Last year, I went with a small group of ophthalmologists to a South Bronx middle school to conduct vision exams. One neatly dressed boy had trouble seeing the big E at the top of the chart. He hesitated and made mistakes on the second line, and then put his head down, embarrassed. “I don’t think you can see the chart,” I said. He told me he couldn’t remember ever having an eye exam. I thought he might be an anomaly.
I was wrong.
My colleagues and I have conducted 2,400 screenings on students in three New York City middle schools: one in the South Bronx, one in Williamsburg and one in the Washington Heights section of Manhattan. We have prescribed and distributed 450 free pairs of glasses to the nearly one-fifth of the kids who had 20/40 vision (which means street signs and chalkboards are blurry) or worse. Many of the kids knew they couldn’t see the board, but hadn’t thought to ask for a checkup, because their vision had deteriorated gradually.
Children who struggle to see don’t tend to make for very good students. At Middle School 223 in the Bronx, the principal reported dramatic differences in several students once they’d received their glasses. An eighth-grade boy who had previously been reprimanded for talking during class stopped being disruptive. When administrators asked him what had caused his sudden change in behavior, he explained that he’d been asking other students to help him read the board. A sixth grader who had been notably quiet in class revealed that she had stopped looking at the board because she couldn’t read it.
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Even more appalling: Of the kids across the three schools who couldn’t read the eye chart, 10 percent had vision that was no longer correctable to 20/20, even with glasses or treatment. Many of these kids were born with two healthy eyes but later developed amblyopia, in which the vision in one or both eyes is reduced because the eye and the brain are not working together properly. Had their vision problems been caught earlier, before they were 7 to 9 years old, when their brains could still accommodate changes to the visual cortex, they might be able to see perfectly today. Instead they’ll go through the rest of their lives with a visual impairment.
The American Academy of Ophthalmology and the American Academy of Pediatrics recommend a comprehensive vision screening around the age of 3 1/2 to 4. New York City has an excellent vision screening program for pre-kindergartners and kindergartners and first- and third-graders; screenings of fifth-graders are ostensibly mandatory but often don’t happen. But for too many older students, visits to the pediatrician are infrequent and visions for screening nonexistent.
Some states mandate vision screenings past the fifth grade. New York is not one of them, which means the onus of regular screenings falls on parents. Parents should take their kids for routine vision screenings, or even use one of the many online vision screenings that are available.
They should also watch for warning signs. A child with poor vision may complain of headaches, or may seem tired or irritable at the end of the day. Decreased vision is a silent condition; if parents don’t specifically ask whether their children can see the board at school, or read the fine print on a box, problems will go undiagnosed.
But parents can do only so much. Vision screenings need to be taken as seriously as vaccination requirements, and we need uniform standards for school-based vision assessments. Many insurers will not even reimburse providers for eye exams if the result is “only glasses,” though Medicaid does.
Furthermore, once kids do get glasses, they sometimes don’t wear them, for fear that they will be teased. Teachers and parents must be taught that glasses are not optional.
Federal law gives a child the right to accommodations for a disability, but a child can’t exercise that right unless we can determine if a disability exists.
As for the middle-school boy who couldn’t see the big E, when I put lenses into a trial frame for him he couldn’t believe what he’d been missing. He put down the frame, saying he didn’t think his family could afford glasses. When I told him they were free, thanks to a corporate donor, he didn’t believe me.
“Really,” I said. “Go pick out a frame.”
“Thank you, Miss,” he said. And then he left to choose one.
The New York Times
Pamela F. Gallin is a professor of ophthalmology and of pediatrics at NewYork-Presbyterian/Columbia University Medical Center.
In North Carolina
North Carolina law mandates only that a child should have a vision screening before entering kindergarten or to determine eligibility for the Exceptional Children’s Program. Each individual school district determines whether it will provide further screening and at what ages, with the most common scenario being kindergarten, first grade, third grade, fifth grade and sometime in middle school. In 2012-13, 512,369 children or 36 percent of North Carolina students were screened for vision, and more than 27,255 students were seen by physicians or eye care professionals as a result of the referrals from school health professionals to obtain comprehensive eye exams.