Seeing Is Believing
By Marcia Groves, MPH

How many times have you seen preschoolers lose their balance, look closely at an object, squint, or rub their eyes? Probably more often than you can count. Before you dismiss these behaviors, consider this: They may be symptoms of visual impairment. Unlike hearing, our sense of sight is not fully developed at birth. During the first few weeks of life, an infant’s visual acuity is low and the infant can see only high-contrast information (i.e., the eyes and mouth of an adult). Infant vision improves rapidly and by the age of six months, infant vision is close to that of adults. Vision plays a critical role in development during the first three years of life. Children use their sight to strengthen their motor functions, establish parent-child bonding, build their picture perception, and gain their balance. Because visual impairments can have a detrimental impact on a child’s development, a growing number of eye doctors are now advocating that young children be screened fro vision problems long before they enter school. The sooner a vision problem is detected, the more likely it can be corrected, because the child’s visual system is still malleable.

A Growing Problem
How common is visual impairment in preschool-age children? More common than most people think. According to Prevent Blindness America, more than 428,000, or one in 20, preschool-age children have a vision problem. Common types of eye problems in young children include:

  • Nearsightedness (myopia).The eyeball is too long for the normal focusing power of the eye. As a result, distant objects appear blurry.
  • Crossed eyes (strabismus).One eye does not aim directly at the object to which the other eye is aimed.

Both of these eye conditions, if not treated, could lead to amblyopia, a leading cause of vision loss in one eye. In amblyopia, both eyes are sending different signals to the brain. The brain ignores the poorer image from the affected eye and eventually “forgets” to see out of that eye. New studies seem to indicate that eye problems such as myopia or strabismus often begin to surface before the age of three. Unless the child shows visible symptoms (i.e., the eyes appear crossed or do not move together), most parents or caregivers don’t know a problem exists. Even children who can communicate may not give you a clue. They believe they see exactly the same way as grown-ups see. That’s why early testing of vision is critical.

Screening Young Eyes
There are two categories of pediatric vision screening: early screening and late screening during the school years. Early screening, which occurs during the preschool years, facilitates the prevention of further visual impairment. Late screening, at school age, looks for refractive errors that might disturb the child’s learning. Groups such as Prevent Blindness America and school health nurses typically screen school-age children for amblyopia and refractive errors.
But, according to the American Optometric Association, the optimal time to screen for nearsightedness and farsightedness is when the child is a year old. That’s because early detection and treatment before the age of three can lead to a 95 percent recovery of vision. After the age of six, however, vision in many cases cannot be totally corrected. By the age of nine or ten, the chances of correcting vision problems such as amblyopia are very low. However, screening children who can hardly walk and talk, let alone read an eye chart, can be a challenge. Any practitioner who has worked with pre-verbal preschool or special needs children knows the difficulty of keeping a child’s attention. As such, vision screening using eye charts may be difficult to do in certain instances. Reviewing symbols with pre-verbal or special needs children before screening also takes time and practice.

Symptoms of Common Eye Problems
As child care providers, you are in a unique position to inform parents of possible eye problems children may be experiencing. Because you spend a great deal of time with children in various activities, you are more apt to spot symptoms of eye problems.
The following are common symptoms of eye problems the children exhibit. If you or a co-worker see any of these problems, it’s essential that the child be checked for vision problems and the parents be alerted:

  • Crossed or misaligned eyes
  • Color photos or eyes show white reflection instead of typical red or no reflection
  • The child rubs eyes excessively
  • Shuts or covers one eye
  • Tilts head or thrusts head forward
  • Holds object close to eyes
  • Squints eyelids together or frowns
  • Head banging or eye poking

There are informational materials that you can distribute to parents and co-workers. Prevent Blindness America provides eye health and safety fact sheets, brochures, and videos through their toll free number, 800-843-2020. Not only do they distribute eye health and safety information, they also provide training to educators and practitioners on how to screen for vision problems. You can play a role in preventing permanent vision loss by learning how to spot vision problems among children in your care. Consider this: If 60 percent of what people learn in their lives us through their sense of sight, shouldn’t we all do what we can to help prevent blindness? Marcia Groves, M.P.H.,is a graduate of the Master of Public Health program at Northern Illinois University in Dekalb, Illinois. Marcia also has an associate degree in early childhood education and holds Illinois K-9 Teacher Certification. As a Marketing Representative for School Health, she works closely with schools, public health departments, special education co-ops, Head Start programs, and early childhood education centers. What I See: Visual Milestones for the First and Second Year

0-3 Months.As a newborn infant, I look at light sources and turn my eyes and head toward them. I develop eye contact between six and eight weeks and follow objects that move slowly – first horizontally, later vertically. By the end of the second month, I become interested in looking at mobiles.

3-6 Months.I discover my hands, reach toward objects, then grasp hanging objects. I watch toys fall and roll away. My visual interest sphere widens gradually.

7-10 Months.I notice small bread crumbs. First I touch them, then I try to grab them. I like to watch you draw simple pictures for me. I also recognize objects that are partially hidden.

11-12 Months.I love to play hide and seek and I know my way around my home. I can look out the window and recognize people. I also start to recognize some pictures. 18 Months.I can play with simple puzzles. I am interested in books and pictures and I can recognize that pictures are representations of real objects. I like to watch you draw while you tell stories. I may be able to name pictures and objects, such as apply, house, block, and ball.

24 Months. I love to scribble and color. I understand pictures can be large and small and still represent the same thing. I can also arrange similar pictures in groups. At this age, my vision can be tested while I play – when I am in the mood! When my vision is tested, I see small pictures equally well with my right and left eye.

This Visual Milestone Chart is taken from My Sight Is Important Home Vision Test, reproduced with permission from Precision Vision, Villa Park, IL, 630-833-1454.