Vision Exams for Children Prior To Entering School

by National Commission on Vision and Health

Undetected and untreated eye disorders, such as amblyopia and strabismus, can result in delayed reading and poorer outcomes in school. Studies indicate that visual factors are better predictors of academic success than race or socioeconomic status. However, one in four school-age children suffers from vision problems that could have been treated if the child had been properly screened upon entering school.

Studies show that while prevalence rates vary between demographic groups, there is an increasing need for eye care among children.

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Vision Screening

The Vision Intervention Program at the Youth ChalleNGe High School in Bend, Oregon

By Willard Bleything OD, MS, and Sandra Landis, OD

In 1993, Congress authorized the National Guard to conduct alternative schools for the high school drop out population – a group now recognized as a key public concern.

As can be expected, learning disabilities are a common characteristic in this special population. Of particular significance to this project is the research that has shown visual dysfunction to be a key risk factor in learning disabilities, especially reading skills.

A pilot project at the Youth ChalleNGe High School (YCHS) in Bend was completed in 2004. Forty percent of the students enrolled in this program demonstrated a definite need for professional eye/vision care.

Based upon what we learned in 2004, the aim of the current project is to design a novel, institution-based vision intervention for treating visual dysfunction in the high school drop out population. Specifically, we are working with YCHS - Bend students that were found during a vision screening to need professional visual care. Our goal is to treat the visual dysfunction thus eliminating or reducing this risk factor in learning.

Methodology: A vision screening, initiated by the Children’s Vision Foundation, started the process. This screening was timed to coincide with the start of the academic portion of the YCHS program. Fifty-six of the126 (44%) students who participated were found to need professional vision care. Eye/vision exams were done by a group of volunteer optometrists from Lane and Washington Counties and from Pacific University College of Optometry over a weekend by utilizing office space provided by a local optometry clinic. Of the 56 students examined, 36 were in need of a new lens Rx. Prescription glasses were furnished free to the students via an anonymous donor. Along with basic refractive problems including nearsightedness, farsightedness, and astigmatism, other visual dysfunctions included problems with eye movements, two-eyed coordination, near-far focusing, and visual information processing. These visual skills are basic to reading success and academic achievement and optometric vision therapy is the treatment of choice for dysfunctions of this nature.

Twenty-four of the students were placed into a vision therapy with each student receiving 60 minutes of therapy twice a week. Half of each hour is devoted to developing basic visual skills (near/far focusing, two-eyed coordination, eye movements) and half is devoted to enhancing visual information processing skills.

Staffing: The Children’s Vision Foundation, which is staffed by community volunteers, provided the initial vision screening. Volunteer optometrists from throughout the state staffed the pre- and post-testing examinations. Vision therapy is provided on-site through a combination of contract therapists and a community volunteer.

Dr. Sandra Landis is a volunteer serving as Clinical Director for the program, and Dr. Willard Bleything is a volunteer serving as overall Project Director.

Benchmark Measures: Care was taken to conduct a standard vision screening with established national norms. Tests for clarity of vision, refractive status, eye coordination, and eye movements were included. A test of visual information processing was also part of the initial assessment. Perhaps the most dramatic finding was this discovery: 99 of the 126 students (78%) fell in the lowest 25th percentile on the visual information processing test. This is a key finding because visual information processing skills along with eye movements skills have been found to have the most direct (visual) connection to reading ability.

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Two Surprising Causes of Photophobia

By: Greg Mischio

Photophobia is a sensitivity or intolerance of light, and it can cause people to avoid sunlight, computers, fluorescent lights and car headlights. Instead of altering their life to avoid the stimuli that provokes light sensitivity, people should address the underlying cause of photophobia.

Our guess is that in many cases, people aren't aware of two surprising reasons for a person's light sensitivity:

1. Poor binocular vision
2. Accommodation

In case you’re not familiar with the terms, binocular vision is the process by which your two eyes work together to produce 3D vision. Accommodation is the process by which your eye changes its optical power to maintain a clear image or focus on an object as its distance changes.

