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Seeing the Light on Vision Screening in Young Children - Brief Article

Family Pratice News , Sept 1, 2000 by Betsy Bates

MAUT, HAWAII -- Primary care physicians can`t be expected to be amateur optometrists in their spare time, but they want to be able to answer parents` questions and detect any vision problems that could have an underlying medical cause, said Dr. Ann Stout, a pediatric ophthalmologist who recently moved from Children`s Hospital Los Angeles to Oregon Health Sciences University in Portland.

The following questions and answers were gleaned from Dr. Stout`s presentations at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics:

* What`s the most common cause of visual loss in children?

Amblyopia, the loss of vision in a normal eye occurring as the result of an imbalance of visual acuity in the eyes. The brain adjusts to receiving visual signals from the strong eye and ceases to respond to signals from the other eye, even if corrective lenses are implemented.

* Should I be worried about a 6-year-old who cannot see 20/40 on a letters chart in the office?

You can refer the child to an optometrist or ophthalmologist, but don`t worry too much. Up to 70% of children may not read the 20 / 20 line until they are at least 7 years old, in part because they aren`t sure of their letters.

* What should I do about a 2-year-old who won`t sit still for a picture-matching test?

Refer. Disinterest, fidgeting, and head turning are a major warning sign of poor vision. Be especially vigilant if the child is much more agitated when one eye is tested than when the other is tested, Dr Stout recommended at the meeting, also sponsored by California District IX, Chapter 2 of the AAP.

* Will wearing glasses make a child dependent on them?

Possibly In mild hyperopia or presbyopia, wearing glasses relieves the eye of the effort required to bring objects into focus. Without constant practice, the child`s eyes will no longer do the work required. The feeling that a child has become dependent on glasses is probably just due to appreciation of clearer vision and an unwillingness to deal with blurry vision.

* Will wearing glasses correct the problem?

Wearing glasses helps to prevent or correct amblyopia in children whose eyes have different refractive errors. Glasses will correct a refractive error as long as they are worn, but they do not "cure" the error. Wearing glasses at a young age for mild refractive errors may interfere with autocorrection that would have developed over time.

* Will there be consequences if a hyperopic or myopic child`s vision is not corrected with glasses or contact lenses?

If a child develops amblyopia, the consequences are serious and permanent. In children whose eyes do not have disparate refractive errors, the consequences vary. Myopic preschoolers generally do not need corrective lenses unless they have a refractive error of 3 or more diopters. Corrective lenses are generally more important in farsighted (hyperopic) children, since in this case, the muscles of the eye cannot accommodate for refractive errors beyond a certain point. In highly hyperopic children, the attempt to focus may lead to esotropia (eye crossing) that may persist despite correction.

* How much of the time should a child wear glasses?

Myopic children should wear them only when they are needed and should avoid wearing glasses for close-up work or play Children with amblyopia or refractive esotropia should wear glasses full-time.

* A parent insists that her toddler functions just as well without glasses, even though he has been diagnosed with amblyopia.

The parent may be correct. It can be difficult to see differences in a toddler`s day-to-day behavior when his or her vision is corrected, since toddlers` activities don`t often require precise vision. Explain that although the child can still pick up pieces of lint off the rug, he is unable to see the difference between a piece of lint shaped like a "T" and one shaped like an "I." Developmentally, he may not be using that information, but he will soon need to appreciate the difference. If he is amblyopic, one eye is doing all the work, and the other will lose visual ability unless it is used.

* Another parent says glasses make her child`s vision blurrier.

True again, at first. Hyperopic children are used to focusing on their own. It takes a while for the eyes to relax while the glasses do the work. Corrections for astigmatism may make objects appear stretched at first.

* Do children ever intentionally perform poorly on office vision screenings?

Indeed they do. Many children find glasses cute and attractive, or they believe glasses will make them perform better in school, thereby pleasing their parents.

A sight for sore eyes: computer displays can be hazardous to your vision - Tech Tips

Black Enterprise , Oct, 1997 by Mildred Nunoo

The personal computer has become ubiquitous in the business world since its introduction, but has not been without problems. Repetitive stress injuries, such as carpal tuned syndrome, have heightened public awareness of the potential health hazards of spending long hours typing on a computer keyboard. Vision-related problems have also become an issue due to the corresponding increase in the use of computer monitors.

"The most common symptoms are eyestrain, headaches, blurred vision and dry or irritated eyes," says optometrist Stanley Segal of Dr.`s Savoy and Segal in Jersey City, New Jersey. "The extent to which someone may experience these symptoms is really based on his or her own visual health," says Segal. "Working long hours at a computer terminal may exacerbate an existing or undiagnosed eyesight deficiency, but it will likely not cause a permanent problem," he says.

When you`re inputting data from paper to a computer, the eye has to refocus every time you switch attention from the monitor to the paper. This causes the muscles in the eye to grow tired, thereby producing eyestrain. Uncorrected vision, poor computer monitor design, workplace ergonomics and a visually demanding job can contribute to the development of eye problems. Older people may find it more difficult to adjust to these working requirements.

According to the American Optometric Association (AOA) in St. Louis, eyesight problems experienced by computer users are generally only temporary and will decline after taking a break from the computer monitor at the end of the work day But to prevent or alleviate eye and vision discomfort, the AOA suggests the following:

* Take frequent alternative task breaks. Stop working at the computer monitor for a few minutes and work on another task. After working at the monitor for one hour straight, do some filing or catch up on phone calls, etc. Anything that will not cause your eyes to work as hard is considered an alternative task break. Another way to relax your eyes is to simply close them for a few minutes.

"Optometrists will tell you that the eye`s natural way of relaxing itself is by looking at a distance. When the eye does this, it does not require much focusing and therefore does not use as many muscles as if you were reading, doing needlepoint or working at a computer monitor," explains Charlotte Rancilio, administrative director of media relations with the AOA.

* When looking at computer screens with dark backgrounds, use lower lighting. When working in a home office setting, use about half the normal office lighting. In an office setting, remove overhead fluorescent light bulbs. Dimmer lighting will reduce glare on the screen. The contrast between the screen and the characters should be high. Dark characters on a light screen are generally more legible than light characters on a dark screen. To check for sources of glare, place a small mirror in front of the monitor. It will direct you to the sources of light that cause glare.

* Keep the computer computer clean. "When the monitor is dean, your eyes will not have to go through the dust and particles to refocus themselves," says Rancilio. An adjustable chair that allows you to sit at a comfortable height, angle and distance from the monitor is also important. Reference material should be on an adjustable holder dose to your screen and at the same viewing distance as your monitor. Having the material at the same height and distance will eliminate focusing strain on your eyes thereby preventing tired eyes.

In addition to taking practical steps to alleviate eye fatigue from monitor use, there are several products on the marker that cater to this problem Glass Plus ($94) is a glare reducer made by Image One Inc. (212-736-4500) that eliminates 99% of glare and reflections. Image One`s Private Eyes Screen, which lists for $169, reduces glare and turns into a privacy screen by making information visible only when viewed from directly in front of the monitor. Radiation and anti glare filter screens are also available from Proformix Inc. (800-9732739). Prices range from $75-$120 depending on the size of the monitor.

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