Long Read
Children need proper eye care (Photo Supplied)
Kumuda Setty
Auckland, April 29, 2022
Sight experts are unanimous in declaring vision problems as one of the most prevalent handicapping conditions in childhood.
Children with undiagnosed and untreated vision problems grow up to become adults with undiagnosed and untreated vision problems.
The failure to detect and treat children’s vision disorders affects the rates of adult criminality, literacy and labour productivity. A literate population is the backbone of a healthy society.
Pre-requisite to academic performance
When children do not have good vision, their school performance suffers. As we work to improve schools and get more books and computers into the hands of children, we must not overlook a prerequisite learning tool – good vision. Experts estimate that 80% of what we learn comes through the visual processing of information.
In New Zealand, the B4 School vision screening is undertaken by lay vision and hearing screeners using the unvalidated Parr Vision Chart. This chart is used because it is quick and easy to administer and is used despite best practices suggesting otherwise. Current research is being undertaken to explore the use of other validated charts or autorefraction.
Data from the South Auckland DHB, which administers the B4 School vision checks, shows in 2009-2010 only 54% of under four-year old were screened. This has recently been improved and in 2016 was raised to 94%. The B4 School vision check, however, only screens for amblyopia, distance acuity and strabismus but does not check for mild to moderate hyperopia or near distance acuity. This means that common refractive errors of mild to moderate hyperopia with or without astigmatism or myopia are not identified despite these issues being recognised as leading to poor school performance and behaviour. We also need to note most classroom activity involves near vision.
Refractive issues
Statistics NZ records that approximately 30% of all under four-year old’s have refractive issues and yet only 14% are referred for further testing. There is also no formal follow-up to the referrals. It is known that many do not take up the referrals due to economic or social reasons.
Even if referrals do occur children often do not go on to get glasses due to costs despite the spectacle subsidy of $287.50. This subsidy is only available to those with community cards and is often not sufficient to cover the costs of special lenses and is only available once a year. There is also no further eye screening undertaken until Year 7 despite international research indicating that vision should be tested annually due to children’s vision rapidly changing. For example, whereas previously myopia was developing at age 12-13 it is now being seen more frequently in children aged 6-7 years of age. It is assumed that children with myopia will self-refer if they have trouble seeing despite research indicating that often children, their families or teachers do not know that vision is an issue.
Survey Results
Children must have the vision care and vision skills required in order to perform successfully in school and later in workplace environments. As children progress through their school years they must be checked regularly for vision problems. These screenings or examinations should include multiple tests to identify a wider spectrum of vision problems, especially those affecting near-vision. Parents must be educated on these points so they do not defer vision care for their children.
Associate Professor Alison Kearney and Dr Julia Budd investigated the impact of corrective lenses on the learning, behaviour and social outcomes of students in years 5 and 6. This study, carried out involved (a) The examination of identified students’ school records in relation to learning and behaviour (b) Questionnaires with the students who received glasses, along with their parents/whanau and teachers.
Participants were children who have been part of a project funded by Essilor Vision Foundation and who have been identified as requiring corrective lenses. It also involved their parents, family and their teachers.
Essilor’s Vision
The Essilor Vision Foundation screened children in Year 5 and 6 using validated tests and autorefraction undertaken by trained optometrists. Essilor found that in four South Auckland schools 30% of the children needed referrals to an optometrist. Of those referred over 50% needed corrective lenses. The majority (90%) of the students were long sighted (hyperopia) needing a prescription ranging from +0.5 to +9.75 often with astigmatism. At least 8% were short sighted (myopia) and needed a prescription ranging from -0.5 – 4.75. 2% had anisometropia a difference in prescription between the eyes, of at least +2. Around 8% had amblyopia or lazy eye, 4% were colour blind and 4% had binocular vision issues while 9% who were tested had or had previously had glasses and 5% had broken glasses, had not worn their glasses, or they needed a new prescription. 2% were identified as having possible keratoconus and a further 8% had a diagnosis of a significant visual impairment including congenital cataracts and Duane’s syndrome who were being seen by eye specialists.
