THE NEED FOR COMPREHENSIVE VISION
EXAMINATION OF PRESCHOOL AND SCHOOL-AGE CHILDREN
Vision disorders are
a common pediatric health problem in the United States. It is
estimated that nearly 25% of school-age children have vision
problems. Despite the economic, social and health care advances
which have occurred in our society, many preschool and school-age
children are not receiving adequate professional eye and vision
care. Only about one third of all children have had an eye
examination or vision screening prior to entering school. Also, a
recent study found that 11.5% of teenagers have undetected or untreated
vision problems. The early detection and treatment of eye and
vision problems for children needs to be a major public health
goal. This is made increasingly important by the enhanced understanding
of critical periods in human visual development. The earlier a
vision problem is diagnosed and treated, the less the potential negative
impact it may have on the child's development.
The American Optometric Association believes
that an eye/vision assessment conducted as part of a preschool or school
physical or a vision screening in the public or private schools cannot
substitute for regular professional care. Vision screening is a
limited process of surveying certain aspects of vision problem
areas. A professional vision examination is essential for the
diagnosis and treatment of eye and vision problems prior to entry into
The need for vision examinations of
school-aged children is supported by a review of various studies, which
||Vision screening programs for school children are intended to help
identify those children who have or may potentially have a vision
problem that may affect physiological or perceptual processes of
vision or that could interfere with school performance. Vision
screenings are not diagnostic nor do they lead to treatment, but
rather only indicate a potential need for further care.
||Only 33 states and the District of Columbia have requirements for
vision screening in public or private schools. The scope and
frequency of school vision screenings vary considerably from state
||The need for a comprehensive vision examination should not be
confused with the need for quality vision screening programs.
Each has a different purpose and generates different results.
||The fact that vision screening is a limited, non-diagnostic
process if often not communicated effectively to the public.
This creates the illusion that "passing" the screening
means that there is no vision problem.
||The greatest concern in vision screening is under referrals.
Failure to identify children who need further attention jeopardizes
the effectiveness and credibility of well-designed and administered
screening endeavors. This is especially evident when only
visual acuity is used as the standard in the screening
program. There is also the unmeasurable hidden costs and
impact of the untreated vision problem on the child's quality of
||Mentally and multiply handicapped children (e.g., children with
such conditions as mental retardation, cerebral palsy, hearing
impairment, and low birth weight syndrome) exhibit an incidence rate
of vision anomalies at least twice as high as normally developed
children. Due to their handicaps, many of these children do
not respond appropriately to standard vision screening
procedures. Unidentified vision problems in this special
population can further impair their growth and development.
These special children have the greatest need for comprehensive
clinical vision examinations well before entering a public or
private school system
Therefore, it is the position of the American Optometric Association
||Any undetected vision problem may result in the reduction of the
efficiency of the visual system. This may further result in
the inability of children to achieve their full potential.
||All children should receive a comprehensive eye and vision
examination assessing and treating any deficiencies in ocular
health, visual acuity, refractive status, oculomotility and
binocular vision prior to entering school. Asymptomatic/risk
free pediatric patients should have a comprehensive examination at
age six months, again at age 3 and followed by another examination
before first grade. The asymptomatic/risk free child should
continue to have comprehensive eye and vision examinations every 2
years thereafter. Symptomatic/at risk children may need to
have examinations more frequently at the discretion of their doctor
||Vision screening programs that are well designed and properly
administered in public or private schools should be utilized to
assist in the identification of children in need of care who have
not had access to comprehensive examination services.
- Information provided by the American Optometric Association -
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