I recently asked a close friend if she would like to bring her four year old daughter in for an eye examination. “That’s okay” she said, “there’s an upcoming screening at her school.” Her response nearly caused me to fall off my chair. After shaking my head in disbelief and catching my breath, I quickly came to realize that perhaps those of us in vision care are not communicating the difference between vision screenings and comprehensive exams effectively enough. This has inspired me to write more about the role of vision in development and learning and to advocate harder for those whose questions remain unanswered.
A vision screening, frequently performed by pediatricians or school nurses usually includes the use of the big “E,” also known as the Snellen chart. How well a child can interpret this chart at a twenty foot distance then determines whether that child will be referred to a vision care provider for further examination. In some cases, a prescription for clearer eyesight (20/20 vision) will be administered and the vision screening, at least to these children’s parents, will have been considered a success.
However, these same vision screenings are usually not exploring eye health, assessment of eye focusing, eye teaming and eye movements, including abnormalities that may exist in the muscles, like eye turns. They more than likely are not examining peripheral vision, depth perception or color vision, either. Because children are completely unaware that seeing words jump around on a page, or even seeing those words split into two is abnormal, they frequently go on to live with the disorder until either someone makes them aware that there are treatments to resolve their issues OR they continue living with poor visual function and not knowing any differently.
Although the eyes are an extension of the brain (and quite literally the only part of the brain that we visibly see), visual issues are wildly undetected and I feel it is our responsibility to effectively communicate and advocate on behalf of those living with visual disturbances. Vision screenings are a start, however, comprehensive examinations, performed by a licensed optometrist or ophthalmologist must become a yearly gold standard of care.
Did you even know that the American Optometric Association recommends a child’s first eye exam be conducted at the age of 1? If you answered ‘no’, don’t worry, most people don’t realize it. The eye and any conditions can change so rapidly that exams are actually recommended at 1, 3 and 5 years of age. Most parents believe the school screening to be adequate, unfortunately, it is not.