ArticlePDF Available

Social, Emotional and Educational Consequences of Undetected Children's Vision Problems

Authors:

Abstract

This paper was designed for educatorsand related professionals who are concerned about learning problems in school-aged children, along with the consequences of these problems. The link between undetected vision problems, social and emotion problems, juvenile delinquency and illiteracy is reviewed. A multidisciplinary approach to deal with these problems is strongly advocated. On the basis of prior research, the author recommends that every child have a comprehensive vision examination prior to entering kindergarten, and additional vision evaluations and specific vision screenings through grade twelve.
SOCIAL,EMOTIONAL,&EDUCATIONAL
CONSEQUENCES
OF
UNDETECTED CHILDREN’S
VISION PROBLEMS
n JOEL N. ZABA, M.A., O.D.
Abstract
This paper was designed for educators
and related professionals who are con-
cerned about learning problems in
school-aged children, along with the con-
sequences of these problems. The link be-
tween undetected vision problems, social
and emotion problems, juvenile delin-
quency and illiteracy is reviewed. A
multidisciplinary approach to deal with
these problems is strongly advocated. On
the basis of prior research, the author rec-
ommends that every child have a compre
-
hensive vision examination prior to
entering kindergarten, and additional vi
-
sion evaluations and specific vision
screenings through grade twelve.
Key Words
illiteracy, juvenile delinquency, multi-
disciplinary approach, social-emotional
problems, vision, vision screening
I
n addressing the social, emotional,
and educational consequences of
undetected vision problems in children,
the most important factor to consider is
that there is no single solution to the prob-
lems and their consequences. The solu-
tion to these problems springs from a
multi-disciplinary approach. Such an ap-
proach means that all involved profes-
sions must work together as a team. To
successfully help any child, you have to
conceptualize the child as a puzzle: you
need to collect the different pieces and put
them together, thereby obtaining a com-
plete understanding of the child. There
are educational components, visual com
-
ponents, medical components, social and
family components, and psychological
components. When all of these parts are
placed together (like the pieces of a puz
-
zle), and each component is addressed in a
satisfactory manner, what emerges is an
enhanced understanding of the child. No
one profession has all the answers, but all
the professions working together as a
team can effectively help the at-risk child.
The field of learning disabilities began
as a result of this multidisciplinary ap
-
proach towards a specific area of chil
-
dren’s learning problems. A review of the
literature in the field of learning disabili
-
ties shows that there was a relatively short
period of time between the publication of
the first textbook in 1947, and the passing
of the first federal statute in the 1970’s es
-
tablishing criteria for identifying the
learning-disabled child.
1-3
We can now see
how an approach in which all involved
professions, working together as a team,
can obtain a result that benefits both the in
-
dividual child and society as a whole.
As we address vision problems, at-risk
children, poverty, learning problems, and
social-emotional problems, we have to re-
turn to the puzzle analogy to put all the
pieces together. All professions must add
their unique contributions to solving the
puzzle of the at-risk child. Most impor-
tantly, we can achieve solutions, which
are based upon research and the practical
application of research that will amelio-
rate these problems.
How do we accomplish this? To iden
-
tify at-risk children, and to achieve practi
-
cal solutions to their problems, we need to
do more than attach labels to the children
or the problems. Labels are important be
-
cause they identify the problem areas, and
they assist in the appropriation of funding.
In addition, we need an “operational diag
-
nosis” to understand the at-risk child. An
operational diagnosis is not simply the
identification of the problem; it also gives
the underlying reason for the problem,
which can then lead us to solutions
.
4
Prevalence Of Visual Problems
The prevalence of visual problems in
our school children is significant.
5
Ac
-
cording to the following national organi
-
zations, the problems have been identified
in the following ways:
·
The National Parent Teacher Associa
-
tion reports that more that ten million
children suffer from visual problems
6
Volume 12/2001/Number 3/Page 66 Journal of Behavioral Optometry
·
The Prevent Blindness America orga
-
nization indicates that vision problems
affect one in twenty preschoolers and
one in four school age children
7
By whatever measure is used, we now
realize that the level of the problem is sub
-
stantial, and the ripple effects have an
enormous social and economic impact.
