Friday, August 2, 2013

My child gets their eyes checked at school and the pediatrician’s office every year. That counts as a full eye exam, right?

A vision screening performed by a pediatrician or school nurse is meant to alert parents to a potential visual problem, but is not a substitute for a comprehensive eye examination. Studies* have found that up to 11% of children that pass these screenings actually have a visual problem that requires treatment.

These screenings will typically identify children with the most common condition that requires spectacle correction: Myopia (or Near-Sighted). Many times, conditions such as Hyperopia (or Far-Sighted), Amblyopia (a broad term for conditions known to many as “lazy eyes”), or medical ocular diseases are simply missed as very specific specialized training is required to catch these problems.

To this end, my office offers a promotional discounted back-to-school exam and heavily stresses the importance of pediatric eye examinations to all of our patients. Remember, a child’s vision can change every year. Proper care starts with an annual eye examination.

What Goes into a Comprehensive Eye Exam for School Age Kids?

The exam starts out with a comprehensive verbal history between the doctor, student, and parent looking to identify any areas of concern. This is not just limited to clarity of vision, but comfort of the eyes, eye allergies, headaches, performance in school, etcetera.

Visual acuity is measured in the distance and near (i.e. reading the eye charts). Then each of the six muscles that control the movement of each is assessed. The doctor looks to identify the presence of any muscle imbalances or eye turns, among other things. Next, depth perception and color vision are assessed using special instrumentation. Next, peripheral vision, or side-vision, is evaluated. Pupil reactions are then evaluated with a bright light.

Then comes the refraction. The doctor will use a specialized instrument to first focus the patient’s eyes without any input from the patient. This allows Hyperopic prescriptions to be identified, making sure the child is not “cheating or fibbing” on the eye exam. This is how glasses are prescribed for those that are too young or unable to answer with certainty. If the child is old enough, we then fine-tune this prescription with the patient’s input (“which is sharper and clearer, 1 or 2?”). If correction is required, this will be demonstrated at this time.
The Retina (inside) of a healthy eye

Then the health of the inside and outside of every aspect of the eyes are carefully examined via a specialized microscope. If the student is in 2nd grade or older, a digital photograph of the back of the eye will be taken in place of traditional dilation. If it is the child’s first eye exam, the doctor will likely dilate the eyes anyway, as this is the standard of care.

The pressure inside the eyes will be measured using a state-of-the-art instrument that is more accurate and much more comfortable than the traditional “air-puff” method.

Finally, the doctor will discuss all the important results of the examination, options for treatment if required, and make a professional recommendation for the next eye exam. Last, but not least, our doctors will ask if the patient or parents have any questions.

This entry was written by Dr. Andrew Neukirch and originally published in Carillon Vision Care's Fall 2013 Quarterly Newsletter. You may contact Dr. Neukirch directly here.
  • Centers for Disease Control and Prevention, November 2005.
  • Insights on the efficacy of vision examinations and vision screenings for children first entering school. Journal of Behavioral Optometry, September/October 2003.
  • *Preschool vision screening in pediatric practice: A study from the Pediatric Research in Office Settings (PROS) network. Pediatrics. May 2002.