How to Screen for & Spot Early Warning Signs at School
There are just over 500,000 children with vision difficulty in the U.S., according to the 2016 American Community Survey (ACS). Vision issues are about more than just having problems seeing; they can contribute to learning problems, poor academic and athletic performance, developmental delays and behavioral issues. The good news is that early diagnosis and treatment of vision disorders can help support more normal visual development, prevent further loss of vision and help equip children with the tools needed to succeed.
This guide provides insight and expert recommendations for common vision problems, discusses how those issues can be detected and treated and offers tips and resources to help teachers identify potential vision problems among school-aged children.
How to Spot Warning Signs of Vision Problems in the Classroom
While you should never attempt to diagnose or treat an eye problem on your own, don’t underestimate your ability as a parent or educator to notice that something may not be right with a child’s vision. Here are signs you can look for in the classroom and beyond that may mean a vision problem exists:
- Constant squinting or grimacing when reading or focusing
- Holding books close to face when reading
- Sitting close to the television or blackboard
- Complaints of blurred, cloudy or double vision
- Complaints of headaches, nausea or dizziness
- Constant burning, itchy or watery eyes
- Unusual sensitivity to light
- Closing or covering one eye while reading or focusing on close objects
- Crossed or “lazy” eye
- Low attention span, fidgetiness and behavioral problems
- Tilts head forward or backward when looking at distant objects
- Discolored or unequal pupil size
- Problems with reading, low reading comprehension and poor spelling
- Swollen eyelids
- Sties or infections on eyelids
- Excessive clumsiness, diminished coordination
- Poor penmanship
- Complaining that computer use “hurts his eyes”
- Lower than usual academic performance
- Often loses place while reading
- Difficulty remembering what is read
Is it ADHD, a Vision Problem or Both?
Excessive fidgeting, hyperactivity and high distractibility are some of the symptoms associated with Attention Deficit Hyperactivity Disorder (ADHD). However, those same symptoms may also indicate that a child is struggling with an undiagnosed vision problem. Sometimes the only tipoff for parents or educators is the disciplinary problems that the child begins experiencing at school.
“Due to these similarities, some children may be mislabeled,” explains optometrist Gayle Y. Daniels, founder of the Daniel Migael Foundation, Inc. For this reason, experts agree that children should be given a comprehensive eye exam to rule out vision problems before making an ADHD diagnosis.
“Eye doctors do not identify or treat ADHD, but they can rule out eye conditions that may mimic ADHD or contribute to reading difficulty,” explains Katherine K. Weise, director of Pediatric Optometry Service at the University of Alabama at Birmingham (UAB) Eye Care and the UAB School of Optometry.
A study from the American Academy of Optometry also concluded that children with vision problems, such as crossed eyes or disorders related to eye movement, were two times more likely to develop ADHD. In the study, 5.6 percent of those with vision problems were found to have ADHD, while only 8.3 percent of children with normal vision had exhibited symptoms of the condition. The presence of ADHD was even higher among children with moderate vision issues.
“Because of the associations with vision conditions, all children with developmental delay or special needs should skip the vision screening and seek out a dilated eye exam by a pediatric eye doctor,” suggests Weise.
Daniels adds that parents must be vigilante and pay close attention to all of the symptoms that their children are experiencing. “Both conditions require diagnosis and treatment from a medical professional,” she says. “Parents should remember to include routine eye examinations as part of the overall wellness care of their child.”
Why It’s Important to Have Your Child Checked for Vision Problems
“According to Vision Learning Centers of America, 80 percent of learning in the classroom is visual; it is also estimated that over 60 percent of problem learners have undiagnosed vision problems,” says Daniels. “That is why maintaining eye health is so important, especially for school-aged children.”
Here are some ways that undetected vision problems can impact a child’s learning in the K-12 classroom.
- Chronic inattention
- Increased fidgeting
- Problems with organization
- Reading difficulties, including comprehension
- Disinterest in school and activities previously enjoyed
- Poor spelling
- Frequently squinting or rubbing the eyes
- Moving closer to the blackboard
When to Check Your Child’s Vision
“The American Academy of Pediatrics recommends vision screenings at each well child check from birth through adolescence, with visual acuity testing and how well the child can see with each eye, beginning at age 4,” says Weise. “The American Optometric Association recommends eye exams at 6 months, 3 years old, and right before first grade. Those who fail the vision screening or who want a comprehensive eye exam should seek out an eye doctor who is comfortable seeing children and who uses dilating drops.”
“Even in the absence of any symptoms, back to school time is a good time to make sure the eyes are ready for school, too,” adds Weise.
Eye Exams vs. Vision Screens
“Many parents think that because their child can see an airplane in the sky or small bugs on the sidewalk that their child’s eyes are perfect,” says Weise. “However, the child will see equally well when it has one healthy and one poorly seeing eye. The brain always chooses to see with the better seeing eye. Vision screenings require that each eye be tested by itself.”