When estimating the monetary costs
to society of undetected vision problems
in children, we have to realize that these
children grow up and become part of the
total population. According to the Healthy
People Twenty Ten Conference, “in 1981,
the economic impact of visual disorders
and disabilities was approximately $14.1
billion per year. By 1995 this figure was
estimated to have risen to more than $38.4
billion.”
8
Looking at just one state, the
Kentucky Optometric Association has re
-
ported that 10% of all preschoolers
(21,100) in Kentucky have vision defi
-
ciencies. “This figure increases in grades
K-6 where 25% or one in four (140,000) of
Kentucky’s children have vision deficien-
cies. The prevalence of vision disorders is
even higher in children at risk.”
9
Working Definitions
What do we mean when we talk about
“undetected vision problems”? To begin
with, it is important to understand vi-
sion,” and to make a distinction between
and vision and eyesight. Eyesight is the
ability to see objects clearly. “20-20 eye-
sight” simply means that, from a distance
of twenty feet, a child can clearly see let
-
ters that are 3/8 of an inch high. However,
children usually read books that they hold
at a viewing distance of 13 to 16 inches
from their eyes. Some view computer
screens at a viewing distance of approxi
-
mately 20-24 inches from their eyes. 20/20
eyesight, even with glasses for vision cor
-
rection, is not good enough. Good vision
goes beyond good eyesight. Keep in mind
some of these important aspects of vision:
·
Eyesight
·
Eye health
·
Eye teaming (the ability of the eyes to
work properly together)
·
Eye focusing (the ability of the eyes to
focus and shift focus at near point and
distance)
·
Eye motility (the ability of the eyes to
move together across a page of print, to
directly view an object, or move from
one viewing area to another)
·
Understanding what the eye sees
The Role Of Vision In The
Developmental Process
Vision is an important process in the
growth, development and performance of
children.
10
It is evident that much of what
we learn occurs through the visual pro
-
cessing of information. Vision is a guid
-
ing mechanism in the child’s daily level of
performance, as well as in his overall
growth and development.
11
Continuing in
this context, when we talk about “vision”
we refer to the ability of the visual system
to guide the individual in specific areas.
The first such area, or level, is the general
(gross) motor abilities, which views the
child’s ability—using the large muscles of
the body—to function in the world around
him. It is vision that gives the child the
guiding mechanism that enables him to
manipulate himself in his immediate envi
-
ronment and in the world around him.
The next level of performance is the
special movements area. This level in
-
volves eye-foot and eye-hand coordina
-
tion, which further enhances the child’s
ability to perform in his or her environ-
ment. In understanding this area of special
movement we have to think in terms of
eye-hand coordination, which is such an
important part of a child’s ability to per-
form satisfactorily in the classroom and in
the world around him.
There are two components of eye-
hand coordination.
12
The first is the more
general aspect, which is the child’s ability
to use the eyes and the hands together as a
team when performing functions in the
world around him. Put simply, this means
that a child can catch a baseball, or pick
up a pencil, or pick up a knife and fork and
began to utilize it. A child can take a piece
of paper from his notebook, place it in
front of him, and begin to work on it. The
child can reach across the dining room ta
-
ble and get a glass of water, or reach for the
ketchup without knocking over the glass
of milk in front of him. These are all ex
-
amples of the child using vision as a guid
-
ing mechanism.
The second component of eye-hand
coordination is visual motor integration,
which is a significant part of the special
movement level of performance. This is
the ability of a child to transfer and repro
-
duce cultural symbols from one plane
onto another. Examples include the abil
-
ity to copy information from the chalk
-
board (vertical plane) onto a piece of
paper (horizontal plane), the ability to
copy information from a reference text,
the ability to know information stored in
the cortical areas of the brain and to write
it down on paper. This sophisticated form
of eye-hand coordination is a significant
and contributory aspect of the child’s per
-
formance in the classroom. So far as is
known at the present time, there is no gene
that gives a child the ability to copy cul
-
tural symbols from one plane onto another
plane. This is a learned visual motor task.
We take it for granted that every child has
the ability to learn and perform it. With
some children this skill has to be trained
and developed.