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Vision Issues in Foster Children. A remarkable progress after Vision Therapy

By Dr. Larry Lefors

This is the story of one of our foster care children who was adopted by the time the following events unfolded.

After three months of weekly in-clinic therapy the child’s vision greatly improved and her school performance began to improve as well. The child was delighted by how much easier it was to read.

The Infant SEE program (www.InfantSee.org) could have caught many of the vision problems of this Washington child and tens of thousands more while the children were infants. If the optometrists in our community and throughout our state checked carefully for focusing and tracking problems, and our children received early treatment for vision dysfunctions fewer of our children would be in special education, others would have better school performance and many would have fewer, or less severe, behavioral problems

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A letter from a foster mother

"We are sworn believers in advanced eye care and vision therapy."

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Underreporting of Concussions and ConcussionLike Symptoms in Female High School Athletes

by Tracy McDonald, MSN, RN / Mark A. Burghart, MOT / Niaman Nazir, MD, MPH

ABSTRACT

Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.

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K. David Epley, M.D. about the vision screenings recommended by the American Academy of Pediatrics.

"Some states have vision screening laws, like Washington, but no states mandate screening in preschoolers at this point. The AAP recommends vision screening but only around 50% of pediatricians actually do this."

    K. David Epley, M.D.
    Children's Eye Care, PLLC

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To find out more about Dr. Epley and his work, visit his website at: www.childrenseyecare.org

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Professor Maino's letter of support

"...Children cannot learn if their vision information processing systems are malfunctioning. Many of these children already have several other hurtles they must overcome to be successful. Let’s make sure that learning related vision problems are not added to that list."

    Dominick M. Maino, OD, MEd, FAAO, FCOVD
    Professor of Pediatrics/Binocular Vision
    Illinois Eye Institute/Illinois College of Optometry

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Dr. Power's letter of support

"...current practices in school and (sadly) often also in doctor's offices do not identify reading-related vision problems. And as you have said - and our data support this assertion - foster children, children of color, juvenile offenders, and children living in poverty are more likely to have vision problems than others. "

    Maureen Powers, Ph.D.
    Senior Scientist

Vision Case Studies of Students in California Schools, Grades 3 through 10

40% of 3721 students tested in two school districts, a charter high school, and an after school program experience significant discomfort while reading or trying to study. Research shows that having symptoms like these correlates significantly with low reading fluency scores. Other research shows about 10% of these students need full eye exams and possible visual correction. The remainder passed school screening and would never be made aware that their visual system - a physical problem – could be holding them back from faster and more efficient reading. Current school vision screening will catch only about ¼ of these children – the rest will continue to be uncomfortable or actually see words wiggle around or come in and out of focus while trying to read.

No wonder they quit reading!
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To find out more about Dr. Powers and her work, visit her website at: www.eyesinconflict.org

Increasing driving vision safety with Dr. Floyd Mizener

Jim Edgar appointed Dr. Floyd Mizener as Chairman of his Vision Advisory Committee. As a result of the work of this committee, three Optometrists and three Ophthalmologists, the changes it made in the vision screening in Illinois were dynamic, thereby increasing driving vision safety. The number of fatalities has continually been reducing since 1982 (2,800 annually then) to 964 fatalities last year, with two million more drivers on Illinois roads.

To further reduce vision driving errors, the House of Representatives passed a Resolution developed by Lion Dr. Floyd Mizener and proposed by State Representative Patti Bellow HR 0385 in May of 2015 to encourage an annual professional eye and visual examination which would include testing of peripheral vision, binocular vision, depth perception and care for the protection of dangerous sun and halo glare. The Rules of the Road carries a statement that a vision screening is not an eye examination. Illinois’ Vision Testing example has filtered to other states and countries. Every life saved is important.

