2. Introduction Major concerns
Signs and symptoms that may indicate vision problems
Types of visual conditions
Refractive Issues
Visual Efficiency Problems
Visual Processing Problems
What is a vision screening?
Parents role in vision development

3. What are the major concerns?
20% of preschoolers are at risk of having eye or vision problems
25% of school age children have eye or vision problems
Students identified as problem learners have high rates of undetected vision problems
These problems are reported to occur at an even higher rate in children living in poor urban environments

4. Signs/Symptoms parents should keep in mind
Sitting too close to the TV
Holding a book very close
Squinting, rubbing eyes
Head tilt
Turning of an eye in or out
Light sensitivity
Difficulty with eye-hand coordination
Avoidance of near work

5. Types of visual conditions
Refractive Issues
Myopia (nearsightedness)
Hyperopia (farsightedness)
Astigmatism

6. General characteristics of Myopia
Blurred distance vision
Tendency to bring near work very close or get close to television
Interest mainly in near activities, less distance work
Highly motivated readers, best learners
Interactive Demo:
use of trial lenses to induce blur

7. General characteristics of Hyperopia
Blurred vision greater at near
Eyestrain, headaches
Difficulty attending to near work
Interactive Demo:
Use of trial lenses to induce blur

8. General characteristics of Astigmatism
Blurred vision at distance and near
Inability to sustain attention
Discomfort of the eyes
Interactive Demo:
Use of trial lenses to induce blur

9. Types of visual conditions
Visual efficiency problems
Eye teaming problems
Eye focusing problems
Eye tracking problems
Strabismus
Amblyopia

10. Eye teaming problems Problems with convergence Symptoms
Headaches
Eyestrain
Double vision (tendency to close one eye)
Moving letters or words on a page
Rubbing eyes frequently
Poor comprehension
Demo: Convergence, Vergence facility, Stereopsis

11. Eye focusing problems Loss of attention to near work
Headaches and eyestrain
Poor comprehension
Avoidance of reading
Example, demonstration
Accommodative facility test, clearing plus/minus

12. Eye tracking problems
Inefficient eye movement skills following targets
Symptoms
Loss of place when reading
Poor comprehension
Decreased reading speed
Demonstration: DEM, King-Devick

13. Amblyopia & Strabismus
Decreased visual acuity not correctable with lenses
Tendency for eyes to turn in, out, up or down
Symptoms
Blurred vision (or not if only in one eye)
Double vision intermittent or constant
Decreased reading speed
Decreased reading comprehension
Demonstration: Prism for diplopia, Neutral density filter for amblyopia

14. Visual processing problems
Form perception
Visual memory
Visual motor integration
Laterality and directionality
Examples, demonstration:
Form board, circus puzzle
VMI test/ Winterhaven copy form test
Parquetry blocks

15. Tests of Vision Visual acuity Refractive issues
Eye teaming / eye alignment
Eye focusing
Eye movements
Color vision
Eye health
Interactive demo:
Show screening tests (DVA only) and others

16. Comprehensive Eye Exams and Vision Screening
The American Optometric Association recommends a comprehensive eye exam from an eye doctor for every child between 6 and 12 months, between 3 and 5 years of age, then again before first grade and annually thereafter.
A vision screening by the school or pediatrician is not the same as a comprehensive eye and vision examination
Vision screenings miss most vision problems; a child passing a vision screening may still need further evaluation

17. Comprehensive Eye and Vision Exams Include
Review concerns, patient and family eye and medical histories, including visual, ocular, general health, developmental status, leisure and sport activities, and school performance
Measurement of visual acuity
Determination of refractive status
Assessment of binocular vision, ocular motility, and accommodation
Evaluation of color vision
Assessment of ocular and systemic health, including evaluation of pupillary responses, anterior and posterior segment, peripheral retina, evaluation /measurement of intraocular pressure, and visual field testing

18. Keeping children’s eyes healthy
Comprehensive eye examination can reveal eye health issues that may interfere with a child’s vision
Important to evaluate all structures of the eye with dilated eye examination to rule out any retinal problems, lens abnormalities, or optic nerve problems

19. InfantSEE®
Public health program designed to ensure that eye and vision care become part of an infant’s wellness examination.
Participating AOA (American Optometric Association) member optometrists provide a comprehensive eye and vision assessment free of charge for infants between 6 and 12 months.

