Why Our Work Matters
More than 80% of learning in the classroom is visual, and it is apparent that if a child cannot see, a child cannot read, and if a child cannot read, a child cannot learn.
Based upon national statistics, as many as 4,500 Nebraska children enter school each year with vision problems significant enough to hinder their ability to learn. If a child is struggling to read or finding it difficult to remain on task, the cause may be an undetected vision problem, even if the child has 20/20 eyesight and has passed the school’s vision screening or a routine eye exam. Many of these children are often suspected of having learning disabilities, dyslexia, or attention deficits—and may be placed unnecessarily in remedial reading or special education--when the real culprit is their vision.
Early detection can save years of struggling. Many of our state’s young children are faced with overwhelming social and emotional challenges that can impact their ability to learn, but vision is one part of the equation that can most likely be controlled. Preventative measures include proper detection through a complete eye exam.
Understanding Terminology & Differences in Vision Evaluations
Here's a description and comparison of various types of vision evaluations that children may receive:
Vision Screening Test
A test that is used to make general categorizations of examinees (i.e. students). Vision screenings typically test only for distance vision. Vision screenings are performed by school nurses. In many instances volunteers also perform vision screening tests. Equipment called “vision screeners” maybe used for the testing and run by the volunteers and/or school personnel. Vision screening tests are a valuable component to vision care but should not be thought of as a comprehensive vision examination.
A vision assessment is a systematic method of obtaining evidence from a series of defined tests that is used to draw inferences about the health and function of the visual system. “See To Learn” is an example of a vision assessment available free of charge from a “See To Learn” provider for every three year old in the state of Nebraska. Vision assessments are valuable to determine a child’s possible problems with visual health and function but vision assessments do not replace comprehensive vision examination.
School Vision Evaluation
All students new to Nebraska schools are required by law to receive a vision evaluation. This evaluation consists of requirements to examine specific components of a student’s visual system: Amblyopia (lazy eye), strabismus(misalignment of the eyes), internal and external health of the eye, and visual acuity. The vision evaluation must be performed by an optometrist (OD), physician (MD), a physician assistant (PA), or an advanced practice registered nurse(APRN).
The school required vision evaluation is important to insure that all students entering Nebraska schools for the first time are prepared to learn. However, the testing and observation components are not complete enough to be considered a comprehensive vision evaluation.
Comprehensive Vision Exam
A Comprehensive Vision Examination is a series of tests and observations that measure the health and function of an individual’s visual system. A comprehensive vision evaluation can only be performed by law within the scope of practice by an optometrist (OD) or ophthalmologist (MD).
Exam & Screening Comparisons
Assuring that children have the vision they need requires evaluation of the visual skills that give us effective vision. Key skills involve visual acuity (clarity of letters), binocular vision (how well the two eyes work together), visual information and perceptual processing (how the brain process visual information), and eye health.
One of the barriers for many parents and educators involves misconceptions or assumptions about what's being evaluated during eye check-ups. It's important to understand what testing is helpful or necessary.
The Elements of a Comprehensive Eye Health Exam and Vision Analysis
The American Optometric Association (AOA) recommends the following information be gathered and tests be performed during a comprehensive eye examination:
- Chief Complaint: assessment of the patient’s reason for getting an eye exam.
- General Physical Health History: complete health history to screen for physical conditions and medications that may affect eyesight.
- General Ocular Health History: complete eye health history including family history of eye conditions, disease, or medication.
- External and Internal Eye Health Evaluation: examination for the signs of eye disorders, including cataracts and other eye disorders.
- Current Prescription Analysis: evaluation of current lens prescription, if applicable.
- Visual Acuity: test for the eyes’ ability to see sharply and clearly at all distances.
- Refraction: test for the eyes’ ability to focus light rays properly on the retina at distances and close by.
- Tonometry: test to measure internal fluid pressure of the eye (increased pressure may be an early sign or glaucoma).
- Visual Coordination: check for external eye muscle balance and coordination.
- Accommodative Ability: test of the eyes’ ability to change focus from distance to near. An exam may also include tests for color vision and depth perception, visual fields, and other vision skills, as needed.
Most screenings assess visual acuity from 20 ft but don’t evaluate other distances, including reading distance.
Standards and criteria for ‘passing’ a screening vary
Experience and resources can vary significantly among people conducting screenings.
“Passing” a screening can give a false sense of security.
Children can peek, memorize correct answers, and otherwise compromise their answers when reading a vision chart
20% of School-Aged Children Fight Double Vision
These children can’t control their eye movements at close ranges, and as a result they fight double vision every day, especially with reading. Still others struggle with print that blurs or jumps around. Is it any surprise that these children don't do well in school?
If your child is struggling to read or finding it difficult to remain on task, the cause may be an undetected vision problem - even if your child’s eyesight is 20/20 and they passed the school’s vision screening or a routine eye exam. The goal of this website is to educate parents and teachers about frequently overlooked vision problems in the hopes of helping those children who struggle unnecessarily because of undiagnosed vision disorders. In fact, many of these children are often suspected of having learning disabilities, dyslexia, or attention deficits when the real culprit is their vision.
Early detection can save years of struggling. If your child has been labeled ADD, learning disabled, dyslexic, unmotivated or even “lazy,” schedule an eye exam to determine if a vision problem could be affecting their learning. This may be the single most important thing you do for your child!