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Dr. Pellicer’s Letter to DSHS Children’s Administration Administrators & Staff

July 25, 2013

As a family physician in the state of Washington, I am writing to express my deep concern and alarm as I have learned about a huge hidden epidemic of undiagnosed vision problems in our children. Due to a long standing system failure, most children in our state do not get examined or even screened for binocular dysfunctions.

We do screen for distance vision with the Snellen chart but this does NOT screen for binocular dysfunctions (an inability of the eyes to work together and function well at close range which is needed for reading). Shockingly, in most of the screenings that I am aware of 25-30% of children have some level of binocular dysfunction. Yes, 25-30% of our school age children have a vision problem that is preventing them from being able to learn properly as about 80% of learning occurs through the visual system. What’s more this problem is treatable in the majority of cases, but not with glasses or surgery.

In studies of children who are placed in special education classes, other remedial education classes and those identified as juvenile offenders the rates of binocular dysfunction are between 50-70%. These children have a correctable vision problem that is now being totally missed by the health care and educational systems. And I think it is safe to say that at least some of their problems of failure to thrive in society and in the education system are due to an inability of their eyes to function well together, a skill that is mandatory for negotiating the educational system.

Now that this problem is being brought to our attention, I feel it is vital that we take action and correct our societal oversight that has such devastating effects for this huge segment of our school age population. Certainly any child at risk, including all foster children, children with special needs, children in any type of special education or struggling in school and all juvenile offenders need to have a comprehensive vision exam by a developmental optometrist who has the ongoing experience and expertise in diagnosing all the binocular dysfunctions.

I urge you as members of the children’s administration, who’s important mission is to identify the needs of children and assure their safety and well-being, to become aware of this overlooked problem of binocular dysfunction in our children and use your talents and skills to be a part of the solution.

Thank you,
Mary Pellicer, MD

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WA State issued new vision screening requirements effective 7/1/17 to address vision issues in children: View the new legislation here

Katie Johnson’s Letter of Support

February 12, 2012

To Whom It May Concern:

Children in even an affluent district have eye-tracking and eye-teaming problems which are only accidentally discovered. In my teaching life I have had about 30% of regular education students who needed intervention by a developmental optometrist; in groups of children who are already targeted as non-readers, I have had up to 70% of children who needed vision help.

As a teacher of reading in grades 1-6 for nine years (in the Washington state Learning Assistance Program) and as a teacher of �rst grade and Kindergarten for the past six years in the Shoreline (WA) school district (after 18 years teaching �rst grade in Maine), I have seen many puzzling children. These are the children who ought to be able to read and can’t.

I have studied with developmental movement and vision therapists to try to begin to understand what to look for and whom to refer for what. During these past �fteen years I have developed a set of movement and vision activities and exercises to help teachers with their puzzling children.

(I have published these in my latest book, Red Flags for Primary Teachers: Vision and Neurodevelopmental Issues and What to Do About Them.)

I wholeheartedly support the possibility of a focus on developing a vision screening system for ALL children of school age. Children, and teachers, become very discouraged when there does not seem to be a reason for their failure with teaching and learning reading.

It would be wonderful for children and for teachers if initiatives in Washington State could come to fruition. I hope that Microsoft will give serious consideration to the idea of a symposium in 2014 on vision and learning/education, to begin this much-needed process. Thank you for your attention.

Sincerely yours,
Katie Johnson
Teacher

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WA State issued new vision screening requirements effective 7/1/17 to address vision issues in children: View the new legislation here

Foster Children are Especially at Risk for Poor Vision Care; Negligent Parents Fail to Promote Good Vision Skills

September 11, 2017

My daughter is a foster parent and I see firsthand the problems foster children have.

Larry Lefors, DO
Zillah, WA

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Vision Problems in Children

An Examination of the Vision Problems and Access to Vision Services among Children in Washington

Prepared by: AMERICORPS CHILD VISION PROJECT/2010-2012

Summary


Vision problems are prevalent worldwide and in the United States, and can be extremely detrimental to children. There is high prevalence of vision problems among children in the United States across ethnic and socioeconomic groups. Vision screening and comprehensive vision exams are both important methods to catch undiagnosed vision problems. However, not every child has access to vision screenings and even fewer have regular access to comprehensive vision exams.