20. Suggested activities to help with infant vision development
Keep reach and touch toys within baby’s focus about 8”-12”
Select toys with bright and contrasting colors
Allow baby to touch, pull, hold, kick toys
Provide toys with different shapes and textures for baby to explore
Encourage tummy time
Stimulate both sides of the body to develop laterality and binocularity
Encourage crawling and creeping to develop eye-hand coordination
Alternate feeding from right and left sides

21. Suggested activities to help with preschool vision development
Encourage Outdoor play
Sports
Encourage activities/games involving puzzles or patterns, problem solving
Play simple memory games
Games requiring eye hand coordination skills
Read aloud to children, allow them to see what is being read, ask questions, encourage interaction and conversation
Maintain good eye contact with children

22. Selection of toys
Stimulate visual development, hand-eye coordination, spatial relationships
Perceptual Toys:
Eye-hand (ex: lite-brite, mazes)
Spatial relations (ex: parquetry blocks,
battleship, tic-tac-toe)

23. Selection of toys Visual Memory Directionality
Concentration
Directionality
Directional arrows with stepping stones
Visual Motor Integration
Puzzles, sketching, bead stringing

24. Selection of toys Eye Hand Coordination Gross Motor skills
Wooden building blocks, mega blocks
Gross Motor skills
Twister, table tennis

25. Conclusion
Early detection and treatment are essential to preventing or reducing the development of vision conditions that have the potential to cause vision loss or affect visual development
Early detection of visual problems is important in a child’s development
Early care  Preventable vision loss
Comprehensive pediatric eye and vision examinations are essential for timely diagnosis and treatment of eye disease and maintenance of good vision

26. Statistics for OD information
NOT INTENDED FOR PRESENTATION TO COMMUNITY

27. Background
Of the three to four million babies born every year in the United States
1 in 20,000 has retinoblastoma (cancer)
1 in 25 will develop strabismus (cross eye)
1 in 30 will develop amblyopia (lazy eye)
1 in 33 will show significant refractive error (prescription)
An estimated one in five preschool children has eye and vision problems and these problems are reported to occur at an even higher rate in children living in poor urban environments
One in four school-age children has a vision problem

28. Background
Vision disorders are the 4th most common disability in the U.S. and the MOST prevalent handicapping condition in childhood
Below the age of 6 years, only 14% of children are likely to have had an eye and vision examination
If left untreated, eye and vision problems can lead to difficulties in development, education, and potential permanent vision loss
Majority of learning in school is done through reading, especially after 3rd grade

29. Visual development
Basic visual functions develop rapidly during the first year of life. By 6 months of age, vision has become the dominant sense and forms the basis for later perceptual, cognitive, and social development
Objective testing (visual evoked response) demonstrates that the visual cortex is capable of achieving 20/20 visual acuity by 6 months of age

30. Refractive Errors: Hyperopia
Hyperopia has a high prevalence among young children, with over 20% estimated to have ≥2.00 diopters (D). Significant hyperopia (≥2.00 D) is commonly found in association with the development of strabismus and amblyopia, and learning difficulties.

31. Refractive Errors: Myopia
One in six children ages 5 to 17 (Asian, Hispanic, African American and White) developed myopia during their school-age years. More than 75% of the new cases of myopia occurred between the ages of 9 and 13.

32. Access to Care
The Centers for Disease Control and Prevention report that less than 15 percent of preschoolers receive an eye examination by an eye care professional and fewer than 22% receive some type of vision screening

33. Limitations of Vision Screenings
Although both laws and guidelines exist for the screening of pre-school children, only about 21% are screened for vision problems
Untestability of preschool children at a screening can be as high as 42%
Of the children who fail the screening, only 20-40% of the children receive examinations – failing the needs of these children even further
Low screening rates and inadequate referral and follow through with a comprehensive eye examination by an eye doctor indicate that screening children in a school, a pediatric care setting or other primary care setting is not an acceptable method to evaluate a child’s normal visual function