What to do if your child fails their school vision screening

Jessica Thayer, M.D.
Ophthalmology

Seeing clearly (or not) can have a real impact on a child’s ability to learn, which is why Texas requires vision screening at school starting at preschool and kindergarten.

Today’s youth face a higher risk of nearsightedness (myopia) due to an increase in near work, such as reading from laptops and smartphones instead of the blackboard. In 2019, the American Academy of Ophthalmology formed a task force on myopia because of the global increase in cases – which is expected to more than triple by 2050.

School-based screenings typically use a standard vision chart, where your child will be asked to read lines of progressively smaller letters. Nonverbal or pre-verbal children or those who struggle to follow instructions might get photo-screening, which checks special light reflexes in a child’s eye. This device allows us to determine if each eye is seeing and functioning properly.

If a child passes the screening, it means their vision is appropriate for their age. If they don’t pass, it just means they might need help, often in the form of glasses.

Most school-based programs don’t have the technology to show why a child fails their vision screening. If your child fails, they should see a pediatric ophthalmologist – rather than an optometrist – to find out what’s causing their vision problem. Pediatric ophthalmologists have advanced training to diagnose and treat all eye conditions in children, from myopia to more complex disorders such as:

• Amblyopia, or lazy eye
• Strabismus, which is eye misalignment
• Pediatric cataracts
• Retinoblastoma, a rare form of eye cancer
• Uveitis, an inflammatory state that can cause vision loss

Spotting and treating a child’s vision problem early is the best way to protect their vision long term. About 1 in 4 children ages 2-17 wear glasses or contacts – and there is much less stigma associated with it than there was just 10 years ago. For most kids, getting glasses opens more doors than it closes – it’s tough to catch a football or get good grades when you can’t see well!

What to expect at a child’s ophthalmology visit

You don’t need a referral from your child’s pediatrician to visit with an ophthalmologist – parents can reach out directly to schedule an appointment. At our office, we have advanced equipment that allows us to look inside the child’s eye without causing any pain or discomfort. Our providers are experienced in working with young patients, and we enjoy helping them feel comfortable during their visit.

Some kids may feel shy or try to give the “right” answers during an eye exam. Before the visit, we encourage parents to talk with their child and explain that there are no “wrong” answers, and they won’t get in trouble if they can’t see each item correctly. Their answers will guide us to the best options to help improve their vision.

First, we will check your child’s vision one eye at a time using charts that list letters, pictures, or shapes. In young and nonverbal children, we may watch them track an object with their eyes to see whether the eyes work together as expected.

We will also dilate the child’s eyes, which is when we temporarily make their pupils bigger with special drops and shine lights (retinoscope and ophthalmoscope) into the eyes to examine inside the eye. Without the drops, the pupils close instinctively and block our view. The drops don’t hurt but putting them in might feel a little awkward. After the exam, your child’s eyes will be light-sensitive for a few hours – we’ll send them home in a fun pair of sunglasses to protect their eyes.

For most conditions, these exams are enough to make a diagnosis. If we suspect something more serious, such as pediatric cataracts, uveitis, or an ocular tumor, we can perform specific tests to pinpoint a diagnosis.

If your child is nearsighted, we will tell you how much of their vision is compromised:

• “Perfect” vision is measured as 20/20, meaning your child can clearly identify an object 20 feet away.
• If they are 20/30, for example, they can identify an object starting at 20 feet away that the average person could see from 30 feet.
• The larger the second number, the tougher it is for your child to see without being up close.

Children who are farsighted (hyperopic) can see distant objects better than near ones. Many kids who are farsighted need glasses at a younger age but typically either grow out the need completely or can use a reduced prescription as they get older.

Tips to choose and start wearing glasses

We tell parents of young, first-time glasses wearers to expect the first few pairs to last 3-6 months. While there are some glasses made specifically to be tougher, my advice is to choose inexpensive frames because there’s a good chance they could get broken or lost. There are a lot of fun and fashionable designs, even at lower prices.Kids love to make their own choices, so many parents let their kids choose the style or color. Some parents who don’t wear glasses themselves may pick up a set of non-prescription glasses to wear at home – it can help the child feel more included and in control of the change.

Wearing glasses can be a big adjustment. Many parents start by connecting wearing glasses with rewards and favorite activities. Depending on your child’s age and motivation, you might try one of these strategies:

• If they wear their glasses for two hours, they get a sticker on a chart.
• They can watch a movie or get screen time if they keep their glasses on during the activity.
• For every day they remember to wear their glasses to school, they get a nickel, dime, or quarter in a jar and they can spend their earnings at the end of the month.

It will take time for your child to adjust to wearing glasses consistently, so be patient and help make each wearing session a positive experience.

Preserving your child’s vision at home

If your child is diagnosed with near-sightedness, limit screen time to 1-2 hours at home. Ask the child to sit farther back from the device rather than using it close to their face.

While you might not have control over their school environment, try to get them to spend an hour outside after classes each day playing sports, at the playground, or just enjoying the outdoors. Breaks from screentime give their eyes a rest.

It can be an adjustment to learn that your child will have to start wearing glasses but catching vision problems early is the key. If your child doesn’t pass their school vision screening, make an appointment with a pediatric ophthalmologist, so we can get to the root of the problem and help your child start to see the world around them more clearly.

To visit with a pediatric ophthalmologist, call 214-645-2020 or request an appointment online.