LEARNING RELATED VISION PROBLEMS EDUCATION AND EVALUATION

1. LEARNING RELATED VISION PROBLEMSEDUCATION AND EVALUATION By: Nicole Kopacz

2. Fast facts: • Vision problems affect one in twenty preschoolers and one in four school-aged children.Source: Prevent Blindness America • A 2005 report from the Centers for Disease Control and Prevention showed only 1 out of 3 children receives an eye exam before entering school. Source: U.S. Centers for Disease Control and Prevention • According to a recent study by the National Institutes of Health, neither trained nurses nor trained lay people using the best screening tests possible were able to identify almost one-third of even the most prevalent vision disorders in children in the study. Disorders such as amblyopia, strabismus, and refractive errors were missed during the study’s screening process. Source: U.S. Department of Health and Human Services • One of every six children is two or more grade levels behind in reading. Of these "slow" readers, 80% have difficulty in eye control and coordination.Source: Optometric Extension Program Foundation • 25% of junior-high school-aged children (11-14 years) can't read the blackboard because of myopia (nearsightedness).Source: Helen Keller International • 70% of juvenile delinquents in a recent study had vision problems.Source: Study published in the Journal of Behavioral Optometry • A report by the National Eye Institute states, "In children, visual impairment is associated with developmental delays and the need for special educational, vocational, and social services, often beyond childhood into adulthood."Source: Report of the Task Force on Vision Impairment and its Rehabilitation, National Eye Institute

3. Objective: • Primarily to educate parents and teachers on vision problems that can hinder children's school performance, interrupt their lives, and limit their futures. • Teach basic definitions of nearsightedness (myopia) and farsightedness (hyperopia) • Review signs and symptoms that educators can use when evaluating a students vision • Discuss the issues related to hidden vision problems • Educate on the importance of efficient and effective vision screenings as well as comprehensive eye exams by an optometrist • What resources are available to teachers and parents?

4. Basic Definition of Terms • Myopia – Also known as nearsightedness or short-sightedness, is a refractive defect of the eye, where the person affected usually can see nearby objects clearly but distant objects appear blurred. • Hyperopia - Also known as farsightedness or longsightedness, is also a refractive defect of the eye causing difficulty to focus on near objects. • Amblyopia - Also known as “lazy eye,” amblyopia is reduced vision in a healthy eye. Vision development is impaired when eyes do not focus equally or maintain proper alignment. The brain ignores the information from the less favored eye. In either case, if this condition persists, the weaker eye will not develop normally. • Strabismus - A misalignment of the eyes where the eyes don't point at the same object. Crossed eyes (esotropia) is one type of strabismus; "wall-eyes" (exotropia) are another. The exact cause is unknown, but appears to be a problem with the eye muscles. Strabismus can affect depth perception.

5. Learning Related Vision Problems • Eye Teaming

6. Tracking skills-or the ability to control the fine eye movements required to follow a line of print, are especially important in reading. Children with tracking problems will often lose their place, skip or transpose words, and have difficulty comprehending because of their difficulty moving their eyes accurately.   • Focusing-If a child is struggling with his focusing system, print on the page will often look like this:

7. Vision Screenings Currently in Place • Most elementary schools do have vision and hearing screening in place, but several do not • These screening tests are ran normally by parent volunteers that are not educated with a background in eye care. • Screening tests for distance vision only and children that are found with vision over 20/50 are sent to the school nurse for a secondary evaluation. (if a school nurse is present) • The nurse then has the option to send a letter home urging parents to have the child’s eyes tested by an eye care professional, but follow up is not mandated • Therefore, if near vision is not tested any child who is having difficulty learning to read will go unnoticed • In conclusion, screenings are designed to alert parents to the possibility of a visual problem, but not take the place of a visit to an eye care practitioner. Sometimes screenings are helpful, but they can miss serious vision problems that your eye care practitioner would catch.

8. Check-list of Signs and Symptoms • Children with vision-based learning problems may . . . • read below grade level • have trouble comprehending • avoid reading or other close-up tasks • omit, turn around, or confuse words when reading • lose their place or use their finger to follow a line of print • become easily distracted, finding it difficult to remain on task • have a short attention span • need a lot of breaks during homework • tire quickly when they read • suffer from eye strain • have red or watery eyes when reading • complain of blurred, double, or moving print • squint, frown, or rub their eyes while reading • have difficulty taking tests • tilt their heads at an angle or hold books too closely when reading • cover an eye to read • have difficulty copying from the board • reverse letters and numbers past the first grade • fail to complete assignments on time • take too long time to do homework • appear to be unmotivated or lazy at school • suffer from poor self-esteem • complain of headaches • struggle with eye-hand coordination • have poor handwriting

9. Problems with vision screenings • Children can have 20/20 eyesight meaning ‘normal’ distance vision and still have vision problems in other areas (Scheiman & Rouse, 2006) • School screenings don’t check to see if children can coordinate both eyes as a team, track print across a written page without losing their place, or comfortably adjust focus when looking from their desk to the chalkboard. (Kemper, 2003) • One study found that 11.3% of children who passed a vision screening were found to have a vision problem in need of correction (Logan and Gilmartin, 2004). • Another problem with school or pediatrician screenings is that sometimes no follow-up occurs even when a vision problem is detected. • According to one study, 50% of parents were unaware two months later that their child had failed a vision screening (Flanagan and Jackson, 2003). • In another study, 80% of the kindergarten-age children examined who were found to have a vision problem had visited a primary care physician in the past 12 months, but fewer than 20% had been told to see an eye doctor (Flanagan and Jackson, 2004). • Another study found that when a 5- or 6-year-old failed an initial vision screening, the average delay before evaluation by an eye care professional was more than four years (Arias, 2004).

