WASHINGTON Dr. William Reynolds covered the 5-year-old's left eye while the boy read an eye chart. The boy's mother wondered aloud why an exam from an eye specialist was now required to enter Kentucky schools especially since her son seemed to see fine.
Then Reynolds covered the boy's other eye, and the youngster piped up, Oh, that's the eye I don't see out of.'' Reynolds recalls the stunned mother almost falling out of her chair.
Kentucky's new law, the first in the nation to require a comprehensive vision exam to enter school, meant the boy's problem was caught in time to cure. Now a study shows that nearly one in seven youngsters examined thanks to the law needed glasses, and an additional 5 percent had major undiagnosed problems.
Lawmakers in other states and Congress are considering similar action to get more youngsters to eye doctors.
An estimated 10 million children age 10 and younger have vision problems. The earlier they're caught, the better: Not only do eye problems hinder learning, but some, such as lazy eye, can lead to virtual blindness if not treated in the first few years of life.
Catching eye problems in pre-schoolers is a tough task for parents and general pediatricians. Like Reynolds' 5-year-old patient, those born with disorders such as nearsightedness, focus problems or lazy eye have no way to know they're not seeing right, and it's easy to miss the subtle signs.
No child is going to raise their hand and say, 'Mommy, I can't see the TV,''' says Joel Zaba of Virginia Beach, Va., an optometrist and child development specialist who co-authored the Kentucky study with Reynolds.
Instead, kids might squint, or turn their head so the best eye aims at the TV. They might seem restless with books or coloring. Once in school, teachers may report behavior problems that really are bad eyes: If focusing is a strain, they're going to close the book and kick the kid next to them,'' Zaba says.
Many children undergo vision screening'' an eye-chart test, with letters or symbols, to check distance vision either before school or in early elementary grades.
Often given by a nurse or pediatrician, screenings don't test if eyes focus and shift properly between distances, if eyes work together or are hooked up to the brain correctly to give realistic images. And most only check for nearsightedness when pre-schoolers more often are farsighted, says Reynolds, a Richmond, Ky., optometrist.
Some pediatricians do additional checks, such as seeing if a baby follows bright objects and if eyes are completely aligned. But there are no strict standards, and only 14 percent of children under age 6 have received a comprehensive eye exam, says the Vision Council of America.
The Kentucky law, which went into effect in July 2000, is sparking interest. Similar legislation has been introduced in New York, and is under consideration in Arkansas, Georgia, Nebraska and New Hampshire, says Reynolds. Federal legislation that would help states fund eye-exam programs is expected to be introduced this spring.
Meanwhile, what should parents do?
An exam from an eye professional by age 3 is a good idea even if a child displays no signs of problems, says Dr. James Donovan of the Ochsner Clinic Foundation in New Orleans.
Watch for signs of vision problems, including: an eye that slightly turns in or out; squinting; closing one eye or turning the head when focusing; avoiding coloring or books; clumsiness or becoming easily frustrated during play or, for older children, study.
The signs may be apparent only in retrospect, cautions Sandy Basham of Garfield, Ky. Her granddaughter, MaKailye Thomas, never squinted or acted like she didn't see something pointed out to her, but simple preschool work was exhausting, something Basham now knows was eye strain.
At age 5, the mandated school-entrance exam uncovered a very rare condition lazy eye in both of MaKailye's eyes. Even powerful glasses let her see only a blurry 20-60, and had her amblyopia been found a few years later, she probably wouldn't have improved. Today at 7, she sees a good 20-30 and schoolwork's a breeze.
Every child deserves to be able to see,'' Basham says. We're just so thankful.''
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