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 acuity.

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 computers.”

“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 criminality.

“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

References:

• 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; joelzaba@cox.net.
• Disclosure: Dr. Zaba has no financial interest in the Essilor Vision Foundation.