A False Sense of Security: Why reading the letter chart at school or the pediatrician’s office can miss 80% of vision problems

November 12, 2019

 

As an optometrist, I see children brought in for their first eye exam at all different ages. Some of them need glasses. Some of them have eye alignment problems that prevent them from having depth perception. Some of them have eye teaming problems that make it hard to read. I also see eye focusing issues and conditions leading to what you may know as “lazy eye.” And sadly, some of them have eye health problems, but thankfully this is less common than vision problems.

 

You may be surprised to know that 25% of all children have a vision problem significant enough to affect their performance in school. That’s a huge number. Often these problems go undetected for years; sometimes they are never found. The number of children being diagnosed with learning disabilities and/or attention deficit disorders continues to grow, some of which are being medicated with drugs that have significant side effects. Consider what portion of these children have a vision problem that translates into the same symptoms being used to diagnose them as needing medication, when what they really need are glasses, vision therapy, or some other vision correction that will allow them to process their environment and learn most effectively.

 

It is important to understand the difference between a vision screening and an eye exam. A lot of parents tell me their child had an eye exam at school or the pediatrician’s office. What that usually entails is your child reading lines of letters on a chart. If they read down to a certain level, they pass. There’s a few reasons why this is problematic. 

 

Firstly, children may be farsighted but still able to strain their focusing system to read the chart. This doesn’t necessarily mean they see clearly all the time, and it doesn’t mean they can see clearly at near when reading and doing screen work. They could have strained just to pass the test, or worse, they are straining their eyes like that everyday to get by which can lead to fatigue and frustration particularly with detailed near work like reading. 

 

Secondly, a lot of children are good at cheating at these tests and may be relying on one eye to pass, leaving the poor vision in the other eye undetected. I’ve seen many children who have squeaked by a vision screening but who are in need of substantial vision correction. 

 

Thirdly, and most importantly, is that these screenings do not test any part of your child’s functional vision such as their ability to focus, use their eyes as a team, depth perception, eye tracking, and many other aspects of a healthy visual system. Many of these functions are necessary for children to learn effectively and to do well in academic and extracurricular activities. 

 

Lastly, a comprehensive eye exam will assess the health of the front and back structures of the eyes. Although most eye diseases are rarer in children, it is still possible for a child to have a blinding disease such as glaucoma. There are also some serious, life-threatening diseases such as retinoblastoma that need to be ruled out. 

 

One of the biggest reasons for bringing your child in for an eye exam is to prevent amblyopia. This is a condition where one or both eyes are permanently blurry and are never able to see 20/20 even with glasses. This occurs for different reasons, but often occurs when the child does not get the prescription glasses they need at a young enough age. It is often entirely preventable. When a child needs glasses to see clearly, but does not get them, a blurry world is the only image the eye(s) ever sees. Visual information is processed in the brain. If the brain was never exposed to a clear image, it never developed the ability to process a clear image. Therefore, even if the eye is corrected with glasses later on, that person can never interpret a 20/20 image because they never learned how. This leaves them with permanently blurry vision. Without 20/20 vision, career options are limited later on in life. This is one of the biggest reasons to bring your child in for an eye exam at the recommended ages. 

 

Eighty percent of learning is visual. Tie that with the fact that 80% of vision problems can be missed even with vision screenings, and the statistics are dismal. Luckily, these problems can be avoided by ensuring your child gets comprehensive eye exams by an eye doctor at the recommended ages. The American Optometric Association recommends that you bring your child in for their first eye exam at 6-12 months old. If no significant problems are found, then the next visits should be at age 3 and 5, then annually after that. Following this recommendation will ensure that vision problems will be caught early enough for effective intervention and that your child can enjoy the best vision possible.

 

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