Many parents are under the impression that the vision screening their children receive from the school nurse or at the pediatrician's office is sifficient. There are no set standards or criteria for passing a vision screening; and a vision screening can give a parent a false sense of security.
Current vision screening methods cannot be relied upon to effectively identify individuals in need of vision care. In some cases, a vision screening may actually serve as an unnecessary barrier to an early diagnosis of vision problems. They can create a false sense of security for those individuals who "pass" the screening, but who actually have a vision problem, thereby delaying further examination and treatment.
To understand why vision screenings may not find a vision problem, we need to look at the factors that can limit their effectiveness.
- Many vision screenings test only for distance visual acuity. While the ability to see clearly in the distance is important, it does not give any indication of how well the eyes focus up close, or work together. It also does not give any information about the health of the eyes.
Some screenings may also include a plus lens test for farsightedness and a test of eye coordination. However, even these additional screening tests will fail to detect many vision problems.
- Often times a vision screening is conducted by administrative personnel or volunteers who have little training. While well intentioned, these individuals do not have the knowledge to competently assess screening results.
Inadequate testing equipment
- Even when done in a pediatricians' or primary care physicians' office, the scope of vision screening may be limited by the type of testing equipment available. Factors such as room lighting, testing distances and maintenance of the testing equipment can also affect test results.
Undetected and untreated vision problems can interfere with a child's ability to learn in school and participation in sports or with an adult's ability to do their job or to drive safely. The earlier a vision problem is diagnosed and treated, the less it will impact an individual's quality of life.
According to a study published by the American Academy of Pediatrics, vision screenings were attempted on fewer than 60% of the three-year old children in pediatricians' offices. They found that in general, the younger the child, the less likely it was that a vision screening was attempted. An attempt was defined as 10 or more seconds spent trying to get the child to cooperate with a vision screening.
The purpose of a vision screening is to diagnose "gross abnormalities" in distance vision. Vision screenings are a limited process and cannot be used to diagnose an eye or vision problem, but rather to indicate a potential need for further evaluation. Additionally, screenings do not typically include any sort of test for near vision; which is the vision used when drawing, coloring, putting puzzles together and in the classroom.
Just as children should visit the pediatrician and the dentist, they should also see a licensed eye care provider for a Learning Related Vision Examination. A pediatric Learning Related Vision Examination differs from a typical eye exam because it includes testing and evaluation of visual skills in addition to visual acuity.
Pediatric Learning Related Eye Examinations are performed by a Pediatric Optometrist and include the following:
- Acuity - Distance Vision: visual acuity (sharpness, clearness) at 20 foot distance.
- Acuity - Near Vision: visual acuity for short distance (specifically, reading distance).
- Focusing Skills: the ability of the eyes to maintain clear vision at varying distances.
- Eye Tracking and Fixation Skills: the ability of the eyes to look at and accurately follow an object; this includes the ability to move the eyes across a sheet of paper while reading.
- Binocular Vision or Fusion: the ability to use both eyes together at the same time.
- Stereopis: binocular (two-eyed) depth perception.
- Convergence and Eye Teaming Skills: the ability of the eyes to aim, move and work as a coordinated team.
- Color Vision: the ability to differentiate colors.
- Reversal Frequency: confusing letters or words (b,d; p,q; saw, was; etc).
- Evaluation of age-appropriate vision skills.
- Visual Memory: the ability to store and retrieve visual information.
- Visual Form Discrimination: the ability to determine if two shapes, colors, sizes, position, or distances are the same or different.
- Visual Motor Integration: the ability to combine visual input with other sensory input (hand and body movements, balance, hearing, etc); the ability to transform images from a vertical to a horizontal plane (such as from the blackboard to the desk surface).
Remember, an eye exam that tests distance vision only is NOT an adequate evaluation of a child's visual development. The visual skills listed above contribute significantly to a child's success with reading and academic achievement.
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