Transcript The Importance of Good Vision for Children

The Importance of Good
Vision for Children
Importance of Good Vision to
Learning
• Approximately 80% of all learning during
a child’s first 12 years comes through
vision
• Undetected and untreated vision
problems can interfere with ones full
learning potential
• Vision disorders are the fourth most
common disability in the United States
and the most prevalent handicapping
condition in children
Courtesy of AOA
Importance of Good Vision to
Learning
• Only 14% of children have had an eye
exam by age 5
• Only half of all children will have an
eye examination before completing
high school
• 20% of children age 9-15 need
glasses, and 90% of those have not
received them
• 75,000 3 year olds develop amblyopia
each year
Courtesy of AOA
Statistics
• American Optometric Association recommends a child
gets his/her first eye exam at 6 months
• 5% of children were identified as having a vision problem
using the Snellen Chart
• 18 Million children will not have had an eye examination
by an Eye Doctor by the time they enter school
• 60% of students identified as problem learners have
undetected vision problems
Statistics courtesy of AOA
Role of Vision In Learning
• 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
• Processing must occur without flaws
• A child must have visual ability to learn to read
prior to reading to learn
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
What is good vision?
Good vision includes:
– Visual acuity
– Eye health
– Visual Integration
– Eye teaming
– Eye focusing
– Eye motility
Visual Acuity
The ability of the eye to see clearly in the
distance and at near
– Near vision- the ability to see at 8 -10 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
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 dilated fundus
exam
Visual Integration
• The ability to
process and
integrate visual
information
• Using our vision and
other senses to
understand what we
see
Eye teaming
• The ability of the eyes to work
properly together
• The ability to coordinate and
align both eyes to allow the
brain to fuse a single image
from the images it receives
from each eye
• The ability to judge relative
distances of objects and have
depth perception
• The ability of the eyes to focus
on something near by turning
towards each other
Eye Focusing
• The ability of the eyes to focus and shift focus to
near and distant points easily and effortlessly
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…
Prevalence of vision problems
Age 6 months to 18 Years
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Hyperopia (farsightedness)
Astigmatism
Accommodative & Binocular disorders
Myopia (Nearsightedness)
Strabismus (eye turn)
Amblyopia
25%
23%
20%
18%
12%
7%
Hyperopia (farsightedness)
• The inability to see close-up things well
• 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
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
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
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
• Any eye turn can happen constantly or
occasionally
Esotropia
Exotropia
Symptoms of Strabismus
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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
Accommodative and Binocular
Disorders
• Accommodative- The eyes cannot focus well
• The inability to contract and relax the eyes’
focusing muscles
• Binocular – The eyes do not work well as a
team; for example, the eyes cannot converge
for up-close reading
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
Binocular Disorder Symptoms
• Headaches
• Fatigue
• Double vision
• Blurriness
• Watery eyes
• Rubs Eyes
• Is Inattentive
• Loses place
• Says Letters or words appear to move
Amblyopia
• Also known as a 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 clearness between
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
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
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
Snellen Chart & Tumbling E
Photos Courtesy of POA
LEA Symbol Charts
Photos courtesy of POA
Criteria for Referral
• If either eye is less than 20/40 or a two-line
difference exists between the two eyes, retest
the child
• If the same results prevail, the student has
failed and immediate referral is indicated
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
Near point cards
Photos courtesy of POA
Referral Criteria
• If either eye is less than 20/40 or a two line
difference exists between the two eyes, retest
the child
• If the same results prevail, the student has
failed and immediate referral is indicated
Color Vision Test
• Detects difficulty in ability to recognize color
• Children with color blindness 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
Color Vision Tests
Photos courtesy of POA
Color Vision Test
• Equipment:
– Occluder
– Pseudo-Isochromatic
Test Plates
• Referral Criteria
– Student fails if does
not correctly identify
the number on the
card
Photos courtesy of POA
Convex Lens Test
• Detects hyperopia and binocular problems
• Equipment
– Distance acuity chart
– Occluder
– Pair of +2.25 Spherical Lens (ages 5-8)
– Pair of +1.75 Spherical Lens(>age 8)
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.
Stereo/Depth Test
• Tests for amblyopia, strabismus, and
binocularity
• Equipment
– Random Dot E
– Stereofly
– Random Dot Stereotest
Stereotests
Photos courtesy of POA
Random Dot E & Polarized Glasses
Photos courtesy of POA
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
Near Cover Test
Cover Test
http://www.city.ac.uk/optics/BVTutor/assets/images/esotropia3.GIF
http://www.city.ac.uk/optics/BVTutor/html/heterophoria_2.html
Near Point of Convergence
• Tests the ability of the
eyes to converge for upclose 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
Near Point of Convergence
Referral Criteria
• If the student reports double vision or either
eye swings out at greater than 5 inches then
he/she has failed
• If the student does not regain alignment or
report single vision at 7 inches or less, then
he/she has failed
Vision Screenings vs.
