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Vision screenings should start well before school age to catch problems

September 07, 2018
Maylen Cabrera, 7
Maylen Cabrera, 7, gets an eye exam at the Storm Eye Institute. Photo by Sarah Pack

As parents and children settle into the new school year, there’s one aspect of health that shouldn’t be forgotten amid the avalanche of forms and fees and sign-ups — their vision. 

South Carolina doesn’t mandate vision screening for children entering school, but the state Department of Health and Environmental Control does recommend that a child’s doctor conduct a vision screening test prior to Head Start, pre-K, kindergarten or first grade. DHEC also recommends that school nurses conduct mass screenings for kids starting kindergarten; in first, second, third, fifth and seventh grades; and once in high school. 

Early vision screenings can catch problems while eye specialists can still correct them, said Millicent Peterseim, M.D., the Bruce G. Pratt, D.V.M. endowed chair in international ophthalmology at the Storm Eye Institute. 

It’s particularly important that young children have their vision tested in each eye. Amblyopia, often called lazy eye, is a condition in which vision in one eye doesn’t develop properly because that eye doesn’t communicate well with the brain. About 2 to 4 percent of children have this condition, which can’t be treated well after age 7, Peterseim said. In fact, it’s the No. 1 cause of single-eye problems in working age adults, she said. But parents aren’t likely to pick up on the problem because the child compensates with the stronger eye and seems to be able to see just fine. 

“Nobody knows it unless you check the vision in each eye individually,” she said. 

“The sad thing is when we see kids who are 8 or 9 and they say, ‘Oh I thought everybody had one good eye and one bad eye,’ and they’ve already passed the age of most effective treatment,” Peterseim said. 

Young children can have their vision checked with automated vision screeners. Storm Eye evaluates some of those screeners, which operate similar to a camera taking a picture of the eyes. Using the red reflex, they judge how straight the eyes are and estimate an eyeglass prescription. The screener can then refer the child for an eye exam if needed. 

Peterseim said either an ophthalmologist or optometrist can conduct the eye exam — the most important thing is to find a well-qualified doctor who is comfortable working with children. 

The American Academy of Pediatrics now recommends that pediatricians use the automated vision screeners on patients beginning at age 1, Peterseim said. In addition, young children beginning at about age 3 can take an eye test with a chart that uses pictograms instead of letters. 

Some nonprofits work to fill the gaps by providing eye exams. The Association for the Blind and Visually Impaired Charleston conducts vision screenings and exams at pre-K programs in 22 Charleston County schools. The Lions Club conducts screenings in Summerville-area schools. 

Teachers are likely to notice when children start having trouble seeing the board, and Peterseim said nearsightedness, or myopia, begins to develop around the ages of 8, 9 and 10. Though genetics are at play, environmental factors also have a hand in nearsightedness, with recent studies indicating the amount of time spent outdoors may play a role. 

“We really don’t understand the etiology of being nearsighted, but I think encouraging your kids to go outside and play is always good advice anyway,” Peterseim said. 

She also noted that any child with a learning disability, developmental delay or systemic medical problems should get a comprehensive, dilated eye exam.  


About the Author

Leslie Cantu

Keywords: Pediatrics