A Kentucky law that requires children to undergo eye exams before they start school helped 7-year-old Dakota Jenkins get the glasses he needed to correct his farsightedness before he entered kindergarten two years ago.
The state mandate wasn’t in place for Dakota’s 13-year-old sister, Debra, when she started school in Shelby County, Ky., with an undetected case of amblyopia, or lazy eye. By the time an optometrist diagnosed the problem at the end of her 4th grade year, Debra was nearly blind in her left eye and had to wear thick glasses and an eye patch.
“Trying to get a 4th grader to wear an eye patch is an absolute nightmare,” Debra’s mother, Dana Jenkins, said last week. “If we’d caught it at age 5, our doctor would have had more time to correct it.”
Passed in 2000 as part of a comprehensive bill on children’s health care, the Kentucky eye-exam requirement is the first and only law of its kind in the United States.
In other states, the responsibility for spotting vision problems in children falls to pediatricians, primary-care physicians, and school nurses, who typically rely on simple vision screenings that test distance vision. The American Academy of Pediatrics recommends that all preschool children receive such screening by age 4.
But many optometrists and ophthalmologists argue that children need a closer look—by a trained eye. The American Optometric Association recommends children receive their first comprehensive eye examinations by medical professionals at 6 months of age.
“In the typical vision screening, if a child can read a chart from 20 feet, they’re considered to have healthy eyes,” said Dr. Joel N. Zaba, an optometrist. “That sounds great, but the children in our classrooms don’t read books and do schoolwork from 20 feet away.”
In short, “sight screening doesn’t take the place of a comprehensive eye exam,” Dr. Zaba said.
Beyond Screening
To underscore the importance of eye exams, Dr. Zaba, a Virginia Beach, Va., optometrist who has written about the social and emotional problems children suffer when vision problems go untreated, points to a recent study he led of the Kentucky program.
The report found that one in seven children examined as part of that initiative needed glasses.
Published in the March issue of Optometry: Journal of the American Optometric Association, the study was based on a sample of 5,316 children examined by eye doctors between July 15, 2000, and April 1, 2001. About 50,000 children enter kindergarten in Kentucky each year.
The more alarming finding, the report’s authors say, was the discovery that nearly 4 percent of the children were diagnosed with the potentially sight-stealing lazy eye, and just over 2 percent had strabismus, more commonly known as crossed eyes.
“It’s critical that we are able to identify and correct [lazy eye] at an early age,” said Dr. William T. Reynolds, a Richmond, Ky., optometrist who was a co-author the study. “Children with this condition can suffer a 50 percent reduction in their vision after the age of 5. The longer it’s ignored, the harder it is to correct.”
The exams performed by Dr. Reynolds and other practitioners across the state went beyond screening for nearsightedness to test whether a child’s eyes can track lines of text across a page or a computer screen, the ability of both eyes to work together properly, and their ability to focus on objects that are 16 to 18 inches away.
The authors of the Kentucky study say there are signs that laws supporting comprehensive vision testing might become more common. Similar legislation has been introduced in New York state and is under consideration in Arkansas, Georgia, Nebraska, and New Hampshire, Dr. Reynolds said.
Federal legislation that would help states pay for children’s eye exams is expected to be introduced this spring in the House and the Senate, he added.
“As far as anything immediate, though, that seems unlikely with the economy the way it is,” he said. “Still, if we can come up with a long-term study at some point that shows the cost-benefit of this program, that will help.”
Follow-up Rare
A number of studies published by pediatric and ophthalmic journals show that as many as 60 percent of children don’t receive even the routine eye screenings recommended by the American Academy of Pediatrics, according to data provided by the Vision Council of America, based in Washington.
Of the minority who do receive screenings, the nonprofit trade group reports, 90 percent are given clean bills of health, only to have later exams by licensed eye doctors reveal vision problems in 10 percent of those children.
And because vision screenings are rarely preformed by doctors, the council estimates that half of all children identified with a vision problem don’t receive the treatment they need.
Those numbers don’t surprise Steven R. Edelman, a psychologist with the 50,700-student Cumberland County school system in Fayetteville, N.C., who helps test special education students for vision problems.
Mr. Edelman recently shared the school health records of a dozen elementary students (with identifying information omitted) who attend a low-performing school that serves primarily black students from low-income families. In every case, school health officials had failed to test near vision, even when a child was diagnosed with attention deficit hyperactivity disorder or labeled “developmentally delayed.”
And in cases where vision problems were discovered, persistent follow-up was rare, and the children typically went untreated.
The fact that students aren’t screened for vision problems until they’re 8 years old “was very odd to me, since they started to learn to read and write well before that,” the psychologist said. “I wonder how many young children who were identified as reading-disabled really had problems with vision.”