During the initial screening and eye examinations some children spoke of a range of issues including; headaches, sore eyes, blurry vision and not being able to read books or the blackboard. Many of the students were recorded as having significant improvement in their near visual acuity and being able to read smaller print size when correction was provided.
Need for corrective lenses
Students, parents and teachers were asked if they knew that they/their child/their students could not see well prior to having their eyes tested. In relation to students, 38% said that they did know, 37% said they did not know and 25% were unsure. For those students who did know, the majority said that they knew because their eyes were blurry while others reported that they could not see writing either in books, on the board or far away. Some children reported that their eyes were sore and that they had to sit close to the board.
A majority of parents (59%) did not know that their child needed glasses prior to them having their eyes tested, 31% were unsure and 10% did know.
The majority of teachers did not know that their student could not see well before they had their eyes tested (82%) 15% did know and 3% were unsure.
Why are these percentages of non-compliance by parents and guardians so high? What are the barriers to vision care for children?
Financial: Many families cannot afford to take their child to see an eye care Professional or pay for glasses. In New Zealand enable subsidy which provides free eye exam and basic glasses is available only for community card holders. The basic cost sometimes does not cover cost of specially made lenses if child needs it.
Logistical: Logistical issues include transportation to the Optometry practice and taking time off work, especially when the caretaker works long hours. Vision care is not a priority: In some cases, families view vision care as an expense that can be deferred. In other cases, parents simply do not believe their child has a vision problem.
Given the low rate of follow up to school vision screenings and the resulting high number of children in need of eye exams and glasses, is it any wonder “Johnny can’t read?”
Consequences of Uncorrected Vision Problems: Research in the US has found when vision problems are not detected early; they can negatively affect a child throughout his or her lifetime. Students, juvenile offenders, illiterate adults, academically at-risk college students, and academically/behaviourally at-risk public-school students have a higher prevalence of undetected vision problems. Between 1992 and 2003, there was a decline in the average prose literacy of adults between the ages of 25 and 39. A significant number of undetected and untreated vision problems are found in adults in the lowest levels of literacy. When evaluating adults with literacy problems, 66% to 74% of the samples failed vision screenings. Many of these adults are the children of yesterday who had undiagnosed and untreated vision problems and grew up to become part of the adult literacy problem we face today.
Early intervention is the key
Success at school is critical. Difficulties with vision that can be corrected with the use of spectacles is something that is easily identified and corrected allowing students to access up to 80% of learning that occurs visually at school. We know that the higher the level of educational attainment, the greater the advantages in adult life – for example higher earnings and better health. Therefore, providing the means by which these children can access learning visually and succeed educationally has lifelong benefits to the student and to society as a whole.
Overseas research tells us that 80% of children who experience difficulties with learning have an undiagnosed vision problem. Early intervention is the key – identifying and intervening for these children as early as possible is critical. It is not just the learning that is affected when children cannot see – difficulties with learning can lead to being turned off school and learning, lack of engagement, lack of involvement in school wide activities and a lack of belief in their ability to be successful
Economic benefits
Investing in intervention as early as possible will have significant short and long term economic benefits. In the short term, providing the means by which student can access learning and feel good about school and learning will save on interventions that may be required further into a child’s school life. The long-term benefits relate to less need for social and health interventions in adult life.
The definition of good vision needs to be updated to reflect the technical requirements of the learning environment of the 21st century and discourage the use of Parr Vision Chart as the sole arbiter of good vision. More tests need to be added to school screening protocols to detect near-vision problems or other potential vision issues that may hinder a child’s ability to read, learn, and perform well in school.
Most parents assume children’s vision problems are addressed by schools. As children progress through their school years, they must be screened for vision problems. These screenings should include multiple tests to identify a wider spectrum of vision problems especially those affecting near-vision and done by qualified vision care experts.
Visit your local optometrists to discuss any vision issues your children have.
Kumuda Setty is National Sales & Marketing Manager at Essilor New Zealand based in Henderson, West Auckland. Essilor is a global leader in the ophthalmic industry, committed to providing solutions to correct and protect the visual health of people worldwide.
