• Approximately 80% of all learning during a child’s first 12 years comes through vision
• Undetected and untreated vision problems can interfere with ones full learning potential
• Vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in children
Courtesy of AOA

• Only 14% of children have had an eye exam by age 5
• Only half of all children will have an eye examination before completing high school
• 20% of children age 9-15 need glasses, and 90% of those have not received them
• 75,000 3 year olds develop amblyopia each year
Courtesy of AOA

• American Optometric Association recommends a child gets his/her first eye exam at 6 months
• 5% of children were identified as having a vision problem using the Snellen Chart
• 18 Million children will not have had an eye examination by an Eye Doctor by the time they enter school
• 60% of students identified as problem learners have undetected vision problems
Statistics courtesy of AOA

• The eyes must see clearly, without double vision, and with accurate focus control
• The brain must interpret the visual image from its background, make assumptions as to its figure, and integrate the information gathered from peripheral vision and from other senses
• Processing must occur without flaws
• A child must have visual ability to learn to read prior to reading to learn

• Trouble finishing written assignments
• Losing their place when reading
• Having a short attention span when doing close work
• Skipping words when reading
• Making errors when copying from the board
• Underperforming

Good vision includes:
– Visual acuity
– Eye health
– Visual Integration
– Eye teaming
– Eye focusing
– Eye motility

The ability of the eye to see clearly in the distance and at near
– Near vision- the ability to see at 8 -10 inches
(reading a book)
– Intermediate vision- the ability to see at 16 -40 inches (computer distance)
– Distance vision- the ability to see at 10 feet or more
– 20/20 indicates that you can see letters 3/8” high at 20 feet

• The absence of anomaly or disease
• If not diagnosed or treated, eye disease can lead to vision loss or impaired vision
• Ocular health is evaluated by external ocular examination with a biomicroscope, eye pressure evaluation, and a dilated fundus exam

• The ability to process and integrate visual information
• Using our vision and other senses to understand what we see

• The ability of the eyes to work properly together
• The ability to coordinate and align both eyes to allow the brain to fuse a single image from the images it receives from each eye
• The ability to judge relative distances of objects and have depth perception
• The ability of the eyes to focus on something near by turning towards each other

• The ability of the eyes to focus and shift focus to near and distant points easily and effortlessly
• The ability of the eyes to move from one point to another
• The ability of the eyes to move across a page of print or to follow a ball, etc…

Prevalence of vision problems
Age 6 months to 18 Years
• Hyperopia (farsightedness) 25%
• Astigmatism 23%
• Accommodative & Binocular disorders 20%
• Myopia (Nearsightedness) 18%
• Strabismus (eye turn) 12%
• Amblyopia 7%

• The inability to see close-up things well
• Eyeball is too short for normal focusing power of the eye
• In children the lens can focus and accommodate through this error providing both clear distance and near vision, but much effort must be used. This can cause headaches, fatigue, and even crossed eyes.
• Symptoms Include:
– Rubs Eyes
– Has watery eyes
– Complains of blurred vision

• Results from an irregular shape of the front surface of the cornea.
• The eye is more football shaped rather than round
• Causes blurred vision for distant and close-up things
• Symptoms include:
– Rubs eyes
– Has watery eyes
– Complains of blurred vision

• The inability to see distant things well
• The eye is too long for the normal focusing power of the eye.
• Symptoms include:
– Squints
– Gets close to the board

• Occurs when the eyes are not aligned when viewing an object
• The eye may turn inward toward the nose
(esotropia) or outward toward the side
(exotropia)
• This is usually caused by poor muscle control
• Any eye turn can happen constantly or occasionally

• Intermittent double vision
• Closes or covers one eye
• Says letters or words appear to move
• Loses place
• Is Inattentive
• Rubs eyes
• Has watery eyes
• Complains of blurred vision
• Has poor reading comprehension

• Accommodative- The eyes cannot focus well
• The inability to contract and relax the eyes’ focusing muscles
• Binocular – The eyes do not work well as a team; for example, the eyes cannot converge for up-close reading

– Headaches
– Tired at the end of the day
– Has blurred vision when looking from board to book or book to board
– Holds things very close
– Is Inattentive
– Rubs eyes
– Has watery eyes
– Complains of blurred vision
– Has poor reading comprehension

