By Robert N. Kang, O.D., Ph.D., Optometrist; U.S. Army Public Health CommandAugust 1, 2013
According to the National Eye Institute, vision disorders are the most common handicapping conditions in childhood in the United States. Yet, fewer than 15 percent of all preschool children receive an eye examination. Also, studies have shown that preschool vision screenings reduce vision disorders among school-age children. For these reasons, many primary care and pediatric clinics as well as schools provide vision screenings. The purpose of vision screening is to identify children who would benefit from a comprehensive eye examination. But how effective are these screenings in identifying those children? And, as a parent can you trust the vision screenings or should you take your preschooler for an eye examination regardless?
A large clinical study on preschoolers conducted by the NEI found that specially trained nurses and lay people were as effective in vision screenings as licensed eye care professionals. Importantly, however, the results depended on the specific tests and equipment used as well as the specific vision condition being tested. This study clearly showed the value of vision screening when properly done but also showed some of its limitations. So, what should a parent do?
The chairperson of the NEI study recommends that parents "question which eye problems are being screened for, the accuracy of the tests…" and, more importantly, that "parents should be aware that vision screening programs do not substitute for a comprehensive eye examinations by a licensed eye care professional."
The American Optometric Association recommends eye examinations for infants and children at six months and 3 years of age. For school age children, eye examination is recommended before first grade and every two years thereafter. Of course, infants at higher risks, for example from family history, should have an examination as soon as medically practicable. Similarly, children with symptoms or higher risks should also be examined more frequently.
It is estimated that up to five percent of 3 to 5 year olds have amblyopia or "lazy eye," and about four percent have strabismus or "squint" where one of the eyes is not aligned straight with the other eye. Also, 10-15 percent of children have significant refractive errors needing correction with eye glasses. Overall, 15 percent of children have an eye or vision problem that, if not corrected, can result in reduced vision. Eye examinations during the early years of any child's development are a must.
Unfortunately, vision problems do not usually hurt and children do not know how well they should be seeing. Vision screenings may be very valuable in identifying children with potential eye and vision problems. However, until much more accurate and effective screening tests and equipment become available, parents should be aware that vision screenings do not replace the need for eye examinations. The precious gift of children's eyesight should be protected and nurtured with comprehensive eye examinations.