During the last year of increased remote learning, children are using digital devices more than ever at home and in the classroom. The consequences on the visual system have been so alarming that the American Optometric Association (AOA) launched an Emergency Children’s Vision Summitwith members of Congress in March 2021. Here are four of the many reasons why it is important for all school-aged children to have a comprehensive eye exam.
1. Children can’t always tell when there is a vision problem
Children are surprisingly resilient and adaptable to their environment. When a young child has blurry or double vision, they may not recognize an issue because that is the only vision they know; They think everyone else sees that way too. When only one eye sees poorly, the child might not be able to notice the difference until covering an eye while reading the eye chart. Since remote learning has become commonplace, kids are looking at a computer screen up close, rather than a board at the front of the room. This has made it more difficult for some children to notice changes to his or her distance vision.
Squinting, excessive blinking, rubbing eyes, and closing or covering an eye are all signs of a potential vision problem. However, some children do not show any signs even when there truly is a visual issue.
Having normal vision means more than reading 20/20 on the eye chart. It is not uncommon for a child to be hyperactive and have a short attention span if there is an untreated vision problem. Blurry vision, double vision, or trouble with eye alignment and tracking (smooth movements of eyes) can hinder a child’s reading ability, which may be misinterpreted as a learning disability. Toddlers can be misdiagnosed with developmental delays when the source of the problem is the eyes.
2. Increased visual demand (especially on digital devices!)
Since the pandemic, children have spent more time on a digital device with prolonged periods during the school day. Research studies1,2,3 across the world have concluded there is an increase in myopia progression in school-aged children since home confinement in early 2020. Myopia progression is an ongoing, worldwide problem that is making children, teenagers, and young adults more nearsighted. Worsening myopia increases the risk of ocular problems, including retinal detachment, cataracts, and glaucoma.
The visual demand and screen time for an 8-year-old is now more comparable to that of an older student. Hours of screen time and blue light exposure can cause symptoms of headaches, blurred vision, eyestrain, and dry eyes for some people. Eye doctors are seeing dry eye syndrome in children, which is an atypical finding for healthy kids. Blue light protection is available for symptomatic children, no matter whether or not they already wear glasses.
In addition to the use of digital devices, children also have an increased visual demand with competitive sports becoming more popular. Active kids and teenagers are great candidates for contact lenses with the proper instruction and guidance. Sports glasses are another beneficial option to help protect the eyes, while providing clear vision. Many kids tend to simply not wear any correction during sports, which limits depth perception and binocular vision. This can be detrimental to hand-eye coordination skills, and therefore, overall sports performance.
3. Early detection is key in many childhood eye conditions
Between the ages of birth to 6 years old, the eyes are developing at a rapid pace. Any constant and significant disturbance to the eyes during that time can lead to amblyopia. Amblyopia is a condition in which the best corrected vision is worse than 20/20 in either one or both eyes, due to poor development during childhood. This can be caused by strabismus (eye turned in or outward), high refractive error (nearsighted, farsighted, astigmatism), or occlusion/deprivation (droopy eyelid or cataractblocking vision). If not treated at a young age, the poor vision is permanent through adulthood. Unfortunately, there are little to no signs of amblyopia unless a significant eye turn is present.
Many vision problems can be misdiagnosed as ADHD, dyslexia, behavioral problems, or learning disability. If a child is having problems in the classroom setting, an eye exam should be included in the list of to-dos. When undiagnosed vision problems occur, it can alter the entire trajectory of a child’s life into adulthood. Poor literacy affects self-esteem and learning ability, which is crucial in future education, careers, and interactions with others.
4. Vision screenings are not the same as a comprehensive eye exam
A vision screening at school or the pediatrician’s office is not a substitute for a comprehensive eye exam. While vision screenings should catch big problems with vision, other aspects of eye health are not assessed. Hyperopia (farsightedness) can be easily missed during a vision screening, if not severe. Even mild cases of hyperopia can negatively impact a child’s ability to comfortably read at near. Eye alignment, eye teaming (how well the eyes work together), accommodation (how well the eyes focus), and eye tracking (how well the eyes move during reading) are all important components of healthy vision.
Here are some examples (from the AOA) of what these conditions might look like to a child:
According to the American Optometric Association, a child’s first eye exam is recommended between 6 to 12 months of age. If there is a low risk of developing eye or vision problems, the child should be seen again at least once between 3 to 5 years of age, before first grade, and annually thereafter. If the child is at high risk for developing eye or vision problems, the eye doctor will determine the appropriate follow-up time based on the situation. If your child is due for an eye exam, please call our office (717-652-7710) or schedule online. Dr. O’Neal received additional certification for her concentrated studies in pediatrics. She would love to examine your children’s eyes!