Three types of vision problems affect children: eye health problems, vision acuity problems, and binocular vision problems. Vision problems can cause learning problems because of the way in which the visual system is used for academic performance. Children who cannot see well may have difficulties with schoolwork. Visual factors have been found to be a better predictor of academic factors than race or socioeconomic status. In order to prevent vision related learning problems early detection and treatment is important. It is important to do this early before a child gets behind in school. There needs to be more advocacy and research to address vision problems, which can have lasting and widespread consequences if left untreated.

Untreated vision problems can be costly. There can be enormous costs to education that could potentially be saved by early detection and treatment. However, cost can also be prohibitive to people looking for vision services, and this must be addressed so that individuals are able to adequately treat their vision problems. The costs of ignoring the problem can have high societal costs in addition to costs to an individual’s quality of life. Vision problems can complicate co-existing conditions and increase the expense of addressing these conditions as well. One way to combat the costs of undetected vision problems is by increasing access to vision services.

Certain populations may be at higher risk for not having access to vision services, thus leading to undetected vision problems. One in particular is foster children. In addition, rural communities have less access to vision services. Native Americans have high rates of undetected vision problems.

A solution to address this issue may be to integrate vision care into existing services. The AmeriCorps Child Vision Project is an example of how this can be done. The program was created in 2010 to work with caseworkers and foster families to help facilitate access to vision services. It was found that 44% of children had undetected vision problems. This is similar to a 2000 study of foster children in New York City that found that 44.4% of foster children had undetected vision problems. These figures exemplify the importance of programs that increase access to vision services for needed populations


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Visual Impediments to Learning - A Study from Canada

By Noëlla Piquette, PhD, University of Lethbridge, Lethbridge, Alberta, Canada
Charles Boulet, OD, Black Diamond, Alberta, Canada

ABSTRACT

Cognition, learning, and motor planning are dependent upon accurate encoding of stimuli from the environment. If there is an error in, or an impediment to, sensory perception, higher cognitive functions, such as reading, memory, emotional awareness, and impulse control can be affected.

In schools, deficiencies of the visual process impede and impair reading acquisition and learning and influence other behavior. Children are affected by different types of functional impediments to eyesight and visual function. The degree to which children are impacted varies according to the depth and nature of the impediments present, and to some degree to socioeconomic status. Some children are at a greater disadvantage simply because of the greater visual demands of the neo-traditional classroom.

These visual impediments to learning (VIL) are rarely detected in common sight screenings and are associated with limited socioeconomic success and increased criminality. Significant VIL limit academic and life outcomes, with some ethnicities affected by a greater prevalence of reading-impairing impediments. This presents difficulties for various public agencies at all levels of government. To complicate matters further, children who are affected by vision difficulties will most often not report the problem, nor will VIL be detected during standard pediatric or psychoeducational assessment.

VIL are described in brief, as is how they alter children’s academic outcomes, health, and behavior. A model of sufficient vision care in the prevention and management of most vision-related learning and behavioral difficulties is proposed. The position is advanced that ensuring adequate vision management for children entering the 12-year academic cycle is a matter of fundamental human rights.

...clinical and epidemiological studies will show that reduced distance acuity due to myopia is not associated with reading delays, and this is consistent with other findings. It is also clear that low to moderate levels of myopia present as a relative advantage in the classroom compared to hyperopia, even though hyperopia is much less likely to be detected in rarified vision checks. Children with astigmatism, hyperopia, and other nonmyopic visual difficulties, and who can still read distance eye charts, can and do struggle with reading. Consider that children who cannot see clearly at a distance are much more likely to be myopic than hyperopic. For example, a child who is farsighted by two diopters will pass a distance acuity check, while a two-diopter myope will see blurred lines. However, the hyperopic child is much more likely to struggle academically.