Vision screenings, often performed by your child’s pediatrician or school nurse, are a great way to alert parents and school staff of the possibility of a vision problem, especially ones that may not be obvious. These screenings primarily help determine whether your child can see the 20/20 line on a visual acuity chart. “vision screenings can help identify kids who need glasses or who are at risk for lazy eye, eye turns and more serious eye conditions,” says Weise.
However, screenings should not take the place of a comprehensive eye exam administered by a professional eye care provider. These exams are more in-depth and therefore more likely to detect a wider array of vision problems and conditions. “A dilated eye exam by a pediatric eye doctor is best at determining what conditions in the eye may be affecting school performance,” asserts Weise.
- “Vision screenings are relatively quick and feasible in a variety of settings,” says Weise
- Can help with early detection
- Often administered free or at low-cost at schools, wellness clinics and health fairs
- Medical insurance likely not required
- May not be performed by an eye doctor or optometrist
- Cannot diagnose specific issues, just indicate the need for a comprehensive eye examination
- Less sophisticated equipment is used; serious vision problems may be missed
- Emphasis often on distance vision; near-vision problems may be missed
- Parents may not be present; risk of little to no follow-up after
- Most thorough and effective method for detecting potential vision disorders or diseases
- Performed by an optometrist or an ophthalmologist
- Usually includes in-depth collection of medical history
- Best for early detection
- Usually includes follow up care
- Usually includes dilation for more in-depth examination of the eyes
- Most high-tech equipment is used
- Can be cost-prohibitive, especially for those without medical insurance
- Longer, more in-depth exam, which may be challenging for children.
- May require multiple follow up appointments
Both vision screens and eye exams can identify vision problems, but vision experts advise against relying on just one method, as it may lead to some issues being overlooked. “Annual eye and vision examinations are an important part of preventive health care,” says Daniels. “Many eye and vision problems have no obvious signs or symptoms, so you might not know a problem exists without them. Early diagnosis and treatment of eye and vision problems are the number one ways to prevent vision loss."
Learning-Related Vision Problems & How They’re Treated
Many vision problems aren’t obvious to those without professional expertise, while others are more easily detectable through general observation. Here are some conditions that may affect school age children; academic performance and behavior often suffer as a result. Experts suggest that you contact your child’s doctor if you notice any of the symptoms described.
“Lazy eye is also known as amblyopia and is a result of poor vision development,” says Weise. “At least two percent of the population has a lazy eye. The majority of lazy eye is in one eye and due to uncorrected refractive error (a need for glasses to correct for near-sightedness, far-sightedness, or astigmatism).”Symptoms
- Crossed eyes
- Frequent squinting
- Tilting the head to see better
- Some children may have poor depth perception and problems seeing in three dimensions
Glasses, eye patches, eye drops, surgery, or a combination of them are used to force the brain to pay attention to the images of the amblyopic or weaker eye so vision in that eye gets stronger. Amblyopia should be treated as early as possible, as research has shown it is more difficult to treat with each passing year, especially after the age of 9.
Also a “refractive error;” it occurs when an eye has an abnormal curvature — instead of being round like a basketball, the eye may be shaped more like a football. Approximately 15 to 28 percent of children ages 5 to 17 have astigmatism, according to the nonprofit advocacy group Prevent Blindness.Symptoms
- Blurred or distorted vision at all distances
- Children who have myopia or hyperopia are more likely to have astigmatism
Astigmatism usually can be corrected with glasses or specially-shaped contact lenses, that add more curvature and focusing power in one axis of the eye than the other. This helps keep images from being distorted.
Also called farsightedness, this common type of refractive error in the eye occurs when the eyeball is too short or the cornea has too little curvature leaving the eye unable to correctly focus on the light that enters it. “About 21 percent of younger children and 13 percent of older children are farsighted,” says Weise. “These kids have difficulty seeing up close or reading for long periods of time.”Symptoms
- Distant objects may be seen more clearly than objects that are near
Often with glasses or contacts. “A small amount of far-sightedness can be self-corrected by using the eye’s focusing muscles,” says Weise. “For higher amounts of farsightedness, glasses are helpful in avoiding eyestrain, intermittent blur or headaches at the end of the day.”
Often called a “cat eye,” it’s a pupil that looks white. The most common cause among children is cataract, a clouding or opaque area over the lens of the eye.Symptoms
- A pupil that looks white
- Often more noticeable in photographs, when light reflects on the eye
Surgical treatment should be completed immediately to avoid permanent visual loss and the potential for retinoblastoma, a life-threatening condition that is the most common eye cancer in children.
Also known as nearsightedness, myopia is among the most common “refractive errors,” because it impacts how the eyes “refract,” or bend, light that is projected onto the retina of the eye. It occurs when the eyeball is too long or the cornea, the front cover of the eye, is too curved that it affects the light entering the eye.
