With the advent of technology and rising academic demand, children’s vision is at stake now more than ever. With underlying vision disorders that remain uncorrected, they could easily fall behind in school and other daily activities. 

At least 25% of school-age children suffer from eye problems, often misdiagnosed as ADHD or some form of learning disability because of their poor academic performance. Growing up, they could miss out on life opportunities with ongoing uncorrected vision problems.

The 2024 World Sight Day takes children at the forefront, advocating for the eyecare community and other healthcare providers and schools to prioritise child eye health by facilitating early detection of vision problems using pediatric vision screening devices and referring cases to the appropriate specialist for early intervention. 

KEY TAKEAWAYS:

• Young children are predisposed to having some form of vision problems due to the biological nature of their eyes. Left undetected, these problems will cause them to struggle in school and their day-to-day social interactions.
• Child caregivers must be aware of the signs and symptoms of vision problems among children that limit their activities and provide assistance for them to undergo vision screening.
• Pediatric vision screening devices are essential in detecting vision problems in young children, enabling early intervention by eye doctors.

The Trouble With School-age Eyes

Young children ages 5 – 12 are unaware how their eyes should function. From an early age, eyes continue to develop up until age 20. During this period, children experience different visual scenarios in their daily activities. Regardless of how they view the world (clear or blurred), they have little way of knowing how it should be. 

That said, you won’t hear them complain about not seeing clearly because they learn to adjust to the situation with some form of compensation — head tilts, side glances, or squinting, to name a few.

Entering school age, they bring along this problem if, by age seven, they have not had any form of vision screening. With eyes still growing and rising visual demands, the struggle becomes more frustrating to a young child. 

They start their academic journey with farsightedness (Hyperopia) that they can easily cope with and correct by itself over time. But, too much of that refractive error could lead to misaligned eyes (Strabismus) or lazy eyes (Amblyopia). In other cases, they could have undetected nearsightedness (Myopia), adding more visual pressure to their day-to-day class activities. 

Signs And Symptoms To Look Out For 

Child caregivers — parents, daycare nannies, school teachers — should be mindful of the telltale signs of eye problems in children so they can help with early intervention.

While looking at an object:

• Head tilting or head-turning
• Moving object closer to eyes
• Squinting their eyes
• Continuous blinking
• Eye rubbing
• Covering one eye
• One eye appears turned in or out

While reading or writing:

• Reads at standard phase, then stops completely
• Keeps on re-reading sentences
• Uses a finger to guide the reading
• Shutting eyes in between reading
• Problem copy-writing images and letters

Other Common Signs:

• Headaches
• Avoiding activities
• Clumsiness 
• Dizziness
• Seeing double (Double Vision)

Vision screening in children, therefore, is crucial because an existing vision problem hampers their learning abilities and social development, impacting them psychologically in the long term.

Child caregivers are encouraged to pay attention to children’s vision needs and facilitate vision screening whenever possible.

The following can facilitate gross screening with proper pediatric vision screening guidelines :

• In doctor’s offices – by pediatricians or family doctors
• In public primary healthcare facilities – by an attending nurse or primary physician
• In schools – by the school nurse or doctor

Any reason to suspect underlying vision problems should be referred to optometrists or ophthalmologists for a thorough checkup using more sophisticated pediatric vision screening devices.

Getting Started With Pediatric Vision Screening

A vision screening is not meant to provide an initial diagnosis of a child’s visual condition; it also cannot be treated as an eye examination. Depending on the manner of facilitation and the skill level of the screener, some eye problems remain undetected. 

There are two ways to conduct vision screening in children:

Optotype-based Screening

Vision screening in children using optotype tools uses distance and near point charts. In this test, the screener instructs the child to identify the figures on the chart. What may be considered good about this type of testing is the child’s active participation, enabling the screener to also observe their overall behavior.

The type of charts to use varies depending on the child’s age, figure or letter recognition, and orientation. 

The commonly used naming and matching charts include:

• SLOAN letter test chart
• HOTV letter test chart
• LEA symbol text chart
• Patti Pics
• Tumbling E chart

There are no set rules for passing an optotype-based screening, but any form of misinterpretation of the testing tools should serve as a sign for further investigation.

Instrument-based Screening

When parents, teachers, or primary care physicians observe a child’s lack of participation in an optotype-based screening, then they should refer them to optometrists or ophthalmologists to conduct an instrument-based screening using photoscreeners and autorefractors.

As a manner of objective testing, the child is not required to talk with the screener during testing, as in the case of preverbal conditions.

The screener uses different instruments held against the child’s eye to measure refractive errors or detect the presence of several factors that could cause Amblyopia. 

When Amblyopia is detected or an anomaly in depth perception is suspected, the screener may proceed with a stereo test. This step is to evaluate the eyes even further and provide the appropriate treatments when necessary.

Parting Thoughts

In summary, a child’s visual capacity should not be overestimated especially during their school age. With eyes still developing during this period of their life, parents and other caregivers must continue to observe how their visual capacities are able to cope with the growing visual demands in school and subject them to regular vision screening using the right vision screening devices. 

Let’s do our share of safeguarding our children’s eyesight to empower them to love their eyes and reach their full potential.