Keywords: ADHD, ethnicity, human rights, learning disability, public health policy, vision, visual impediments to learning

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Recommendations for the new EYE Center for Children’s Vision, Learning & Technology at the University of Washington Bothell

Presented by Dr. Kathleen Ross, snjm, President Emerita of Heritage University;
Rhonda Stone, Author, The Light Barrier (St. Martin's Press 2002 & 2003);
Katie Johnson, Retired Teacher and Author;
Mary Pellicer, MD, May 2017

Summary
A Center for Vision, Learning and Technology is critical if we are to address the vision needs of our population. The narrow medical model/question, "is the eye healthy?", is inadequate to assure that children and youth are able to read comfortably and with good comprehension. The appropriate and accepted standard is what constitutes a "well child."

A Center will develop a clear and verifiable definition for convergence insufficiency and then develop reliable data for just how common this particular problem is. Other eye coordination issues can also be identified and quantified. The effectiveness of computer treatment programs and other vision therapy will be studied until there is agreement on what procedures are most helpful.

The work of an independent Center, not affiliated with an optometry school, will provide needed credibility to this work.

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To learn more about the Center for Vision, Learning and Technology at UW in Bothell and it's projets, visit: www.educatingyoungeyes.org

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The scientific basis for and efficacy of optometric vision therapy in nonstrabismic accommodative and vergence disorders

by Kenneth J. Ciuffreda, O.D., Ph.D.

State University of New York, State College of Optometry, Department of Vision Sciences, New York, New York

Summary

Background: For nearly 75 years, optometric vision therapy has been an important mode of therapy for both children and adults who manifested a range of nonstrabismic accommodative and vergence disorders.

Methods: In this article, the scientific basis for, and efficacy of, optometric vision therapy in such patients will be discussed. Using bio-engineering models of the oculomotor system as the conceptual framework, emphasis will be focused on studies that used objective recording techniques to directly assess therapeutically related changes in oculomotor responsivity.

Results and Conclusions: The findings clearly support the validity of optometric vision therapy. Furthermore, the results are consistent with the tenets of general motor learning. Key Words: Accommodation, behavior modification, motor learning, oculomotor plasticity, oculomotor responsivity, vergence, vision therapy

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Vision and Audiology Status of Foster Children in New York City

by Trudy Festinger, D.S.W. & Robert Duckman, O.D., M.A

Abstract

Between January, 1998, and July, 1999, 351 children in foster care placements in New York City received comprehensive visionexaminations. Onehundredandfiveof these children also received a hearing evaluation. The children from one of the sites (St.Christopher-Otillie, Brooklyn)were also examined in the audiology department of Brooklyn Hospital. The children were the charge of three different agencies at four sites. The aim of the study was to investigate the visual status of children in foster care placements and whether or not those children with significantvisualproblems were being identified and followed. Visual acuity, ocular motor function, refractive error, ocular health status, eye vergence skills and stereopsis were evaluated in the vision examinations. Anomalies were rated mild, moderate and severe, newly or previously identified and whether they were likely or not likely to have been present one year earlier (the time of their last physical). In all areas tested, children in foster care had higher prevalences of visual and audiological anomalies, than their «normal» counterparts. Theresultsindicatethatthevisionandaudiological screenings now being provided tothesechildrenattheirmandatedannual physical examination, are not sufficiently identifying children with moderate or severevisionandaudiologicaldysfunctions.

Key Words: foster children, vision, audiology, refractive error, visual acuity, convergence, stereopsis, ocular motor function

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Optometry Community Outreach EyeVan

by Pacific University College of Optometry

Abstract

Pacific University College of Optometry Community Outreach program provides vision screenings, examinations and education to the community.

Vision screenings are performed at head start preschools, elementary schools, vineyards, migrant camps, health fairs and other locations. The mobile EyeVan is utilized for vision assessments throughout the community.

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