For Children, 20/20 Vision Doesn’t Tell the Whole Story

It’s the doctor’s exam even the most conscientious parents don’t schedule--because they often are not aware it is needed.

Comprehensive vision exams are vital for children before entering school and at regular intervals after that, but many parents assume that the school vision screening is enough, says Irene Sang, a South Pasadena optometrist.

Passing a school vision screening with flying colors does not necessarily mean that there are no vision problems, Sang says. A 20/20 result on the school eye chart test means your child can see at 20 feet what he or she should be able to see. But the test does not detect all vision functions.

“Vision screenings have a place in preventive care, but they are not a substitute for a thorough vision exam,” she says.

“The test is fine as far as it goes,” agrees Dr. Gerhard Cibis, chief of ophthalmology at Childrens Mercy Hospital in Kansas City and a member of the American Academy of Ophthalmology. (Of course, says Cibis, there’s always the possibility that some kids memorize the chart.)

Doctors usually recommend that a child’s first comprehensive eye exam be performed about age 3 or 4, and that the exam be repeated every one or two years throughout childhood. Exams should be considered earlier if there is a family history of vision problems or complaints about such problems as blurred vision.

Beside testing visual acuity, a complete eye exam should include evaluations of eye alignment and depth perception, Sang and Cibis say. The eye doctor should also determine if there is nearsightedness, farsightedness or astigmatism.

Focusing ability should be evaluated, including the ability to sustain focus and to switch focus from near objects to far objects and vice-versa. The eye doctor should also review your child’s medical history, test for color perception and assess overall eye health, according to American Optometric Assn. guidelines.

When detected early, vision problems are more amenable to treatment, says Cibis. One example is amblyopia or “lazy eye,” a condition in which an otherwise normal appearing eye has poor vision, sometimes because of crossed eyes. After age 8 or 9, effective treatment is rarely achieved, according to the American Academy of Ophthalmology.

Parents can recognize these warning signs of vision problems, Sang says:

* Squinting and rubbing eyes.

* Closing or covering of one eye while reading.

* Omission or confusion of small words while reading aloud.

* Headaches.

* Tilting the head while reading.

* Schoolwork performance is below potential.

Once your child’s vision is evaluated as normal, or corrected if necessary, encourage good reading and work habits, advises the American Optometric Assn. To prevent eye strain, keep the homework area evenly lighted. For television watching, keep lighting soft and even and sit back from the screen--a distance at least five times the width of the screen.