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The Importance of Good Vision for Children. Presentation provided by: Randolph E. Brooks, O.D. AOA Member Ledgewood, NJ.

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Presentation on theme: "The Importance of Good Vision for Children. Presentation provided by: Randolph E. Brooks, O.D. AOA Member Ledgewood, NJ."— Presentation transcript:

1 The Importance of Good Vision for Children

2 Presentation provided by: Randolph E. Brooks, O.D. AOA Member Ledgewood, NJ

3 Importance of Good Vision to Learning Approximately 80% of all learning during a child’s first 12 years comes through vision Undetected and untreated vision problems can interfere with ones full learning potential Vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in children Courtesy of AOA

4 Importance of Good Vision to Learning Only 14% of children have had an eye exam by age 5 Only half of all children will have an eye examination before completing high school 20% of children age 9-15 need glasses, and 90% of those have not received them 75,000 3 year olds develop amblyopia each year Courtesy of AOA

5 Statistics American Optometric Association recommends a child gets his/her first eye exam at 6 months 5% of children were identified as having a vision problem using the Snellen Chart 18 Million children will not have had an eye examination by an Eye Doctor by the time they enter school 60% of students identified as problem learners have undetected vision problems Statistics courtesy of AOA

6 Role of Vision In Learning The eyes must see clearly, without double vision, and with accurate focus control The brain must interpret the visual image from its background, make assumptions as to its figure, and integrate the information gathered from peripheral vision and from other senses Processing must occur without flaws A child must have visual ability to learn to read prior to reading to learn

7 Symptoms of Children Struggling in the classroom Trouble finishing written assignments Losing their place when reading Having a short attention span when doing close work Skipping words when reading Making errors when copying from the board Underperforming

8 What is good vision? Good vision includes: –Visual acuity –Eye health –Visual Integration –Eye teaming –Eye focusing –Eye motility

9 Visual Acuity The ability of the eye to see clearly in the distance and at near –Near vision- the ability to see at inches (reading a book) –Intermediate vision- the ability to see at inches (computer distance) –Distance vision- the ability to see at 10 feet or more –20/20 indicates that you can see letters 3/8” high at 20 feet

10 Eye Health The absence of anomaly or disease If not diagnosed or treated, eye disease can lead to vision loss or impaired vision Ocular health is evaluated by external ocular examination with a biomicroscope, eye pressure evaluation, and a dilated fundus exam

11 Visual Integration The ability to process and integrate visual information Using our vision and other senses to understand what we see

12 Eye teaming The ability of the eyes to work properly together The ability to coordinate and align both eyes to allow the brain to fuse a single image from the images it receives from each eye The ability to judge relative distances of objects and have depth perception The ability of the eyes to focus on something near by turning towards each other

13 Eye Focusing The ability of the eyes to focus and shift focus to near and distant points easily and effortlessly Eye Motility The ability of the eyes to move from one point to another The ability of the eyes to move across a page of print or to follow a ball, etc…

14 Prevalence of vision problems Age 6 months to 18 Years Hyperopia (farsightedness) 25% Astigmatism 23% Accommodative & Binocular disorders 20% Myopia (Nearsightedness) 18% Strabismus (eye turn) 12% Amblyopia 7%

15 Hyperopia (farsightedness) The inability to see close-up things well Eyeball is too short for normal focusing power of the eye In children the lens can focus and accommodate through this error providing both clear distance and near vision, but much effort must be used. This can cause headaches, fatigue, and even crossed eyes. Symptoms Include: –Rubs Eyes –Has watery eyes –Complains of blurred vision

16 Astigmatism Results from an irregular shape of the front surface of the cornea. The eye is more football shaped rather than round Causes blurred vision for distant and close-up things Symptoms include: –Rubs eyes –Has watery eyes –Complains of blurred vision

17 Myopia (Nearsightedness) The inability to see distant things well The eye is too long for the normal focusing power of the eye. Symptoms include: –Squints –Gets close to the board

18 Strabismus Occurs when the eyes are not aligned when viewing an object The eye may turn inward toward the nose (esotropia) or outward toward the side (exotropia) This is usually caused by poor muscle control Any eye turn can happen constantly or occasionally

19 Esotropia

20 Exotropia

21 Symptoms of Strabismus Intermittent double vision Closes or covers one eye Says letters or words appear to move Loses place Is Inattentive Rubs eyes Has watery eyes Complains of blurred vision Has poor reading comprehension

