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Parents, when you are reviewing "back to school" necessities for your child, be sure to include an eye examination as his or her vision should be among the top priorities on your checklist. Clear vision is one of the most important things to have in order to bring home good grades throughout the school year. Regular eye exams are always important for children, starting with their first exam at age 6 months.

The National Society of Prevention of Blindness has designated August as "National Eye Exam Month". Their goals for this month are to stress the importance of periodic eye exams, especially for children, and that safety in the home prevents eye injuries.

Before school starts, a thorough eye exam is one of the best ways to insure that your child gets off to their best start for the upcoming academic year. A cornerstone of a good education is good vision. School-age children's eyes are constantly changing so when his/her vision is not functioning properly, learning and participation in recreational activities will suffer.

Usually during the grade-school years, your child has the advantage of having their distance vision checked by the school nurse or a counselor. These yearly "Vision Screenings" are not a substitute for a comprehensive eye examination by an eye care professional and you should not totally rely on this simple test. A screening simply checks what your child is able to see at a 20-foot distance and does not relate to any of the other visual skill needed for learning. Good vision involves many different skills working together to enable your child to not only see clearly but to understand what he/she sees.

Some of the basic visual skills needed for school, in addition to clear distance vision, which a screening does not address are:

  • Near vision - the ability to see clearly and comfortably at 12"-16", the approximate distance at which schoolwork is done at a desk.
  • Binocular Coordination - the teaming ability of the two eyes to work together, and with clear vision, which is more commonly referred to as depth perception.
  • Eye Movement Skills - the ability to aim the eyes together accurately. An example of this would be reading the lines across the pages of a book smoothly and being able to move to the next line accurately. Recreational uses of this skill would be tracking a ball.

There are other things that school screenings don't test for such as Peripheral Awareness and Hand/Eye Coordination. If any of these skills are lacking or deficient your child's eyes have to work harder than necessary and this can lead to headaches, fatigue, and/or other eyestrain symptoms. Additionally, the routine stress of schoolwork can affect these visual skills causing a vision problem where none existed before. Vision screenings have a useful place in preventive eyecare but they are no substitute for a thorough examination.

For school-age children, it is important to seek an eyecare professional. Vision changes can occur without you or child realizing it and it is for this reason that a vision examination be done by your doctor every year. A thorough exam include:

  1. A full review of your child's health and vision history.
  2. Tests for both far and near visual acuity, peripheral vision awareness, eye alignment, muscle function, color vision, depth perception (binocular coordination), pupil assessment, focusing ability, refractive error testing (for nearsightedness, farsightedness, and astigmatism).
  3. An eye health evaluation, including glaucoma testing and a dilated retina evaluation (with photographic recordings, when possible).

After the examination a review of the test result should be discussed with the parent or guardian, as well as the intended treatment plan, which may include eyeglasses, contact lens, visual therapy, or the improvement of ergonomic factors such as rest breaks, glare reduction, chair/desk relationships, and overall lighting.

As for the preschools children, their eyes are no less important. Virtually all the same test can be done and almost all the same areas can be assessed. The American Optometric Association released their revised guidelines for periodic eye exams suggesting low risk infants should have their first eye exam at the age of 6 months, followed by their next two exams at the age of 3 and then 5 (something that this author has advised for the past five years).

One might ask "how can my six month old child answer the doctor which lens is better, 'one or two', when they can't even speak yet?", and the answer is they don't have to. All above tests, with the exception of color vision and depth perception tests, can be done accurately without the verbal response of the patient, including testing for an eyeglass prescription. With today's diagnostic instruments and testing techniques your child doesn't have to know the alphabet or how to read to have his/her eyes thoroughly examined.

Early testing might reveal an existing problem that needs to be cared for in order to preserve vision. Examples of this would include cataracts, high refractive errors, high amounts of astigmatism, and uneven amounts of refractive error (anisometropia), or any pathology.

One of the common understandings that parents of preschool age children have is that they should wait to have their child's eyes tested after they've had their first school screening, which usually is about the age of six years. In humans, visual acuity develops from birth to about the age of six months and at six months adult visual acuity has been reached. The critical period of development for the other components of the visual system are from birth through the age of six years. By the time a child usually gets a school screening they have already passed the critical period of growth. If any existing problems have not been addressed the chance of a permanent visual can occur, such as amblyopia (which is the inability of a healthy eye to be corrected to see 20/20).

No one can see through your child's eyes and symptoms aren't always apparent. The only way to be sure that your child's sight is developing normally is with a professional eye examination. Your care and concern for your child's vision can enrich his/her future and, help him/her develop eye care habits for a lifetime of good vision.

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