“About four percent of young children and nine percent of older children are nearsighted,” says Weise. “The prevalence of nearsightedness has nearly doubled in the last two decades. Researchers are studying why that is. We are looking for treatments that show promise in slowing the growth of nearsightedness using special contact lenses and/or eye drops and modifying environmental factors like getting outdoors more often.”Symptoms
- Distant objects look fuzzy or blurry
With glasses or contacts.
What it is: A drooping eyelid that diminishes visibility in the eye. The drooping eyelid blocks part of what the eye can see which may affect a child’s ability to read. It may also be a sign of a more serious medical condition. In a young child, it can lead to astigmatism and eventually amblyopia.Symptoms
- A drooping eyelid
Surgery tightening the elevator muscles to lift the eyelids for improved vision and appearance is usually the best treatment.
Also called “cross-eyed,” “squint” or “wall-eyed,” this vision condition results when both eyes are unable to align simultaneously. “About two percent of the population has strabismus, or an eye turn,” says Weise. “A child may see double in cases of strabismus. He may also choose to turn off or suppress the vision in one eye. While this helps the child avoid double vision, it increases the risk for lazy eye because one eye is getting more visual connections to the brain than the other is.”Symptoms
- Double vision
- Eyes that turn in, out, up or down
With early detection, vision can be restored by covering the properly aligned eye with a patch, forcing the misaligned eye to work. In some cases, surgery or specially designed glasses are needed to help realign the eyes.
How Teachers Can Help Students with Vision Problems Succeed
Here are some ways that teachers can help students with vision problems succeed in the classroom.
- Consult with an O&M (orientation and mobility) specialist regarding needed/requested modifications
- Use high contrast writing instruments on boards; for example, white chalk on a clean chalkboard or dark markers on dry erase boards
- Avoid writing in bright colors like red, orange and yellow on paper and Smartboards
- Use soft lead pencils and felt-tipped pens with black ink on light or tinted paper
- Allow the student to move seats or adjust the position of his/her work as needed
- Verbalize as you write on the board or make demonstrations
- Avoid large print materials; some vision conditions may distort those images
- Seat student near the board (within 3 to 5 feet) when needed
- Avoid any terminology that requires visual acuity; such as “over there” and “like this one”
- Try partnering the visually-impaired student with another student for help and support
- Give the visually impaired student extra time to complete work when needed or requested
- Provide a personal tour of the school, classroom, restrooms and other areas of the school
- Modify physical education class activities, such as catching, kicking and throwing as needed
- Darken or adjust classroom lighting as needed
There are plenty of organizations dedicated to sharing and providing many of the resources available to help parents support their children with vision problems.
- Children’s Eye Foundation Nonprofit that for more than 40 years has provided educational programs and advocacy efforts dedicated to its mission: to eliminate preventable blindness in children.
- Delta Gamma Center for Children with Visual Impairment A nonprofit aimed at improving access to family-centered and specialized services and support referrals for families with children who are blind or visually impaired.
- Lighthouse Guild Leading not-for-profit healthcare organization dedicated to providing resources for parents of newly-diagnosed children with visual impairments. They provide resources for e-learning and coordinated care.
- Family Connect A website created by the American Foundation for the Blind (AFB) and the National Association for Parents of Children with Visual Impairments (NAPVI) that gives parents of visually impaired children a place to support each other, share stories and concerns and find resources on raising their children from birth to adulthood.
- Eye Care 4 Kids Provides professional eyecare service referrals for low income, visually impaired children and families from underserved communities.
- Institute for Families A non-profit organization that provides no-cost help for families of children with vision loss, including counseling and support services.
- The Vision of Children Foundation Non-profit that provides research funding, education and support for a worldwide network of families affected by vision disorders, including video magnifiers that assist American students with low-vision.
- Vision to Learn Advocacy organization that provides children with free eye exams and free glasses by bringing its mobile eye clinics to schools and community organizations.
Many organizations provide helpful tips, tools and resources aimed at helping teachers and others in the educational setting address the unique needs of students with vision problems and impairments that are critical to the success of students facing vision problems.
- Teaching Students with Visual Impairments Website provides a list of visual impairment program resources for educators, vision professionals, family members and others seeking support and referrals for those with a visual impairment.
- The Vision Therapy Center Website that provides instructional tips and resources to help teachers strengthen their awareness of learning-related vision problems.
- Perkins School for the Blind Massachusetts-based school for the blind provides resources for teachers, families and professionals around the globe, including information on workshops, services, education and community resources that support those with visual impairments.
- National Catalogue for Copyright Works in Alternate Formats An online catalog of copyright works in alternate formats for people with print disabilities. Users may easily upload and search for copyright works in alternate formats such as Braille, large print, digital and audio.
- Bright Hub Education Helpful advice, resources and lesson plan ideas aimed at helping teacher accommodate the needs of students with partial or full visual impairment.
- National Association of School Nurses Online guide provides information and resources for school nurses, including the in-depth “12 Components of a Strong Vision Health System of Care” guide.