1. Children’s Eyes and Vision
Presented by Dr. [Name here]
Hello, my name is Dr. ______________.
Thank you for welcoming me today. It’s a pleasure to talk to you about how your children’s eyes work and the importance of eye care.
Date goes here

2. The Amazing Eye
For children, vision plays an essential role in the learning process.
An infant should receive his or her first eye exam between the ages of 6 and 12 months. Even if no eye or vision problems are apparent, at about age 6 months, you should take your baby to your doctor of optometry for his or her first thorough eye examination.
Children then should receive additional eye exams at 3 years of age, and just before they enter kindergarten or the first grade at age 5 or 6.

3. The process of vision
To start off, let’s examine how the eye actually functions.
An object in the world is seen by the eye upside down
The brain processes the eye’s image to create the picture of the object

4. When vision is bad...
The cornea and lens need to focus light onto the retina for clear vision
Often, the focus is not sharp...
When certain visual skills have not developed, or are poorly developed, learning is difficult and stressful, and children will typically:
Avoid reading and other near visual work as much as possible.
Attempt to do the work anyway, but with a lowered level of comprehension or efficiency.
Experience discomfort, fatigue and a short attention span.

5. Hyperopia (farsightedness)
Farsightedness, or hyperopia, is a vision condition in which distant objects are usually seen clearly, but close ones do not come into proper focus.

6. Hyperopia (farsightedness)
Too little focusing power causes light to be focused “behind” the retina
Convex (+) lenses focus light onto the retina
A significant cause of learning problems; often goes undetected by school screenings
Common need for reading glasses
[Explain 2nd talking point regarding Convex (+) lenses]
Expanding on 3rd talking point: Some children with learning difficulties exhibit specific behaviors of hyperactivity and distractibility. These children are often labeled as having "Attention Deficit Hyperactivity Disorder" (ADHD). However, undetected and untreated vision problems can elicit some of the very same signs and symptoms commonly attributed to ADHD. Due to these similarities, some children may be mislabeled as having ADHD when, in fact, they have an undetected vision problem.
Common signs of farsightedness:
Difficulty in concentrating and maintaining a clear focus on near objects
Eye strain, fatigue and/or headaches after close work
Aching or burning eyes
Irritability or nervousness after sustained concentration

7. Myopia (nearsightedness)
Nearsightedness, or myopia, is a vision condition in which close objects are seen clearly, but objects farther away appear blurred.

8. Myopia (nearsightedness)
Light is focused “in front of” the retina
Distant objects look blurred
Very common vision condition affecting nearly 30% of the U.S. population
Concave (-) lenses focus light onto the retina
Generally, nearsightedness first occurs in school-age children. Because the eye continues to grow during childhood, it typically progresses until about age 20. However, nearsightedness may also develop in adults due to visual stress or health conditions such as diabetes.
[Explain 4th talking point regarding Concave (-) lenses]

9. Astigmatism
Astigmatism is a very common vision condition. Most people have some degree of astigmatism. Slight amounts of astigmatism usually don't affect vision and don't require treatment. However, larger amounts cause distorted or blurred vision, eye discomfort and headaches.
Causes blurred vision due either to the irregular shape of the cornea or sometimes the curvature of the lens inside the eye
May be found in combination with farsightedness and nearsightedness
Results in blur at distance and near

10. Strabismus
“Eye turn”
Inward, out, up or down
Double vision is uncommon because of brain adaptation called suppression
Treatments include: proper prescription, patch to equalize the individual eyes’ abilities, visual therapy and possible surgery
Early treatment is essential

11. Amblyopia Phrase “lazy eye” is often used to describe amblyopia
Can cause permanent reduction of vision if not treated (even with glasses), which results from the brain constantly ignoring the image of an eye that is crossed or from an eye that is significantly different in prescription than the other eye
Treatment: amblyopia may be improved with vision therapy or patching

12. Accommodative disorders
Accommodation = ability to focus from near objects to far
Problems can include insufficient amount of focus, overly active focus, lack of focus, and slowly shifting focus
The muscle that controls focus can be trained to work more efficiently
Bifocals or reading glasses can be used for children

