By Rivka Markowitz, OD

Q: My child failed the vision screening, should I really be concerned?

A: Vision screenings are, thankfully, commonplace at your child’s pediatric office and/or school. The purpose of these screenings is early detection of any visual problems that cannot be overtly observed. The most common screening tests look for decreased vision in one or both eyes.

Q: Why is this so important to your child’s visual development?

A: A comprehensive eye exam is important to determine the underlying cause for any noted decreased vision. This may be due to an underlying refractive error or need for glasses, which is the most common and simplest cause. There are also anatomical abnormalities that may cause decreased vision that will need to be ruled out.

Refractive errors are limited to three main conditions; myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (when the prescription is different in two directions usually secondary to the eye being shaped more like a football than a perfect sphere) and will be checked via a process known as refraction. Refractive errors are corrected with glasses (and for the older pediatric population, contact lenses are a viable option as well). Learning and academic performance can often be negatively affected by an uncorrected refractive error. This is important to mention, as some learning deficiencies can be assisted simply with a pair of glasses.

Myopia, more commonly known as nearsightedness, is when things in the distance appear blurry. This is usually due to the eye being slightly longer in length, thereby causing the pinnacle of the light image to fall in front of the retina. The most common symptoms or complaints related to childhood myopia include, but are not limited to, inability to see the board at school, squinting, inattention in the classroom, and a feeling of eye strain. Excessive squinting can turn into a complaint of “headaches.”

Hyperopia, or farsightedness, is not as easily notable in children. In this condition, the eye is slightly shorter, thereby causing the pinnacle of the light image to fall behind the retina instead of on it. Many children with hyperopia will not complain of any symptoms, yet some will complain of eye strain, headaches, or eye fatigue more commonly associated with near vision tasks. These children may abstain from reading altogether in order to prevent visual discomfort.

Astigmatism is the diagnosis that panics most parents although it is only a form of a refractive error and not a disease (albeit maybe a scary-sounding word). When the eye is a perfect sphere, the light enters the eye equally in all directions, causing a symmetric refractive error. When the eye is shaped in a more oval-like pattern like a football, the light entering the eye in one direction will be a different length than the light entering in another direction.

When asymmetric vision between the two eyes is noted, the doctor will be concerned about ruling out amblyopia, or “lazy eye.” A lazy eye is when an eye cannot achieve maximum visual acuity. Amblyopia affects approximately 3% of the American population. Amblyopia causes can generally be divided into three categories; refractive (related to a refractive error), strabismic (related to a misalignment of the eyes or “a crossed/wandering” eye), and deprivational (related to something blocking the eye from obtaining a clear image). Many studies have been done regarding amblyopia and treatment is found to be extremely effective. It is crucial that any amblyopia risk factors be determined and treated during your child’s young critical years as the effectiveness of treatment post this time period decreases with increased age. Glasses and/or patching are the most common treatments for amblyopia.

In summation, your child’s visual development for his or her future is based on fundamental younger years. If something is noted on a vision screening, there is no need to be an alarmist, but please schedule an appointment with an eye-care professional proficient in pediatric vision to provide the best care for your child. n

Rivka Markowitz, OD, is a pediatric optometrist at Long Island Eyesite, a multispecialty ophthalmology practice in Hewlett.


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