22 Accommodative and Binocular Disorders Accommodative- The eyes cannot focus well The inability to contract and relax the eyes’ focusing muscles Binocular – The eyes do not work well as a team; for example, the eyes cannot converge for up-close reading

23 Accommodative Symptoms –Headaches –Tired at the end of the day –Has blurred vision when looking from board to book or book to board –Holds things very close –Is Inattentive –Rubs eyes –Has watery eyes –Complains of blurred vision –Has poor reading comprehension

24 Binocular Disorder Symptoms Headaches Fatigue Double vision Blurriness Watery eyes Rubs Eyes Is Inattentive Loses place Says Letters or words appear to move

25 Amblyopia Also known as a lazy eye Reduced vision in an eye that was not stimulated in early childhood Can result from strabismus or misaligned eyes or a difference in clearness between eyes. One eye is focusing better than the other one. One eye becomes stronger from its use and the other eye is suppressed and not worked hard enough

26 Vision Screenings Designed to identify gross visual problems and to indicate the immediate need for an eye examination. Parents must follow through on the referral. Most children who fail a vision screening will also fail a diagnostic professional examination

27 Components of Visual Screenings Distance Visual Acuity –Purpose-To test for myopia, amblyopia, astigmatism, and high hyperopia –Equipment-Distance VA chart and Occluder –Visual Acuity Charts Include: Snellen Chart Tumbling E chart Lea Symbols

28 Snellen Chart & Tumbling E Photos Courtesy of POA

29 LEA Symbol Charts Photos courtesy of POA

30 Criteria for Referral If either eye is less than 20/40 or a two-line difference exists between the two eyes, retest the child If the same results prevail, the student has failed and immediate referral is indicated

31 Near Visual Acuity Purpose- To test for hyperopia, astigmatism, amblyopia, and focusing problems Equipment- Near Acuity Cards and Occluder Near Acuity Cards include: –Snellen –Lighthouse acuity –Lea Cards –Tumbling E

32 Near point cards Photos courtesy of POA

33 Referral Criteria If either eye is less than 20/40 or a two line difference exists between the two eyes, retest the child If the same results prevail, the student has failed and immediate referral is indicated

34 Color Vision Test Detects difficulty in ability to recognize color Children with color blindness are not actually blind to color, but simply have difficulty identifying and distinguishing between different colors Color Deficiencies are usually hereditary and affect 1 in 12 boys but only 1 in 200 girls

35 Color Vision Tests Photos courtesy of POA

36 Color Vision Test Equipment: –Occluder –Pseudo-Isochromatic Test Plates Referral Criteria –Student fails if does not correctly identify the number on the card Photos courtesy of POA

37 Convex Lens Test Detects hyperopia and binocular problems Equipment –Distance acuity chart –Occluder –Pair of Spherical Lens (ages 5-8) –Pair of Spherical Lens(>age 8)

38 Convex Lens Test Referral Criteria If the student cannot read the 20/40 line while wearing the lenses then he/she has passed the test If the student can read the 20/40 line while wearing the lenses then the student has failed and should be referred.

39 Stereo/Depth Test Tests for amblyopia, strabismus, and binocularity Equipment –Random Dot E –Stereofly –Random Dot Stereotest

40 Stereotests Photos courtesy of POA

41 Random Dot E & Polarized Glasses Photos courtesy of POA

42 Cover Test Tests for ocular alignment disorders, strabismus, and binocular problems Done both at distance and near Unilateral cover test –Movement on Unilateral cover test = strabismus –No movement on unilateral cover test = normal Alternate Cover Test –Movement on Alternate cover test = Strabismus or binocular problem, depending on severity –No movement on alternate cover test = normal

43 Near Cover Test

44 Cover Test

45 Near Point of Convergence Tests the ability of the eyes to converge for up- close tasks If the eyes cannot effectively converge for near vision tasks, then the patient has convergence insufficiency Equipment –Near Point fixation stick –Tape Measure Photos courtesy of POA

46 Near Point of Convergence Referral Criteria If the student reports double vision or either eye swings out at greater than 5 inches then he/she has failed If the student does not regain alignment or report single vision at 7 inches or less, then he/she has failed

47 Vision Screenings vs. Comprehensive Eye Examinations Screenings only detect gross visual problems and cannot substitute for regular professional eye examinations Periodic eye health and vision examinations are essential for the prevention and diagnosis of conditions of the visual system Parents MUST follow through on the referral

