Seeing is Believing

1. Seeing is Believing

2. The Importance of Good Vision for Children Dr. Teri Geist, OD Nebraska Optometric Association

3. Good Vision Means Better Learning • Vision is a dominant process in growth, development and daily performance of children • Undetected, untreated vision problems can interfere with students’ learning potential. Nearly 75% of the school day is spent on visual activities. • Vision disorders are 4th most common disability in U.S. Courtesy of AOA Clinical Practice Guidelines on Pediatric Examination

4. Good Vision Means Better Learning • Only 15% of children have had an eye exam by age 5 • Only half of all children will have an eye examination before completing high school • 75,000 3-year-olds develop amblyopia each year • Vision deficiencies in school age children are often misidentified as behavior or social problems, which my put the child into the wrong “treatment track”. • More than 75% of juvenile offenders have undetected and untreated vision problems. Courtesy of AOA Clinical Practice Guidelines on Pediatric Examination

5. Statistics • 60% of students identified as problem learners have undetected vision problems. • Based on that, as many as 4,500 Nebraska children enter school each year with vision problems significant enough to hinder their ability to learn!! Statistics courtesy of AOA

6. Role of Vision In Learning • Vision occurs in the brain, not in the eyes • The eyes must see clearly, without double vision, and with accurate focus control • The brain must interpret the visual image from its background, make assumptions as to its figure, and integrate the information gathered from peripheral vision and from other senses • A child must have visual ability to learn to read prior to reading to learn

7. Signs of a Visually Related Learning Problem Frequent rubbing of the eyes Frequent blinking of the eyes Short attention span or frequent daydreaming Poor reading Avoiding close work Frequent headaches A drop in scholastic or sports performance

8. Signs of a Visually Related Learning Problem Continued Covering one eye Tilting the head Squinting one or both eyes Placing head close to book or desk when reading or writing Difficulty remembering, identifying and reproducing geometric forms Poor eye-hand coordination skills

9. What is good vision? Good vision includes: • Visual acuity • Eye health • Eye teaming • Eye focusing • Eye motility

10. Vision Screenings • Designed to identify gross visual problems and to indicate the immediate need for an eye examination. Parents must follow through on the referral. • Most children who fail a vision screening will also fail a diagnostic professional examination

11. Visual Acuity How clearly one sees • Near vision- the ability to see at 8 -16 inches (reading a book) • Intermediate vision- the ability to see at 16 -40 inches (computer distance) • Distance vision- the ability to see at 10 feet or more • 20/20 indicates that you can see letters 3/8” high at 20 feet

12. Components of Visual Screenings Distance Visual Acuity • Purpose-To test for myopia, amblyopia, astigmatism, and high hyperopia • Equipment-Distance VA chart and Occluder • Visual Acuity Charts Include: • Snellen Chart • Tumbling E chart • Lea symbols

13. Snellen Chart & Tumbling E Photos Courtesy of POA

14. Near Visual Acuity • Purpose- To test for hyperopia, astigmatism, amblyopia, and focusing problems • Equipment- Near Acuity Cards and Occluder • Near Acuity Cards include: • Snellen • Lighthouse acuity • Lea Cards • Tumbling E

15. Near point cards Photos courtesy of POA

16. LEA Symbol Charts Photos courtesy of POA

19. Eye Teaming Ability of the eyes to: • work properly together • to coordinate and align both eyes to allow brain to fuse a single image from the images it receives from each eye • to judge relative distances of objects and have depth perception • to converge on something near by turning towards each other

20. Eye Focusing • The ability of the eyes to focus and shift focus to near and distant points accurately and efficiently Eye Motility • The ability of the eyes to move from one point to another • The ability of the eyes to move across a page of print or to follow a ball, etc…

21. Myopia (Nearsightedness) • The inability to see distant things well • The eye is too long for the normal focusing power of the eye • Symptoms include: • Squints • Gets close to the board

22. Hyperopia (farsightedness) • The ability to see at all distances with additional focusing effort • Eyeball is too short for normal focusing power of the eye • In children the lens can focus and accommodate through this error providing both clear distance and near vision, but much effort must be used. This can cause headaches, fatigue, and even crossed eyes. • Symptoms Include: • Rubs Eyes • Has watery eyes • Complains of blurred vision

23. Astigmatism • Results from an irregular shape of the front surface of the cornea. • The eye is more football shaped rather than round • Causes blurred vision for distant and close-up things • Symptoms include: • Rubs eyes • Has watery eyes • Complains of blurred vision

