This time of year is synonymous with going back to school and often a reminder for parents to take their children to the dentist. It’s also a perfect time to undergo a check on eyes and vision, but few children are booked in for one at this time of year, or on a regular basis. While 70% of children go to the dentist once a year, only 25% of children visit an optometrist.
There seems to be no problem
Many parents will not actively avoid taking their child for an eye examination. Rather, it never occurs to them. It may be that they assume children will say if they can’t see clearly, or that they themselves or a teacher will notice some unusual behaviour such as a child avoiding reading or sitting unusually close to the TV. If parents themselves have no history of eye-vision problems in childhood, then it may not occur to them that their child could have sight problems.
But is it safe to assume that a visual problem will always be apparent? Generally, the answer is no. Children may have difficulty recognising when there are problems affecting their vision. While there are likely to be definite signs and symptoms of poor vision when a child has myopia (short-sightedness), substantial amounts of astigmatism and, in particular, hyperopia (long-sightedness) can exist without overt signs or the child experiencing reduced vision, especially if only one eye is affected.
Visual problems are uncommon
Parents might not place strong emphasis on eye examinations because they think that the prevalence of conditions that cause problems is very low. Eye disease and severe visual impairment in children are rare, but the prevalence of significant disorders such as amblyopia (lazy eye), strabismus (squint) and hyperopia is in fact around 7%, or about two children in a class of 30. In addition, some children may experience difficulties with focusing or co-ordination of the two eyes – and these may or may not be linked with their short or long-sightedness. Therefore a variety of visual defects, including some developmental disorders, can be latent and only revealed by an eye examination.
Children’s vision is tested in school
Another reason why children may not undergo regular eye-vision checks is that in most parts of the UK, a “vision screening” takes place in school at around the age of five. Parents may be reassured by a pass in this screen and assume that no further examination is required. But vision screening is just that, a “screen” to determine only whether a child has poor vision, typically lasting for no more than a couple of minutes and usually without including any checks for focusing defects or other possible problems.
So again, substantial hyperopia, focusing or eye coordination difficulties, for example, could be missed. Screening will identify children with poor vision at age five but will not detect problems that do not result in reduced vision, nor can we assume that a child who is problem-free at the age of five will remain so throughout their primary and secondary school years.
Lifestyle does not cause visual problems
Parents may take the view that there are no unusual or abnormal things which children can do with their eyes that will lead to eye or vision problems. Contrast this with teeth, where environmental influences such as excessive sugar or a poor cleaning regime are known to lead to dental problems.
Broadly speaking, this is correct. While there is much we don’t know about what causes eye and vision problems to develop, it is true to say that sitting very close to the TV or holding a book close to the eyes, for example, are unlikely to be the cause of visual problems – though they could be signs that something is wrong.
Glasses might be given that aren’t needed
Other reasons that children are not taken for eye examinations may include concerns that glasses might be given unnecessarily, or that wearing glasses can “weaken” a child’s eyes. The question of appropriate prescribing of spectacles for infants and children has been addressed in academic studies, and relevant professional body guidance to optometrists is available.
Parental attitudes towards eye and visual health are probably varied and complex. However, undetected and untreated vision problems can adversely affect performance and progress in school, and eye examinations for children are free under the NHS. We are not suggesting that every school child needs to have an eye examination every autumn, but that parents should not assume that vision is necessarily normal in the absence of symptoms or that a single vision screening around the age of five provides anything other than a superficial and short-term assurance about their child’s vision.