• Headaches
• Fatigue
• Double vision
• Blurriness
• Watery eyes
• Rubs Eyes
• Is Inattentive
• Loses place
• Says Letters or words appear to move

• Also known as a lazy eye
• Reduced vision in an eye that was not stimulated in early childhood
• Can result from strabismus or misaligned eyes or a difference in clearness between eyes. One eye is focusing better than the other one. One eye becomes stronger from its use and the other eye is suppressed and not worked hard enough

• Designed to identify gross visual problems and to indicate the immediate need for an eye examination. Parents must follow through on the referral.
• Most children who fail a vision screening will also fail a diagnostic professional examination

Distance Visual Acuity
– Purpose-To test for myopia, amblyopia, astigmatism, and high hyperopia
– Equipment-Distance VA chart and Occluder
– Visual Acuity Charts Include:
• Snellen Chart
• Tumbling E chart
• Lea Symbols

Photos Courtesy of POA

Photos courtesy of POA

• If either eye is less than 20/40 or a two-line difference exists between the two eyes, retest the child
• If the same results prevail, the student has failed and immediate referral is indicated

• Purpose- To test for hyperopia, astigmatism, amblyopia, and focusing problems
• Equipment- Near Acuity Cards and Occluder
• Near Acuity Cards include:
– Snellen
– Lighthouse acuity
– Lea Cards
– Tumbling E

Photos courtesy of POA

• If either eye is less than 20/40 or a two line difference exists between the two eyes, retest the child
• If the same results prevail, the student has failed and immediate referral is indicated

• Detects difficulty in ability to recognize color
• Children with color blindness are not actually blind to color, but simply have difficulty identifying and distinguishing between different colors
• Color Deficiencies are usually hereditary and affect 1 in 12 boys but only 1 in 200 girls

Photos courtesy of POA

• Equipment:
– Occluder
– Pseudo-Isochromatic
Test Plates
• Referral Criteria
– Student fails if does not correctly identify the number on the card
Photos courtesy of POA

• Detects hyperopia and binocular problems
• Equipment
– Distance acuity chart
– Occluder
– Pair of +2.25 Spherical Lens (ages 5-8)
– Pair of +1.75 Spherical Lens(>age 8)

• If the student cannot read the 20/40 line while wearing the lenses then he/she has passed the test
• If the student can read the 20/40 line while wearing the lenses then the student has failed and should be referred.

• Tests for amblyopia, strabismus, and binocularity
• Equipment
– Random Dot E
– Stereofly
– Random Dot Stereotest

Photos courtesy of POA

Photos courtesy of POA

• Tests for ocular alignment disorders, strabismus, and binocular problems
• Done both at distance and near
• Unilateral cover test
– Movement on Unilateral cover test = strabismus
– No movement on unilateral cover test = normal
• Alternate Cover Test
– Movement on Alternate cover test = Strabismus or binocular problem, depending on severity
– No movement on alternate cover test = normal

http://www.city.ac.uk/optics/BVTutor/assets/images/esotropia3.GIF
http://www.city.ac.uk/optics/BVTutor/html/heterophoria_2.html

• Tests the ability of the eyes to converge for upclose tasks
• If the eyes cannot effectively converge for near vision tasks, then the patient has convergence insufficiency
• Equipment
– Near Point fixation stick
– Tape Measure
Photos courtesy of POA

• If the student reports double vision or either eye swings out at greater than 5 inches then he/she has failed
• If the student does not regain alignment or report single vision at 7 inches or less, then he/she has failed

• Screenings only detect gross visual problems and cannot substitute for regular professional eye examinations
• Periodic eye health and vision examinations are essential for the prevention and diagnosis of conditions of the visual system
• Parents MUST follow through on the referral

Optometrists are independent, primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions.
Courtesy of American Optometric Association

• Red Eye
• Chemical Burns
• Foreign Body
• Blunt Trauma

“BLOODSHOT”
Painful and/or Vision Blurred
YES
NO
“BLOODSHOT”
Discharge
Gritty Sensation
YES
NO
YES
Blood Red Spot on
White of Eye
RED EYE
NO
No illness/trauma Hx
No Discharge
Slightly Red Eye
YES
See Doctor Now
See Doctor Today
No Treatment Generally
Required
Lubricants
Warm Compresses
See Doctor if Worsens
Courtesy of AOA