10. Why is this a educational problem? • Children who are struggling with undetected vision problems often fail to consistently progress in school • Vision plays a vital role in the reading process • For succes in school, children must have other equally important visual skills besides their sharpness of sight, or visual acuity. • They must be able to coordinate their eye movements as a team. • They must be able to follow a line of print without losing their place.  • They must be able to maintain clear focus as they read or make quick focusing changes when looking up to the board and back to their desks. • They must be able to interpret and accurately process what they are seeing.  • If children have inadequate visual skills in any of these areas, they can experience great difficulty in school, especially in reading. www.pavevision.org

11. Solution? • Kentucky is the first state to require mandated eye exams prior to entering elementary school • Controversy in funding and procedures • 34 states provide vision screening guidelines and 15 states require vision screening of at least some of their preschool-aged children, but no follow-up procedures are in place (Kemper, 2003) • Oregon is one of nineteen states that have NO requirement for children to receive preventive vision care before starting school or during the school year.

12. Resources • Vision Service Plan (VSP) is a nationwide insurance company dedicated to high quality eye care. VSP has organized two extremely important programs called “Sight for Students” and “Get Focused.” • Sight for Students is a VSP charity that provides free vision exams and glasses to low-income, uninsured children. The program operates nationally through a network of community partners who identify children in need and VSP network doctors who provide the eyecare services (https://www.vsp.com/about/html/community.jsp#). • VSP helps over 50,000 children each year help the valuable eye care services they need. • Get focused is a classroom curriculum designed to help teachers and parents educate their students on the importance of eye exams. • The program has curriculum activities that educate students on the basic anatomy of eye, cooperative learning activities as well as the importance of eye safety

13. The Oregon Foundation for Vision Awareness (OFVA), is a local non-profit agency whose mission and goal are to provide education and charitable services for children who have eye care needs (http://www.ofva.org/ofva/). The OFVA strives to connect Oregon’s children with essential eye care services, which has been under-utilized by Oregon’s elementary schools. Pacific University College of Optometry – Virginia Garcia Clinic and Vision Therapy Services Resources

14. Resolution • In today’s society, teachers have to go above and beyond the call of duty by not only teaching their curriculum, but also dealing with social and behavioral issues. By mandating eye exams prior to elementary school we would be reducing several obstacles like cognitive, emotional and behavior problems. In the end, we would be giving our children a head start on learning and allowing our teachers to do what they do best, teach!!

15. References • Arias, D. C. (2004). Eye exams for young children key in preventing vision loss. Nation's Health, 34(9), 20-20. • Dreby, C. (1979). "Vision" problems and reading disability: A dilemma for the reading specialist. Reading Teacher, 32(7), 787-795. • Flanagan, N. M., Jackson, A. J., & Hill, A. E. (2003). Visual impairment in childhood: Insights from a community-based survey. Child: Care, Health & Development, 29(6), 493-499. • Greenstein, T. Identification of children with vision problems that interfere with learning. • Vision and learning disability. American Optometric Association, St. Louis, 1976, p. 95-114. • Groves, N. (2005). Controversy swirls around mandatory eye exams for kids. Ophthalmology Times, 30(20), 54-58. • Halle, C. (2002). Achieve new vision screening objectives. Nurse Practitioner, 27(3), 15. • Johnson R., Zaba J. Examining the link between vision and literacy. Journal of • Behavioral Optometry, 1994; 5(2): 41-43. • Kang, H. Y., Park, I. H., & Kim, M. J. (2003). The role of vision screening and classroom illumination in the vision health of korean school children. The Journal of School Health, 73(9 (Print)), 358-362. • Kemper, A. R., Fant, K. E., & Badgett, J. T. (2003). Preschool vision screening in primary care after a legislative mandate for diagnostic eye examinations. Southern Medical Journal, 96(9), 859-862. • Logan, N. S., & Gilmartin, B. (2004). School vision screening, ages 5–16years: The evidence-base for content, provision and efficacy. Ophthalmic & Physiological Optics, 24(6), 481-492. • Ophir-Cohen, M., Ashkenazy, E., Cohen, A., & Tirosh, E. (2005). Emotional status and development in children who are visually impaired. Journal of Visual Impairment & Blindness, 99(8), 478-485. • Rouse, M. W., & Ryan, J. B. (1984). Teacher's guide to vision problems. Reading Teacher, 38(3), 306-317. • Scheiman, M.M., Rouse, M.W. (2006). The Role of the Optometrist in the Management • of Learning-Related Vision Problems. Editor, Optometric Management of Learning • Related Vision Problems (283-292). Philadelphia, Pennsylvania: Mosby Incorporated.

16. Thank-you • Any questions?