problems affect a child’s school performance?

Lowe: Experts agree that 80 percent of what grade-school children learn is processed through their visual systems. Imagine if a problem causes the visual system to not work efficiently, how significantly that could affect a child’s success as a student. The impact of poor academic performance due to undetected vision disorders not only labels a child as a problem learner, but also can lead to poor eye-hand coordination that can significantly affect a child’s physical performance.

Children who struggle with academic and physical tasks easily could develop low self-esteem, which only adds to a child’s frustration. The best way to ensure that children have every opportunity to be successful students is to be certain they have a comprehensive eye examination before entering school. The continuum of care for children’s vision is a comprehensive eye exam in the first year of life; if no issues are found, then schedule another exam at 3 years of age. If that exam is normal, children should have another eye exam before entering kindergarten, and then an exam every year or two, depending on the findings.

EW: How often do students with academic or behavior problems actually have vision problems?

Lowe: Students with academic or behavior issues very commonly have an underlying eye condition. In fact, studies show that more than 60 percent of children with a behavior disorder also have an eye disorder. Conversely, children with eye conditions sometimes get labeled as having ADD or ADHD because they cannot stay focused or act out in class due to poor visual skills. Once diagnosed properly, those children function well without having to be treated with medications for behavior issues.

This e-interview with Dr. Pamela Lowe is part of the Education World Wire Side Chat series. Click here to see other articles in the series.

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