When Kelly and Christine’s son Sean was in second grade, his school nurse discovered that some students with vision problems had been able to “cheat” on previous eye exams by peeking at the eye chart with both eyes while they were supposed to be covering one. Sean had likely used this unconscious method of compensating for his bad eye when he’d been tested in kindergarten. This year, the nurse used a type of mask that automatically blocked vision on one side, and discovered that Sean was nearly blind in his left eye. After the nurse began using a type of mask that automatically blocked vision in one eye, she discovered that Sean was nearly blind in his left eye.
A teacher in Kuna noticed her first grade student was having a hard time paying attention. His parents did not speak English at home and were not much help with homework, nor could they communicate well with his teacher, who was about to recommend he be tested and receive help as a special needs student.
“It wasn’t that he couldn’t learn,” says Jay Lugo, executive director of the Idaho & Eastern Oregon Lions Sight & Hearing Foundation, “it was that he couldn’t see the board from the back of the room.”
Statewide, nearly one in four school-aged children experience vision problems, according to the Idaho Kids Vision Coalition (kidsvisioncoalition.org), an organization dedicated to detecting vision problems and other sight-threatening disorders through vision screening for young children. Experts say that because 80 percent of learning is visual, undetected vision problems can not only affect a child’s ability to perform well in school, they may also be easily misdiagnosed as a learning disability or attention deficit disorder.
Lugo says he hears story after story about students who have problems in school until vision problems are detected and addressed. The foundation he directs screens more than 20,000 elementary school students in districts across Idaho each year. The Meridian and Boise School Districts screen their own students through their school nurse programs.
Lions Sight & Hearing Foundation volunteer screeners administer eight different tests, including those for visual acuity (farsightedness and nearsightedness) in children. Lugo says that every year foundation volunteers refer more than 40 percent of the elementary school students they screen for vision impairments to professionals for further testing. Their biggest concern for kids in kindergarten and first grade, Lugo says, is muscle imbalance, or amblyopia.
Amblyopia (more commonly known as “lazy eye”) is when one of the six different muscles controlling eye movement isn’t functioning. Lugo says sometimes this problem is readily apparent to others. Often, however, the problem is undetectable without a formal screening.
“You can look at a kid and not notice a half millimeter difference in an eye,” he says. “This might be causing blurry or double vision, but to the child who doesn’t know any better, he thinks he’s seeing normally.”
Amblyopia can result in poor or no transmission of signals from the retina to the brain, Lugo says. After a while, the brain will shut down transmission completely, resulting in permanent vision loss in that eye. Amblyopia can be corrected if caught and treated early by wearing an eye patch over the good eye to encourage the bad eye to correct itself. The longer one waits to correct the problem, Lugo says, the less likely it is treatable.
“By third grade, it can be corrected,” Lugo says, noting that as a child ages, and the brain becomes more and more accustomed to accommodating the disability, the process of correcting amblyopia becomes progressively more difficult. By eighth grade, Lugo says, the damage is likely permanent.
Experts recommend that parents watch their children for signs of vision problems, including sitting too close to the television or computer screen, or holding a book too close. But don’t be too confident you’ll notice problems without the help of a professional.
Lugo, who is a certified ophthalmic technologist with experience in diagnostic eye testing, says that even parents who know the signs can miss vision problems in their children. His own daughter was diagnosed with vision loss as a kindergartener. Her impairment was detected initially through a Lions Foundation screening. Lugo had noticed her sitting too close to the television, but had chalked it up to behavior typical of children her age.
The American Academy of Pediatrics says that childhood vision problems constitute the fourth most common disability in school-aged children, and that children with a family history of vision problems are more likely to have them. Often, however, a child will not complain of vision problems (since she may think the way she sees the world is the way everyone sees the world), and there may be no warning signs.
No matter how old your child is, if you spot any one of the following, let your pediatrician know:
• Eyes that look crossed, turn out, or don’t focus together
• White, grayish-white, or yellow-colored material in the pupil
• Eyes that flutter quickly from side to side or up and down
• Bulging eye(s)
• Persistent eye pain, itching, or discomfort
• Redness in either eye that doesn’t go away in a few days
• Pus or crust in either eye
• Eyes that are always watery
• Drooping eyelid(s)
• Excessive rubbing or squinting of the eyes
• Eyes that are always sensitive to light
• Any change in the eyes from how they usually look
If you are curious about vision screenings at your child’s school, call your school nurse. I discovered that our school screens for vision and hearing in kindergarten and second grade. Our first grade son attended private kindergarten and therefore missed the first screening. I called and was able to have him screened the same day. They didn’t detect any problems in his vision.
“You really can’t be too careful,” Christine says. Her son Sean’s vision impairment had gone undetected until second grade, but he was able to retrain his bad eye after a period of wearing a patch over his good one.
“I went back later and thanked her in person,” Christine says of the nurse who started using alternative tools to keep students from compensating at vision tests. “I was just so thankful.”
Idaho Kids Vision Coalition (kidsvision coalition.org): website includes an informational brochure on vision problems in children, and signs that your child may have problems with his vision.
Idaho & Eastern Oregon Lions Sight & Hearing Foundation (idaholions.org): provides free vision and hearing screening for many school districts in Idaho and at their Boise office on Latah Street (by appointment). The Foundation also offers financial assistance to individuals in need of vision and hearing care who cannot afford treatment, including eyeglasses, hearing aids, and eye and ear surgeries.
American Academy of Pediatrics (www.aap.org/publiced/BR_Eyes.htm): offers a Q&A for parents about when to have their child’s vision and hearing checked and what to look for.
Beth Markley is a Boise freelance writer and consultant. She lives in Boise with her husband and two boys, and midway through this article she called the school nurse to have her first grader’s vision checked.