November 10, 2016 8 min to read
Eye Examination in School Children
Category : Pedagogy
Author: Ms. Farida Raj
Email Id: firstname.lastname@example.org
“Another disorder is squint (strabismus). It is a condition where one eye focuses on an object and the other turns inwards, outwards, upwards or downwards, thus preventing the eyes from working properly together. Some children may have intermittent squint”
“Deficiencies in the visual skills are more often associated with problems in classroom learning. This can be treated with vision therapy.”
“Another important visual skill is eye focusing… A deficit in this area may cause blurred vision, visual fatigue, trouble copying from the board and avoidance of near point activities.”
“Teachers must sensitize the parents that when they take their child to an eye professional, they must demand that his visual skills are also tested along with eye-sight.”
Dr. Farida Raj is the Director at the Centre for Special Education in Hyderabad and has been a regular author for MENTOR. She writes immensely and profusely on issues concerning psychosocial and physical disorders in children. With sound subject matter knowledge and enthusiasm to be heard she takes pleasure in spreading awareness among teachers, parents and educationists about sensitive issues in children. In this informative article for MENTOR, Dr. Farida Raj, sheds light on the relevance of eye examination in school children.
Eight year old Arjun was having a tough time in school. He was punished every day by almost all teachers. The parents were appraised about his inappropriate behaviour in the classroom. Teachers complained that Arjun was impatient, restless fidgety and most importantly did not pay attention to what was being taught in the class. His memory and language acquisition skills were poor too. The teachers implied to the parents that he may have hyperactivity disorder. Out of sheer desperation the parents consulted me. A thorough assessment revealed that he did not have Attention Deficit Hyperactivity Disorder (ADHD). I suspected behaviour could be vision related. A visit to an Ophthalmologist to test for eyesight confirmed my suspicion. He had +1.75 in the right eye and +2.75 in the left. The poor child could not see clearly. No wonder he was restless and fidgety in class!!
The Real Problem
When a school going child does not do well academically, his failure to perform at the age appropriate level is attributed to short attention span, hyperactivity or dyslexia – a reading disability, but seldom to a problem of sight and vision.
The most common disorder in children is poor visual acuity[eyesight] due to refractive error which can be corrected with spectacles. Another disorder is squint (strabismus). It is a condition where one eye focuses on an object and the other turns inwards, outwards, upwards or downwards, thus preventing the eyes from working properly together. Some children may have intermittent squint which may not be easily detected by a lay person. In case of near vision, often one eye converges and the other eye diverges – this means that the child will have difficulty in coordinating the eyes for near vision. The images falling on the retinal area are not linked together neurologically, to perceive a single combined image. The child may momentarily see double making reading difficult. Most squints happen in young children. The younger the child, more the possibility of him being binocularly unstable. This means that he will have difficulty in trying to co-ordinate the eyes for near vision. Since maximum learning happens between 0 to 7 years, he misses out on a lot of first hand experiences.
Some children with poor visual acuity may complain that print swims around on the page or appears out of focus or is not uniformly black. There may be a child who turns the head either to the right or to the left or he may switch from one eye to another with alteration of head position. In such cases, he may be searching for a suitable position so that he can read. Some may have faulty eye movement and therefore skip or re-read lines. The struggle with the instability of the print is so great that the comprehension of the content is lost. Such children perhaps develop abnormal visual scanning and processing habits as a reaction to their difficulty with print. A good and observant teacher should be able to notice the postural abnormalities.
It may be helpful to consider why they arise. It is important that both teachers and parents are sensitized to notice the signs of visual strain in children even in those who wear spectacles and refer them to an ophthalmologist to check for visual acuity. Over the years I have found that for every ten children that I assess for scholastic backwardness, three have a refractive error! It is better to “over” refer than to fail in providing him the treatment he needs. If the condition is not rectified, he will remain a poor reader. Visual problems and their implications have tremendous impact on a child’s learning and success in school. A key factor is fatigue. Yet, 90 % of children start school without having an eye examination.
Let us understand the role of sight and vision. Eye sight is simply the ability to see something clearly at a distance of twenty feet, whereas vision is the ability to take in information coming through the eyes, process it and draw meaning from it. Since 75 percent to 95 percent of a child’s learning comes to him through the visual pathways, it can be assumed that any interference in these pathways will certainly get in the way of his academic growth.
Unfortunately, most eye exams and screening tests in our system, merely test the 20/20 eyesight. Visual acuity though important, plays a small role in what good vision is. Visual skills such as tracking, focusing, eye teaming, adequate convergence, directionality and form perception, important for academic success, are almost never tested. Deficiencies in the visual skills are more often associated with problems in classroom learning. This can be treated with vision therapy.
Ram had perfect vision yet he made mistakes while writing. He was labelled as being dyslexic. It was by chance that an eye doctor was able to diagnose that Ram had problem with directionality. Vision therapy helped him overcome the difficulty.
Visual skills and reading
Reading is one of the most important skills that a child needs to learn. It is the foundation on which he builds new skills, expands knowledge and derives great pleasure. Reading demands the child to focus on the reading matter held at a distance of 14 to 16 inches from the eyes. The two eyes should accurately track. Difficulty with tracking can cause loss of space when reading, skipping over words, poor or hesitant reading, careless errors and difficulty with eye-hand activities.
Another important visual skill is eye focusing. The eye muscles make it possible for us to focus on near point for a sustained period of time and switch focus from near to far and back again. A deficit in this area may cause blurred vision, visual fatigue, trouble copying from the board and avoidance of near point activities.
Eye teaming is one more visual skill which is crucial to success in academics. It is the ability of the eyes to work together as a team, move smoothly and be able to sustain an activity for more than 30 seconds. If it does not happen then the images falling on the retinal area will not be linked together neurologically to be perceived as a single continued image, the child may see two images momentarily. Any deficit here will affect processing of visual information, especially at near when reading and writing. The child may complain of eye strain, blurred vision, headaches, words may run together while reading, difficulty with writing/spacing, covering or closing one eye and difficulty keeping attention on reading and writing tasks.
The act of reading requires both the eyes to turn inwards so that they focus on the reading task. Most children learn to do this properly while in some the eyes have a tendency to deviate outward. The child has to make a conscious effort to maintain fixation on the reading task. He may lose his place while reading, may leave out small words or add a word or two to make the sentence make sense. This brings on tiredness and the child avoids a reading task. This is the child who is fidgety or may look out of the window rather than be attentive to reading. Some children do not have a settled left to right sense of order. And since reading and writing in English and other European languages is from left to right, one can assume that they may have tremendous difficulty with reading, writing and spelling.
Studies indicate that 60 percent of children identified as “problem learners” actually suffer from undetected problems in vision or hearing modalities and in some cases have been inaccurately diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or Learning Disability [LD]. We should interpret children’s disinterest, confusion, behaviour or lack of comprehension as signals that something is not right.
Identifying the problem
There is an urgent need to identify children with challenging behaviours early in order to increase school success and decrease the escalation of more social and academic problems.
It is important to be aware of the variations of visual development in children that can be corrected with vision therapy, so that the problems in sight and vision are not interpreted as behaviour problems or a learning disability. Teachers must sensitize the parents that when they take their child to an eye professional, they must demand that his visual skills are also tested along with eye-sight.
- Signs of problem in Visual acuity
- Moves head while reading
- Holds head at a peculiar angle
- Switches from one eye to another with alteration of head posture
- Difficulty in copying from the black board
- Often rubs eyes
- Watering of eyes
- Complains of headaches
- Copying from neighbours, being attentive only when teacher speaks and not when she writes
- Shabby/ messy handwriting