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Early vision screenings for children a must

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Early vision screenings and comprehensive eye exams can have a profound effect on a child's success in the classroom, in sports and for the rest of his or her life, says Jatinder Bansal, a Doctor of Optometry at Clarus Eye Centre in DuPont.

"Vision disorders are the fourth most common disability in the U.S." she says, "and the most prevalent during childhood."

Less than a third of all children between 6 and 16 years of age have had a comprehensive eye examination, she says. What's even more sobering is that among those between 9 and 15 years for whom glasses have been prescribed, nearly 90 percent don't wear them.

Uncorrected vision in children can lead to eye strain, discomfort, fatigue and short attention span when performing tasks that require close focus. As a result, these youngsters tend to avoid reading and school work. They may even exhibit hyperactivity and distractibility that can be misdiagnosed as a learning disability, such as Attention Deficit Hyperactivity Disorder (ADHD).

The problem is more widespread than many parents realize.

"Vision problems generally are not the direct cause of learning disorders," says Bansal, "but they can interfere with a child's ability to perform up to his or her potential."

A study published in the Journal of American Optometric Association suggests that more than 60 percent of children between 6 months and 6 years may have a refractive error, either nearsightedness or farsightedness, or irregularities in the shape of the eye, which is known as astigmatism.  

Nearsightedness, also known as myopia, is the inability to see objects clearly at a distance. This is usually because the eyeball is slightly longer than normal as measured from the front of the eye to the back. Light rays that form the image end up focusing in front of, rather than directly on, the retina.  Many children have a progressive form of myopia that becomes more severe as they progress through childhood.

Farsightedness, also known as hyperopia, is the tendency to see objects that are at a distance better than those that are nearby. Hyperopia results when the eyeball is too short, a cornea that isn't curved enough or a lens that is positioned too far back in the eye. Light rays focus behind the retina rather than directly on it. Symptoms include blurry vision, difficulty seeing objects up close, aching eyes, eyestrain and headaches.

Both nearsightedness and farsightedness are easily corrected with glasses.

The term astigmatism is less familiar to most people than either nearsightedness or farsightedness and seems to cause a lot of confusion among parents, Bansal observes.

Astigmatism occurs when the surface of the eye, called the cornea, is not completely round and has irregular curvature, she says. It may also involve an irregularly shaped lens, which is located behind the cornea.

"Most of us have some degree of astigmatism," she says. "It seldom is a problem, but can contribute to blurry vision."

The severity of astigmatism can be affected by trauma to the eye or even eye surgery, she adds.

 It is important to understand that astigmatism is not a disease, nor is it contagious. And, she continues, vision issues resulting from astigmatism can easily be corrected with eyeglasses, contact lenses or surgery.

The study published by the American Optometric Association concluded that more than a third of children with nearsightedness, farsightedness and astigmatism have other vision issues as well. Among the most common of these is amblyopia, which is commonly - and inaccurately - referred to as lazy eye.

Amblyopia occurs when one eye develops more rapidly than the other and the brain does not fully acknowledge the images seen by the weaker amblyopic eye. It can be caused by uncorrected nearsightedness, farsightedness, high astigmatism, a congenital cataract or another form of structural obstruction, a droopy lid, trauma or muscle misalignment, a condition known as strabismus.  

Anything that interferes with clear vision in either eye during what is known as the critical period - from birth to 6 years of age - can result in amblyopia. If not treated by the end of this critical period, vision in the affected eye cannot be corrected with eyeglasses, contact lenses or surgery.

"It's a neurological process," Bansal explains. "It can result in permanent vision loss in the amblyopic eye."

Sadly, she says, many parents fail to recognize the symptoms and believe screening performed by their child's pediatrician, primary care physician or school nurse is sufficient to rule out significant visual disorders. As worthwhile as these screenings are in identifying youngsters who may have impairments, their efforts can't compare with a comprehensive examination by an eye doctor.

That's why it's vitally important for parents to have their children's eyes tested more thoroughly than the simple vision screening provided by most schools.

During a pediatric eye exam, Bansal confirms through various tests that the child's eyes are developing normally - that light is focusing on the retina properly, that both eyes are seeing equally well and that the muscles of both eyes are moving properly.  In addition, the health of each eye is evaluated during dilation.

The American Optometric Association recommends a comprehensive eye exam at 6 months, 3 years and before first grade, then at intervals determined by the child's eye doctor. Even children who appear to be risk free are urged to have an exam at least once every two years.

Clarus's DuPont clinic is open evenings to accommodate working families and parents in the military and is on the preferred provider lists of Tricare and more than 40 insurance companies.

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