The Importance of Good Vision for Children

1. The Importance of Good Vision for Children

2. Importance of Good Vision to Learning • Approximately 80% of all learning during a child’s first 12 years comes through vision • Undetected and untreated vision problems can interfere with ones full learning potential • Vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in children Courtesy of AOA

3. Importance of Good Vision to Learning • Only 14% of children have had an eye exam by age 5 • Only half of all children will have an eye examination before completing high school • 20% of children age 9-15 need glasses, and 90% of those have not received them • 75,000 3 year olds develop amblyopia each year Courtesy of AOA

4. Statistics • American Optometric Association recommends a child gets his/her first eye exam at 6 months • 5% of children were identified as having a vision problem using the Snellen Chart • 18 Million children will not have had an eye examination by an Eye Doctor by the time they enter school • 60% of students identified as problem learners have undetected vision problems Statistics courtesy of AOA

5. Role of Vision In Learning • 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 • Processing must occur without flaws • A child must have visual ability to learn to read prior to reading to learn

6. 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

7. What is good vision? Good vision includes: • Visual acuity • Eye health • Visual Integration • Eye teaming • Eye focusing • Eye motility

8. Visual Acuity The ability of the eye to see clearly in the distance and at near • Near vision- the ability to see at 8 -10 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

9. 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 dilated fundus exam

10. Visual Integration • The ability to process and integrate visual information • Using our vision and other senses to understand what we see

11. Eye teaming • The ability of the eyes to work properly together • The ability to coordinate and align both eyes to allow the brain to fuse a single image from the images it receives from each eye • The ability to judge relative distances of objects and have depth perception • The ability of the eyes to focus on something near by turning towards each other

12. Eye Focusing • The ability of the eyes to focus and shift focus to near and distant points easily and effortlessly 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…

13. Prevalence of vision problems Age 6 months to 18 Years • Hyperopia (farsightedness) 25% • Astigmatism 23% • Accommodative & Binocular disorders 20% • Myopia (Nearsightedness) 18% • Strabismus (eye turn) 12% • Amblyopia 7%

14. Hyperopia (farsightedness) • The inability to see close-up things well • 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

15. 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

16. 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

17. 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 • Any eye turn can happen constantly or occasionally

18. Esotropia

19. Exotropia

20. 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

21. Accommodative and Binocular Disorders • Accommodative- The eyes cannot focus well • The inability to contract and relax the eyes’ focusing muscles • Binocular – The eyes do not work well as a team; for example, the eyes cannot converge for up-close reading

22. 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

23. Binocular Disorder Symptoms • Headaches • Fatigue • Double vision • Blurriness • Watery eyes • Rubs Eyes • Is Inattentive • Loses place • Says Letters or words appear to move

24. Amblyopia • Also known as a 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 clearness between 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

25. 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

26. 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

27. Snellen Chart & Tumbling E Photos Courtesy of POA

28. LEA Symbol Charts Photos courtesy of POA

29. Criteria for Referral • If either eye is less than 20/40 or a two-line difference exists between the two eyes, retest the child • If the same results prevail, the student has failed and immediate referral is indicated

30. 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

31. Near point cards Photos courtesy of POA

32. Referral Criteria • If either eye is less than 20/40 or a two line difference exists between the two eyes, retest the child • If the same results prevail, the student has failed and immediate referral is indicated

33. Color Vision Test • Detects difficulty in ability to recognize color • Children with color blindness 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

34. Color Vision Tests Photos courtesy of POA

35. Color Vision Test • Equipment: • Occluder • Pseudo-Isochromatic Test Plates • Referral Criteria • Student fails if does not correctly identify the number on the card Photos courtesy of POA

36. Convex Lens Test • Detects hyperopia and binocular problems • Equipment • Distance acuity chart • Occluder • Pair of +2.25 Spherical Lens (ages 5-8) • Pair of +1.75 Spherical Lens(>age 8)

37. 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.

38. Stereo/Depth Test • Tests for amblyopia, strabismus, and binocularity • Equipment • Random Dot E • Stereofly • Random Dot Stereotest

39. Stereotests Photos courtesy of POA

40. Random Dot E & Polarized Glasses Photos courtesy of POA

41. 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

42. Near Cover Test

43. Cover Test http://www.city.ac.uk/optics/BVTutor/assets/images/esotropia3.GIF http://www.city.ac.uk/optics/BVTutor/html/heterophoria_2.html

44. 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 Photos courtesy of POA

45. Near Point of Convergence Referral Criteria • If the student reports double vision or either eye swings out at greater than 5 inches then he/she has failed • If the student does not regain alignment or report single vision at 7 inches or less, then he/she has failed

46. Vision Screenings vs. Comprehensive Eye Examinations • Screenings only detect gross visual problems and cannot substitute for regular professional eye examinations • Periodic eye health and vision examinations are essential for the prevention and diagnosis of conditions of the visual system • Parents MUST follow through on the referral

47. Definition of Optometrist Optometrists are independent, primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions. Courtesy of American Optometric Association

48. Ocular Emergencies • Red Eye • Chemical Burns • Foreign Body • Blunt Trauma

49. “BLOODSHOT” Painful and/or Vision Blurred YES See Doctor Now NO “BLOODSHOT” Discharge Gritty Sensation See Doctor Today YES NO YES Blood Red Spot on White of Eye No Treatment Generally Required RED EYE NO Lubricants Warm Compresses See Doctor if Worsens No illness/trauma Hx No Discharge Slightly Red Eye YES Courtesy of AOA

50. Is the Chemical a strong base? Example: Drain Cleaner Lime Irrigate 30 Mins Lids Forced open then see Doctor immediately after YES Chemical Burns NO Irrigate for 15 mins. Then see Doctor. Is it a strong acid? Example: Battery Acid YES NO Irrigate 15 minutes. See Doctor Today A mild acid or alkali? Example: Chlorine, bleach Gasoline and Hairspray YES NO See Doctor Today Mild Thermal Burn Example: Singed eyelashes UV Burn / Welding YES Courtesy of AOA