Why a Child Eye Exam Belongs on Your Back-to-School Checklist

August 12, 2016

Lisa Esposito
U.S. News & World Report

You don't have to wait for back-to-school time to get your child's eyes examined. But if your kids haven't had their yearly eye checks yet, make an appointment. Eye exams detect unsuspected problems that can affect kids' ability to read and study, see the board in class, excel in sports and reach their full potential at school.

Sofia, a 13-year-old from Huntington, New York, is going back to school with a difference. She'll be starting eighth grade without the need for academic accommodations known as inclusion, unlike previous school years. Months of vision therapy – for a condition that had gone undiagnosed and caused learning problems since kindergarten – have made this change possible for Sofia, says Rosanne Haskelson, her mother.

It took an intensive eye examination, weekly visits to an eye specialist, the right eyeglasses and contact lenses, and the young teen's determination to do nightly "homework" to exercise, strengthen and train her eyes. Now, Sofia's performance has improved so much that she's ready to make her move further into the school mainstream.

"Since kindergarten to seventh grade, she could never really read," Haskelson says. "And she's always had issues with every subject because a lot of the math questions are reading problems." Even so, her parents knew Sofia was bright, with good comprehension. "When you explained math to her, she would get it," her mother says. "When you read to her, she would understand it."

Sofia's parents did all the right things, including annual eye checks with their pediatrician and an ophthalmologist. Nothing really helped. Finally, a sixth-grade teacher pointed out that although Sofia had difficulty with small, common words, she could understand big words. That didn't seem like dyslexia, said the teacher, who suggested vision therapy.

School-age children should have yearly vision checks to examine each eye, according to the American Academy of Pediatrics. This could be done by an ophthalmologist, optometrist or a pediatric ophthalmologist.

An ophthalmologist is a medical doctor who specializes in eye care. These doctors diagnose and manage eye disorders and diseases with treatments including surgery. An optometrist – a doctor of optometry – is a primary health provider of comprehensive eye and vision care.

An eye exam done by health professional is not the same as a visual screening done in school, says Dr. Andrea Thau, president of the American Optometric Association. School screenings are simply "pass-fail tests," Thau says, often limited to measuring kids' clarity of sight and distance acuity. The problem, she says, is they "can provide a false sense of security to the parent."

After an infant eye assessment, Thau says, children should have a comprehensive eye exam every year or two years thereafter, starting at age 5 – just in time for school.

Kids may not tell you they're having eyesight issues or even realize it. They may simply think everyone sees the same way they do. But kids often give indirect clues. If they continually blink, rub their eyes or tilt their head to the side, these can indicate a problem.

Reading habits – from holding books or screens close to the face, having problems recalling what they've read or avoiding reading altogether – may point to vision problems that can clearly affect school performance. Signs may also include short attention span, frequent headaches and seeing double.

At times, parents pick up on hints that their child is having problems with vision. "But sometimes there are no clues and symptoms, which is why a very essential part of a back-to-school checklist should be a comprehensive eye exam," Thau says. "Because vision is the primary sense used in learning."

It's mid-August and the schedule is swamped with kids getting back-to-school eye exams, says Dr. Roberto Warman, a pediatric neuro-ophthalmologist and the director of ophthalmology at Nicklaus Children's Hospital, part of Miami Children's Health System. Most of the kids were referred for further evaluation by pediatricians or family practitioners who did their regular eye screenings.

Parents bring in their kids for many concerns, including eyes that don't appear well-aligned, droopy lids, constant tear flow and suspected allergies or infections. For school, Warman says, nearsightedness is the most common issue. "Sometimes parents are concerned because kids bring their books too close to their face," he says. "Or they get too close to the TV. Or they're squinting."

With nearsightedness, or myopia, Warman says, kids "aren't optimizing their school performance." However, lazy eye, or amblyopia, poses a bigger health risk: "The vision can be permanently decreased if you don't intervene at an early, appropriate age," he says.

Certain diseases of the eye call for the expertise of a pediatric ophthalmologist, Warman says. Retinal disease; strabismus, or misalignment of the eye; tumors; masses and malformations; and genetic or neurological eye conditions are examples.

However, most kids don't need to see a specialist like Warman for common vision problems. When it comes to deciding among ophthalmologists and optometrists, he says, "The most important thing, probably, would be whomever checks the child is somebody who's really interested in children and has experience seeing them."

Eye Detective

Last year, the Haskelson family connected with Dr. Thau. She told Sofia to think of her as an "eye detective" putting together clues, Rosanne recalls. The thorough history included questions about the family members' vision, Sofia's birth and even issues of her posture while sitting. Then came the in-depth eye exams, which revealed a constellation of issues.

"In addition to being near-sighted, Sofia had difficulty using her eyes together as a team," Thau explains. "Her eyes aimed closer than objects were. This caused eyestrain, as she had to exert a lot of effort to maintain clear and single vision when reading." Her diagnosis was "convergence excess" – not something that would be picked up on a routine eye exam.

Besides getting eyeglasses and being fitted with one-day, disposable contact lenses, Thau says, "Sofia underwent optometric vision therapy to train her eyes and brain to work together more efficiently."

The therapy, along with Sofia's hard work these past months, is paying off. "It's made a huge difference in her academic world," Rosanne says. She's proud that Sofia made the principal's honor roll every quarter of her seventh-grade school year.

Teachers and school specialists told the family Sofia was doing well and didn't seem to need extra help anymore. "I was apprehensive; I was nervous," her mother says. But with her vision problems identified and corrected, Sofia can now be more independent at school.

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