13. Dilation is safe for kids
Why we do it?
Periodically required to evaluate parts of the inner eye that can show abnormality
Relaxes focusing muscles to better assess prescription
Examples include retinal degenerations, retinal detachments, and retinal tumors

14. Digital eye strain
A temporary vision condition caused by prolonged use of screens/technology
Symptoms include:
Burning, itchy or tired eyes after using electronic devices
Headaches
Fatigue
Loss of focus
Blurred vision
Double vision
Head and neck pain

15. Digital eye strain
Parents severely underestimate the time their children spend on digital devices.
AOA survey: 83% of children: estimate using an electronic device for 3+ hours each day
Only 40% of parents: believe their kids use an electronic device 3+ hours each day
The use of technology among children both at home and in the classroom is on the rise, and a new survey shows that parents drastically underestimate the time their kids spend on digital devices.
According to an AOA survey of children between the ages of 10 and 17, 83 percent of kids say they spend three or more hours each day on digital devices.
However, only 40 percent of parents believe their children use an electronic device for that same amount of time. Most parents believe the time their kids spend using technology is far less than what it is.

16. Digital eye strain Significant disparity:
Parents more likely to overlook warning signs and symptoms of digital eye strain
80% of children experience burning, itchy or tired eyes after using electronic devices for long periods of time
This disparity may indicate that parents are more likely to overlook warning signs and symptoms associated with vision problems due to technology use.

17. Inside the numbers...
More than 23% of the U.S. population is less than 17 years of age.
1 in 4 children has a vision problem that can cause problems in learning and behavior.
In the U.S., only 7% of children beginning first grade report having received an eye exam (when parent or caregiver is surveyed).
(references):
1st talking point: U.S. Census Bureau American Community Survey 3-Year Estimates
2nd talking point: Think About Your Eyes and AOA
3rd talking point: 2002 National Health Interview Survey as cited in CDC MMWR, 54(17), 425-9

18. Vision exams and screenings
Vision screening is never a replacement for a comprehensive eye examination
Screenings check for blurred vision
Exams evaluate vision, PLUS eye muscle teaming, focus ability, and overall eye health
To understand why vision screenings may not find a vision problem, we need to look at the factors that can limit their effectiveness.
Limited testing - Many vision screenings test only for distance visual acuity. While the ability to see clearly in the distance is important, it does not give any indication of how well the eyes focus up close, or work together. It also does not give any information about the health of the eyes. Some screenings may also include a plus lens test for farsightedness and a test of eye coordination. However, even these additional screening tests will fail to detect many vision problems. Untrained personnel - Often times a vision screening is conducted by administrative personnel or volunteers who have little training. While well intentioned, these individuals are not eye doctors and do not have the knowledge to competently assess screening results. Inadequate testing equipment - Even when done in a pediatricians' or primary care physicians' office, the scope of vision screening may be limited by the type of testing equipment available. Factors such as room lighting, testing distances and maintenance of the testing equipment can also affect test results.

19. Why so few eye exams?
Parent reliance on vision screenings provided by pediatrician or school
Lack of good public information as to the importance of periodic eye care
Families may be unaware of pediatric vision care benefit under the health care law

20. Pediatric Vision Care Benefit
Four things you should know…
Your child's coverage is based on a comprehensive eye exam
Your child's coverage extends through at least age 18
Your child's coverage is included in your health plan
Your child's coverage ensures direct access to optometrists
Here's what every parent needs to know about the new pediatric optometric care benefit, which took effect nationwide Jan. 1, 2014:
Your child's coverage is based on a comprehensive eye exam The federal government requires states to define the new benefit as coverage for regular comprehensive eye exams, including all follow-up care and—in almost every case when needed—eyeglasses and contact lenses.
Your child's coverage extends through at least age 18
Your child's coverage is included in your health plan Unlike limited stand-alone plans that can be offered as add-ons to coverage but are not required, the new pediatric eye care essential health benefit will be included as a core benefit and embedded within the overall health plan. This approach provides the seamless primary eye health and vision care children need. Your child's coverage ensures direct access to optometrists Parents can directly access eye care for their children through their local doctor of optometry, both for comprehensive eye exams and needed treatment.