24. Strabismus • Occurs when the eyes are not aligned when viewing an object • The eye may turn inward toward the nose (esotropia) or outward toward the side (exotropia) • This is usually caused by poor muscle control • An eye turn can happen constantly or occasionally

25. Esotropia

26. Exotropia

27. Symptoms of Strabismus • Intermittent double vision • Closes or covers one eye • Says letters or words appear to move • Loses place • Is Inattentive • Rubs eyes • Has watery eyes • Complains of blurred vision • Has poor reading comprehension

28. Accommodative & Binocular Disorders • Accommodative- The eyes cannot focus well • The inability to contract or relax the eyes’ focusing muscles efficiently • Binocular – The eyes do not work well as a team; for example, the eyes cannot converge for up-close reading

29. Accommodative Symptoms • Headaches • Tired at the end of the day • Has blurred vision when looking from board to book or book to board • Holds things very close • Is Inattentive • Rubs eyes • Has watery eyes • Complains of blurred vision • Has poor reading comprehension

30. Binocular Disorder Symptoms • Headaches • Fatigue • Double vision • Blurriness • Watery eyes • Rubs Eyes • Is Inattentive • Loses place • Says Letters or words appear to move

31. Amblyopia • Also known as “lazy eye” • Reduced vision in an eye that was not stimulated in early childhood • Can result from strabismus or misaligned eyes or a difference in clarity between the two eyes • One eye is focusing better than the other one • One eye becomes stronger from its use and the other eye is suppressed and not worked hard enough

32. Color Vision Test • Detects difficulty in ability to recognize color • Children with color deficit are not actually blind to color, but simply have difficulty identifying and distinguishing between different colors • Color Deficiencies are usually hereditary and affect 1 in 12 boys but only 1 in 200 girls

33. Color Vision Tests Photos courtesy of POA

34. Color Vision Test • Equipment: • Occluder • Pseudo-Isochromatic Test Plates • Referral Criteria • Student fails if does not correctly identify the image on the card Photos courtesy of POA

35. Convex Lens Test • Detects large amounts of hyperopia • Equipment • Age-appropriate distance acuity charts • Occluder • Pair of +2.25 Spherical Lens (ages 5-8) • Pair of +1.75 Spherical Lens(>age 8)

36. Convex Lens Test Referral Criteria • If the student cannot read the 20/40 line while wearing the lenses then he/she has passed the test • If the student can read the 20/40 line while wearing the lenses then the student has failed and should be referred.

37. Stereo/Depth Test • Tests for amblyopia, strabismus, and binocularity • Equipment • Random Dot E • Stereofly • Random Dot Stereotest

38. Stereotests Photos courtesy of POA

39. Random Dot E & Polarized Glasses Photos courtesy of POA

40. Cover Test • Tests for ocular alignment disorders, strabismus, and binocular problems • Done both at distance and near • Unilateral cover test • Movement on Unilateral cover test = strabismus • No movement on unilateral cover test = normal • Alternate Cover Test • Movement on Alternate cover test = Strabismus or binocular problem, depending on severity • No movement on alternate cover test = normal

41. Near Point of Convergence • Tests the ability of the eyes to converge for up-close tasks • If the eyes cannot effectively converge for near vision tasks, then the patient has convergence insufficiency • Equipment • Near Point fixation stick • Tape Measure Photos courtesy of POA

42. Symptoms of Children Struggling in the Classroom • Trouble finishing written assignments • Losing their place when reading • Having a short attention span when doing close work • Skipping words when reading • Making errors when copying from the board • Underperforming

43. Eye Health • The absence of anomaly or disease • If not diagnosed or treated, eye disease can lead to vision loss or impaired vision • Ocular health is evaluated by external ocular examination with a biomicroscope, eye pressure evaluation, and a retina exam

44. The Current Lawwww.NECHILDRENSVISION.org • Took effect in 2006-07 school year • Within 6 months of enrollment • Distance and Near Acuity • Amblyopia/Strabismus • External and Internal Eye Health

45. Cost of Neglecting the Problem • Increased school failure and drop out rates • Inappropriate learning disability referrals • Loss of self esteem and motivation • Increased behavior problems • Long term increase in illiteracy, joblessness • and crime

46. Learning Preparedness • If a child cannot see, • a child cannot read, • and if a child cannot read, • a child cannot learn.

47. Good Vision = Good Education nechildrensvision.org