Is the Chemical a strong base?
Example: Drain Cleaner
Lime
YES
NO
Chemical Burns
Is it a strong acid?
Example: Battery Acid
YES
Irrigate 30 Mins Lids
Forced open then see
Doctor immediately after
Irrigate for 15 mins.
Then see Doctor.
NO
A mild acid or alkali?
Example: Chlorine, bleach
Gasoline and Hairspray
YES
NO
Mild Thermal Burn
Example: Singed eyelashes
UV Burn / Welding
YES
Irrigate 15 minutes.
See Doctor Today
See
Doctor
Today
Courtesy of AOA

• Alkali- based chemicals
• Lime (cement, plaster, whitewash)
• Drain cleaners
• Lye
• Metal polishes
• Ammonia
• Oven cleaners
• Acid-based chemicals
• Swimming pool acid (muriatic acid)
• Battery (sulfuric) acid

Are any of the following true?
-Can the foreign body be seen and does it remain after gentle washing?
-Could the injury have penetrated the globe of the eye?
-Can blood be seen in the eye?
- Does it feel as though a foreign body might be trapped behind the upper lid?
YES Ocular Foreign Body
See Doctor Now
NO
Is there any problem with vision?
YES
Foreign
Body
NO
Is there any eye pain?
Call
Doctor
Today
Courtesy of AOA

Are any of the following true?
-Is lid swollen shut?
-Is blood in anterior chamber?
-Is cornea white/hazy?
-Is pupil irregularly shaped, fixed, dilated or constricted?
YES
NO
Is there any problem with vision?
-example: blur, visual field loss
Flashes, floaters, double vision
YES
NO
Is there pain?
NO
YES
Apply home treatment
-example: ice pack first 2 hrs.
Then warm compresses
- If no overnight relief, see Doctor now
Blunt Trauma
See Doctor Now
See Doctor Today
Courtesy of AOA

Other Examples of Blunt Trauma cases….

John, 6 years old, kindergarten
– Screened in school
– Screening findings:
• Distance VA: 20/70 RE and 20/60
LE
• Near VA: 20/30 OU
• Could read the 20/40 line through the plus lens
• All other findings within normal limits
• John was referred for a comprehensive eye examination

• John was diagnosed with farsightedness
(hyperopia)
• He received a pair of glasses to correct his farsightedness
• John’s corrected vision is now 20/20 at both distance and at near

• Julie complains of occasionally seeing double, headaches, and blurry vision while reading for an extended period of time
• Screening Results
– Distance VA: 20/20 RE 20/20 LE
– Near VA: 20/20 RE 20/20 LE
– Stereovision: Normal
– Color Vision: Normal
– Plus Lens Test: Normal
– Cover Test: Exophoria
– NPC: Left eye swung out at 7 inches and patient could not regain alignment until 11 inches

• Julie was referred for a comprehensive eye examination
• Julie was diagnosed with convergence insufficiency
• Julie was enrolled into the vision training program to help improve her eye teaming

• Megan accidentally sprayed hairspray into her eye when she was styling her hair in the girls’ bathroom
• Megan came in complaining that her eye was red and bothering her
• What is the next course of action?

• Megan’s eye should be irrigated with saline or clean water for 15 minutes
• Megan should see her eye doctor today

Healthy People 2010: National Health and Disease Prevention Program
• Increase proportion of persons who have a dilated eye exam at appropriate intervals;
• Increase the proportion of preschool children aged 5 years and under who receive vision screening;
• Reduce uncorrected visual impairment due to refractive errors;

Healthy People 2010: National Health and Disease Prevention Program
• Reduce blindness & visual impairment in children aged 17 & under;
• Reduce visual impairment due to diabetic retinopathy;
• Reduce visual impairment due to glaucoma;
• Reduce visual impairment due to cataract;
• Reduce occupational eye injury;

Healthy People 2010: National Health and Disease Prevention Program
9. Increase the use of protective eyewear in recreational activities & hazardous situations around the house; and
10. Increase the use of vision rehabilitation services & adaptive devices by people with visual impairments.