48 Definition of Optometrist Optometrists are independent, primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions. Courtesy of American Optometric Association

49 Ocular Emergencies Red Eye Chemical Burns Foreign Body Blunt Trauma

50 “BLOODSHOT” Painful and/or Vision Blurred “BLOODSHOT” Discharge Gritty Sensation Blood Red Spot on White of Eye NO No illness/trauma Hx No Discharge Slightly Red Eye NO See Doctor Now See Doctor Today No Treatment Generally Required Lubricants Warm Compresses See Doctor if Worsens YES Courtesy of AOA RED EYE

51 Is the Chemical a strong base? Example: Drain Cleaner Lime Is it a strong acid? Example: Battery Acid A mild acid or alkali? Example: Chlorine, bleach Gasoline and Hairspray Mild Thermal Burn Example: Singed eyelashes UV Burn / Welding Irrigate 30 Mins Lids Forced open then see Doctor immediately after Irrigate for 15 mins. Then see Doctor. Irrigate 15 minutes. See Doctor Today See Doctor Today NO YES Chemical Burns Courtesy of AOA

52 Burns Alkali- based chemicals Lime (cement, plaster, whitewash) Drain cleaners Lye Metal polishes Ammonia Oven cleaners Acid-based chemicals Swimming pool acid (muriatic acid) Battery (sulfuric) acid

53 Are any of the following true? -Can the foreign body be seen and does it remain after gentle washing? -Could the injury have penetrated the globe of the eye? -Can blood be seen in the eye? - Does it feel as though a foreign body might be trapped behind the upper lid? Is there any problem with vision? Is there any eye pain? NO See Doctor Now Call Doctor Today YES NO Ocular Foreign Body Foreign Body Courtesy of AOA

54 Are any of the following true? -Is lid swollen shut? -Is blood in anterior chamber? -Is cornea white/hazy? -Is pupil irregularly shaped, fixed, dilated or constricted? Is there any problem with vision? -example: blur, visual field loss Flashes, floaters, double vision Is there pain? NO Apply home treatment -example: ice pack first 2 hrs. Then warm compresses - If no overnight relief, see Doctor now NO See Doctor Now See Doctor Today YES Blunt Trauma Courtesy of AOA

55 Other Examples of Blunt Trauma cases….

56 Case Studies John, 6 years old, kindergarten –Screened in school –Screening findings: Distance VA: 20/70 RE and 20/60 LE Near VA: 20/30 OU Could read the 20/40 line through the plus lens All other findings within normal limits John was referred for a comprehensive eye examination

57 John John was diagnosed with farsightedness (hyperopia) He received a pair of glasses to correct his farsightedness John’s corrected vision is now 20/20 at both distance and at near

58 Julie, 10 years old Julie complains of occasionally seeing double, headaches, and blurry vision while reading for an extended period of time Screening Results – Distance VA: 20/20 RE 20/20 LE –Near VA: 20/20 RE 20/20 LE –Stereovision: Normal –Color Vision: Normal –Plus Lens Test: Normal –Cover Test: Exophoria –NPC: Left eye swung out at 7 inches and patient could not regain alignment until 11 inches

59 Julie Julie was referred for a comprehensive eye examination Julie was diagnosed with convergence insufficiency Julie was enrolled into the vision training program to help improve her eye teaming

60 Megan, 13 Megan accidentally sprayed hairspray into her eye when she was styling her hair in the girls’ bathroom Megan came in complaining that her eye was red and bothering her What is the next course of action?

61 Megan, 13 Megan’s eye should be irrigated with saline or clean water for 15 minutes Megan should see her eye doctor today

62 Healthy People 2010: National Health and Disease Prevention Program Increase proportion of persons who have a dilated eye exam at appropriate intervals; Increase the proportion of preschool children aged 5 years and under who receive vision screening; Reduce uncorrected visual impairment due to refractive errors;

63 Healthy People 2010: National Health and Disease Prevention Program Reduce blindness & visual impairment in children aged 17 & under; Reduce visual impairment due to diabetic retinopathy; Reduce visual impairment due to glaucoma; Reduce visual impairment due to cataract; Reduce occupational eye injury;

64 Healthy People 2010: National Health and Disease Prevention Program 9.Increase the use of protective eyewear in recreational activities & hazardous situations around the house; and 10.Increase the use of vision rehabilitation services & adaptive devices by people with visual impairments.

65 Good Vision = A+ Good Education Questions??


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