Comprehensive Eye Examinations
• Screenings only detect gross visual problems
and cannot substitute for regular professional
eye examinations
• Periodic eye health and vision examinations
are essential for the prevention and diagnosis
of conditions of the visual system
• Parents MUST follow through on the referral
Definition of Optometrist
Optometrists are independent, primary health
care providers who examine, diagnose, treat,
and manage diseases and disorders of the
visual system, the eye and associated
structures as well as diagnose related
systemic conditions.
Courtesy of American Optometric Association
Ocular Emergencies
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Red Eye
Chemical Burns
Foreign Body
Blunt Trauma
YES
“BLOODSHOT”
Painful and/or Vision Blurred
See Doctor Now
NO
“BLOODSHOT”
Discharge
Gritty Sensation
See Doctor Today
YES
NO
Blood Red Spot on
White of Eye
YES
No Treatment Generally
Required
RED EYE
NO
No illness/trauma Hx
No Discharge
Slightly Red Eye
YES
Lubricants
Warm Compresses
See Doctor if Worsens
Courtesy of AOA
Is the Chemical a strong base?
YES
Example: Drain Cleaner
Lime
Chemical Burns
NO
Is it a strong acid?
Example: Battery Acid
Irrigate 30 Mins Lids
Forced open then see
Doctor immediately after
YES
Irrigate for 15 mins.
Then see Doctor.
NO
A mild acid or alkali?
Example: Chlorine, bleach
Gasoline and Hairspray
Irrigate 15 minutes.
See Doctor Today
YES
NO
Mild Thermal Burn
Example: Singed eyelashes
UV Burn / Welding
YES
See
Doctor
Today
Courtesy of AOA
Burns
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Alkali- based chemicals
Lime (cement, plaster, whitewash)
Drain cleaners
Lye
Metal polishes
Ammonia
Oven cleaners
Acid-based chemicals
Swimming pool acid (muriatic acid)
Battery (sulfuric) acid
Are any of the following true?
-Can the foreign body be seen and
does it remain after gentle washing?
-Could the injury have penetrated the globe
of the eye?
-Can blood be seen in the eye?
- Does it feel as though a foreign body might
be trapped behind the upper lid?
YES
Ocular Foreign Body
See Doctor Now
NO
YES
Is there any problem with vision?
NO
Is there any eye pain?
Foreign
Body
Call
Doctor
Today
Courtesy of AOA
Are any of the following true?
YES
-Is lid swollen shut?
-Is blood in anterior chamber?
-Is cornea white/hazy?
-Is pupil irregularly shaped, fixed, dilated
or constricted?
Blunt Trauma
See Doctor Now
NO
Is there any problem with vision?
-example: blur, visual field loss
Flashes, floaters, double vision YES
NO
Is there pain?
NO
YES
Apply home treatment
-example: ice pack first 2 hrs.
Then warm compresses
- If no overnight relief, see Doctor now
See Doctor Today
Courtesy of AOA
Other Examples of Blunt Trauma
cases….
Case Studies
John, 6 years old, kindergarten
– Screened in school
– Screening findings:
• Distance VA: 20/70 RE and 20/60
LE
• Near VA: 20/30 OU
• Could read the 20/40 line through
the plus lens
• All other findings within normal
limits
• John was referred for a
comprehensive eye examination
John
• John was diagnosed with farsightedness
(hyperopia)
• He received a pair of glasses to correct his
farsightedness
• John’s corrected vision is now 20/20 at both
distance and at near
Julie, 10 years old
• Julie complains of occasionally seeing
double, headaches, and blurry vision while
reading for an extended period of time
• Screening Results
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Distance VA: 20/20 RE 20/20 LE
Near VA: 20/20 RE 20/20 LE
Stereovision: Normal
Color Vision: Normal
Plus Lens Test: Normal
Cover Test: Exophoria
NPC: Left eye swung out at 7 inches and patient
could not regain alignment until 11 inches
Julie
• Julie was referred for a comprehensive eye
examination
• Julie was diagnosed with convergence
insufficiency
• Julie was enrolled into the vision training
program to help improve her eye teaming
Megan, 13
• Megan accidentally sprayed
hairspray into her eye when she
was styling her hair in the girls’
bathroom
• Megan came in complaining that
her eye was red and bothering her
• What is the next course of action?
Megan, 13
• Megan’s eye should be irrigated with saline or
clean water for 15 minutes
• Megan should see her eye doctor today
Healthy People 2010: National Health
and Disease Prevention Program
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Increase proportion of persons who have a
dilated eye exam at appropriate intervals;
Increase the proportion of preschool
children aged 5 years and under who
receive vision screening;
Reduce uncorrected visual impairment due
to refractive errors;
Healthy People 2010: National Health
and Disease Prevention Program
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Reduce blindness & visual impairment in
children aged 17 & under;
Reduce visual impairment due to diabetic
retinopathy;
Reduce visual impairment due to glaucoma;
Reduce visual impairment due to cataract;
Reduce occupational eye injury;
Healthy People 2010: National Health
and Disease Prevention Program
9. Increase the use of protective eyewear in
recreational activities & hazardous
situations around the house; and
10. Increase the use of vision rehabilitation
services & adaptive devices by people with
visual impairments.
Good Vision = A+ Good
Education
Questions??