21. The Role of Vision in Learning
The eyes must see clearly, without double vision, and with accurate ability to focus
A child must have the visual ability to learn to read prior to reading to learn
When a child has difficulties learning, think first of his or her ability to see, then of his or her ability to learn

22. Comprehensive Eye Exams
Optometrists and ophthalmologists are eye doctors who provide eye examinations
Can find the problems that relate to poor learning
Here is a “peek”...

23. Color Vision
Color vision deficiency is the inability to distinguish certain shades of color or in more severe cases, see colors at all. The term "color blindness" is also used to describe this visual condition, but very few people are completely color blind.
Most people with color vision deficiency can see colors, but they have difficulty differentiating between particular shades of reds and greens (most common) or blues and yellows (less common).
People who are totally color blind, a condition called achromatopsia, can only see things as black and white or in shades of gray.
The severity of color vision deficiency can range from mild to severe depending on the cause. It will affect both eyes if it is inherited and usually just one if the cause for the deficiency is injury or illness.
Color deficiency is usually an inherited condition, but disease and injury can also result in color recognition loss.
Usually, color deficiency is an inherited condition caused by a common X-linked recessive gene, which is passed from a mother to her son. But disease or injury damaging the optic nerve or retina can also result in loss of color recognition. Some specific diseases that can cause color deficits are:
diabetes
glaucoma
macular degeneration
Alzheimer's disease
Parkinson's disease
multiple sclerosis
chronic alcoholism
leukemia
sickle cell anemia
Other causes for color vision deficiency include:
Medications - certain medications such as drugs used to treat heart problems, high blood pressure, infections, nervous disorders and psychological problems can affect color vision.
Aging - the ability to see colors can gradually lessen with age.
Chemical Exposure - contact with certain chemicals such as fertilizers and styrene have been known to cause loss of color vision.

24. Depth Perception

25. Keratometry
This test measures the curvature of the cornea, the clear outer surface of the eye, by focusing a circle of light on the cornea and measuring its reflection. This measurement is particularly critical in determining the proper fit for contact lenses.

26. Visual Acuity Reading charts are often used to measure visual acuity.
Visual acuity measurements evaluate how clearly each eye is seeing. As part of the testing, you are asked to read letters on distance and near reading charts. The results of visual acuity testing are written as a fraction such as 20/40.  When testing distance vision, the top number in the fraction is the standard distance at which testing is done, twenty feet. The bottom number is the smallest letter size you were able to read. A person with 20/40 visual acuity would have to get within 20 feet of a letter that should be seen at 40 feet in order to see it clearly. Normal distance visual acuity is 20/20.

27. Refraction
Refraction is conducted to determine the appropriate lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism). Using an instrument called a phoropter, your optometrist places a series of lenses in front of your eyes and measures how they focus light using a hand held lighted instrument called a retinoscope. The doctor may choose to use an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient's responses to determine the lenses that allow the clearest vision.  This testing may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. In some cases, such as for patients who can't respond verbally or when some of the eyes focusing power may be hidden, eye drops are used. The drops temporarily keep the eyes from changing focus while testing is done.

28. Eye Health Test
External examination of the eye includes evaluation of the cornea, eyelids, conjunctiva and surrounding eye tissue using bright light and magnification.

29. Eye Pressure
Tonometry measures eye pressure. Elevated pressure in the eye signals an increased risk for glaucoma.

30. Eye Drops — Dilating the Pupil

31. Eye Health Tests

32. The “Headlight” Health Exam
AOA recommends:
Visit your optometrist annually for a comprehensive eye exam. Children should see the optometrist at 6 months of age, again at age 3, and at age 5 and every year afterward.
Visit the AOA website at aoa.org for more information about eye and vision health.

33. Thank you!
Questions?