The Importance of Good Vision for Children

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The Importance of Good Vision for Children
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Presentation provided by

• Randolph E. Brooks, O.D.
• AOA Member
• Ledgewood, NJ

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Importance of Good Vision to Learning

• Approximately 80 of all learning during a
  childs 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
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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
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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
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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

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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

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What is good vision?

• Good vision includes
• Visual acuity
• Eye health
• Visual Integration
• Eye teaming
• Eye focusing
• Eye motility

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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

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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

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Visual Integration

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

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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

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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

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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

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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

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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

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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

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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

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Esotropia
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Exotropia
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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

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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

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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

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Binocular Disorder Symptoms

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

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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

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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

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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

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Snellen Chart Tumbling E
Photos Courtesy of POA
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LEA Symbol Charts
Photos courtesy of POA
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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

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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

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Near point cards
Photos courtesy of POA
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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

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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

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Color Vision Tests
Photos courtesy of POA
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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
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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(gtage 8)

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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.

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Stereo/Depth Test

• Tests for amblyopia, strabismus, and binocularity
• Equipment
• Random Dot E
• Stereofly
• Random Dot Stereotest

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Stereotests
Photos courtesy of POA
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Random Dot E Polarized Glasses
Photos courtesy of POA
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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

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Near Cover Test
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Cover Test
http//www.city.ac.uk/optics/BVTutor/assets/images
/esotropia3.GIF http//www.city.ac.uk/optics/BVTu
tor/html/heterophoria_2.html
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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
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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

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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

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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
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Ocular Emergencies

• Red Eye
• Chemical Burns
• Foreign Body
• Blunt Trauma

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RED EYE
BLOODSHOT Painful and/or Vision Blurred
See Doctor Now
YES
NO
See Doctor Today
BLOODSHOT Discharge Gritty Sensation
YES
NO
No Treatment Generally Required
Blood Red Spot on White of Eye
YES

NO
Lubricants Warm Compresses See Doctor if Worsens
No illness/trauma Hx No Discharge Slightly Red Eye
YES
Courtesy of AOA
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Irrigate 30 Mins Lids Forced open then
see Doctor immediately after
Is the Chemical a strong base? Example Drain
Cleaner Lime
YES
Chemical Burns
Irrigate for 15 mins. Then see Doctor.
NO
YES
Is it a strong acid? Example Battery Acid
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
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Burns

• Alkali- based chemicals
• Lime (cement, plaster, whitewash)
• Drain cleaners
• Lye
• Metal polishes
• Ammonia
• Oven cleaners
• Acid-based chemicals
• Swimming pool acid (muriatic acid)
• Battery (sulfuric) acid

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YES
Ocular Foreign Body

• Are any of the following true?
• Can the foreign body be seen and
• does it remain after gentle washing?
• Could the injury have penetrated the globe
• of the eye?
• Can blood be seen in the eye?
• Does it feel as though a foreign body might
• be trapped behind the upper lid?

See Doctor Now
NO
YES
Is there any problem with vision?
Foreign Body
NO
Call Doctor Today
Is there any eye pain?
Courtesy of AOA
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Blunt Trauma

• Are any of the following true?
• Is lid swollen shut?
• Is blood in anterior chamber?
• Is cornea white/hazy?
• Is pupil irregularly shaped, fixed, dilated
• or constricted?

YES
See Doctor Now
NO
Is there any problem with vision? -example
blur, visual field loss Flashes, floaters, double
vision
YES
NO
Is there pain?
NO
YES
See Doctor Today

• Apply home treatment
• example ice pack first 2 hrs.
• Then warm compresses
• - If no overnight relief, see Doctor now

Courtesy of AOA
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Other Examples of Blunt Trauma cases.
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Case Studies

• John, 6 years old, kindergarten
• Screened in school
• Screening findings
• Distance VA 20/70 RE and 20/60 LE
• Near VA 20/30 OU
• Could read the 20/40 line through the plus lens
• All other findings within normal limits
• John was referred for a comprehensive eye
  examination

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John

• John was diagnosed with farsightedness
  (hyperopia)
• He received a pair of glasses to correct his
  farsightedness
• Johns corrected vision is now 20/20 at both
  distance and at near

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Julie, 10 years old

• Julie complains of occasionally seeing double,
  headaches, and blurry vision while reading for an
  extended period of time
• Screening Results
• Distance VA 20/20 RE 20/20 LE
• Near VA 20/20 RE 20/20 LE
• Stereovision Normal
• Color Vision Normal
• Plus Lens Test Normal
• Cover Test Exophoria
• NPC Left eye swung out at 7 inches and patient
  could not regain alignment until 11 inches

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Julie

• Julie was referred for a comprehensive eye
  examination
• Julie was diagnosed with convergence
  insufficiency
• Julie was enrolled into the vision training
  program to help improve her eye teaming

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Megan, 13

• Megan accidentally sprayed hairspray into her eye
  when she was styling her hair in the girls
  bathroom
• Megan came in complaining that her eye was red
  and bothering her
• What is the next course of action?

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Megan, 13

• Megans eye should be irrigated with saline or
  clean water for 15 minutes
• Megan should see her eye doctor today

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Healthy People 2010 National Health and Disease
Prevention Program

• Increase proportion of persons who have a dilated
  eye exam at appropriate intervals
• Increase the proportion of preschool children
  aged 5 years and under who receive vision
  screening
• Reduce uncorrected visual impairment due to
  refractive errors

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Healthy People 2010 National Health and Disease
Prevention Program

• Reduce blindness visual impairment in children
  aged 17 under
• Reduce visual impairment due to diabetic
  retinopathy
• Reduce visual impairment due to glaucoma
• Reduce visual impairment due to cataract
• Reduce occupational eye injury

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Healthy People 2010 National Health and Disease
Prevention Program

• Increase the use of protective eyewear in
  recreational activities hazardous situations
  around the house and
• Increase the use of vision rehabilitation
  services adaptive devices by people with visual
  impairments.

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Good Vision A Good Education

• Questions??