In a culture growing ever more reliant on electronic products that are
shrinking in size and increasing demands on near point visual skills, children
are being left behind because Snellen chart screenings, which most schools (and
parents) rely on for determining visual acuity, measure only for distance
Joel N. Zaba
“We have to realize that the children of this generation are using
their near point visual skills more than any other children in the history of
the world,” Joel N. Zaba, OD, MA an optometrist specializing in
learning-related vision problems in adults and children, said in an interview
with Primary Care Optometry News. “They use these skills for
computer work, computer games, cell phones, texting and tablet
“The more aware school administrators become of this close-up
vision, the more they’ll begin to use these various types of screening
techniques that allow you to screen not just at 20 feet, but at that 16 inches
where the children read, from the 13 inches to 24 inches where they may be
working on their desks and the 16 inches to 18 inches where their computer
systems may be, as well as the handheld aspects,” Dr. Zaba said.
“A child can view an eye chart and read the letters, but yet, close
up, he may see double vision. And you would miss that entirely,” he added.
“Or if they’re really bright and they’re standing in line,
they’ll memorize the chart.”
In a paper commissioned by the Essilor Vision Foundation and published
in the Journal of Behavioral Optometry, Dr. Zaba explained that
early vision problems have been linked to elevated school drop-out rates,
literacy issues in adulthood, social and emotional problems, and
“Two out of three children in the U.S. do not receive preventive
vision care before entering elementary school,” he wrote. As of 3 years
ago, he said, nine states require no preventive vision care before or after
entering school, and even though 39 states require vision screenings in
schools, 32 of those states do not require children failing these screenings to
be examined by an eye doctor. Moreover, considering most classroom activities
involve near vision, the vision screenings are most commonly performed with the
use of the Snellen chart, a 150-year-old test for distance vision.
“Nothing takes the place of a complete visual and eye health
evaluation,” Dr. Zaba told PCON. “My personal recommendation would be
that all children receive an eye exam – and deserve an eye exam –
before entering the school system.
“Theoretically, I’d like to see a child get a visual
evaluation every year because the demand is changing so much,” he
continued. “There’s so much more work a child does in third grade
where he’s reading to learn than in the first grade where he’s
beginning to learn to read. What could be a subtle problem they have at first
may end up being something significant as they progress through school because
of the change in their near vision demands.”
Dr. Zaba believes the gold standard should be eye exams every year.
“Can we reach that? Let’s try,” he said. “Whatever we do
for our kids will be better than what we’ve done in the past.” –
by Daniel Morgan
- Barber A, Johnson R, ed. Behavioral aspects of vision care. Santa
Ana, CA: Optometric Extension Program, 2002;42:1-7.
- Zaba JN. Children’s vision care in the 21st century and its
impact on education, literacy, social issues and the workplace: A call to
action. J Behav Optom. 2011;22(2):39-41.
- Joel N. Zaba, OD, MA can be reached at 281 Independence Blvd.,
Virginia Beach, VA, 23462; email@example.com.
- Disclosure: Dr. Zaba has no financial interest in the Essilor