Seeing is Believing

Seeing is Believing

The Importance of Good Vision for Children

Dr. Teri Geist, ODNebraska 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

ContinuedCovering 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 AcuityHow 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


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

• 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• 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


Color Vision Test• Equipment:

– Occluder– Pseudo-

Isochromatic Test Plates

• Referral Criteria– Student fails if

does not correctly identify the image on the card


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


Random Dot E & Polarized Glasses


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 up-close tasks

• If the eyes cannot effectively converge for near vision tasks, then the patient has convergence insufficiency

• Equipment– Near Point fixation

stick– Tape Measure


Symptoms of Children Struggling in the Classroom

• 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 Lawwww.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

http://www.NECHILDRENSVISION.org/

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

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Seeing is Believing