The third area of performance com
-
prises the ability to acquire and process vi
-
sual information. This includes the
following ocular motor skills: teaming,
tracking, and focusing. “Teaming” simply
means that the eyes have the ability to
work together. First, the brain receives an
image from each eye, and then it success
-
fully fuses the images together to produce
one visual image. “Tracking” (motility) is
the ability of the eyes to move properly
across the page of print, or to follow an ob-
ject, or to look directly at an object using
just the eyes, without using one’s finger or
a pointer as an aid. Focusing is the ability
of the eyes to obtain clarity of objects at
distance and at nearpoint. It includes the
ability to shift focus from the nearpoint of
the desk to the farpoint of the chalkboard,
for example, or to focus for extended peri-
ods of time at a computer screen.
The fourth area or level of perfor
-
mance is the auditory-speech-language
complex and its relation to vision. This is
significant because after there is visual
recognition of an object there must be an
appropriate language match or response to
that visual stimulus. Previously learned
auditory information must be matched
with the visual stimulus so that appropri
-
ate verbal responses can be made. This en
-
ables the child to communicate with
others. Included in the processing of audi
-
tory stimuli are both speech and language.
Dysfunction at this level requires the ex
-
pertise of all the relevant professions,
working together and taking a multidisci
-
plinary approach to the problems.
The fifth level or area of performance
is that of visual perception and cognition.
This area requires that a child receives vi
-
sual information properly, and then is able
to make the appropriate interpretation of
this information. All aspects of the visual
Journal of Behavioral Optometry Volume 12/2001/Number 3/Page 67
process, including reception, and ulti
-
mately integration of the visual stimuli,
have to be performed satisfactorily in or
-
der to achieve adequate visual perception
and cognition. For example, a child re
-
ceives the visual data, recognizes it and ul
-
timately is able to communicate it to
others.
These levels of performance guide the
child in all daily activities. A dysfunction
in one or more of these levels of perfor
-
mance means that the child may not be
able to perform satisfactorily in the class
-
room environment, and in many activities
in the home and the play environments.
This is true irrespective of the child’s liv
-
ing in a higher or lower economic situa
-
tion, in a one or two-parent home, or in an
urban or suburban location.
The Impact of Undetected Vision
Related Learning Problems on
School Age Children
It is not surprising that some of the ini
-
tial research in the 1970’s found that emo
-
tional problems existed in those children
who had visual problems. “The question
at that period was whether children who
were experiencing learning and visual
problems also had emotional problems in-
volved in the overall picture.”
13
Spe-
cifically, it was important to determine
whether children who had undetected and
untreated visual problems, and displayed
difficulty in the school environment, were
also prone to having more emotional
problems than those who did not have vi
-
sual problems. The research indicated
that, indeed, this was the case. The re
-
search indicated that the human figure
drawings of children with vision related
learning problems were experiencing
feelings such as a lack of direction, a sense
of not belonging, an inadequate sense of
self-assurance, feelings of insecurity, in
-
adequacy and inferiority.
13
Vision And Juvenile Delinquency
Consider the child who is having diffi
-
culty in school because of undetected vi
-
sion related learning problems. Now he is
experiencing the attendant emotional
components as well. Although this might
begin as a minor problem, if the child’s vi
-
sion problems remain undetected, they
might lead to other types of emotional
problems, which might be more signifi
-
cant. Research in the late 1960’s and the
1970’s with the juvenile courts, psychol
-
ogy, and optometry collaborating, indi
-
cated a significant number of children
with learning disabilities were appearing
in the juvenile court system.
14,15
A rela
-
tionship was found to exist between juve
-
nile delinquency, learning problems, and
associated visual problems. An additional
factor now had to be considered: the emo
-
tional problems that can be associated
with undetected visual problems. As more
research was conducted in the 1980’s and
the 1990’s, a much clearer picture was de
-
veloping, one that showed that a relation
-
ship existed between vision, learning
disabilities, and juvenile delinquency. By
the year 2000, it was accepted that a sig
-
nificant number of undetected visual
problems could be found in the population
of adjudicated juveniles.
16
As we consider this issue of emotional
problems leading to social problems and
delinquency, we must again recognize that
no single profession holds the key solu
-
tion. When it comes to delinquency, we
need appropriate counseling, court ser
-
vices, psychological services, educational
and medical services, as well as basic
optometric services.
One of the earlier studies relating
learning disabilities to juvenile delin-
quency indicated that the use of a multi-
disciplinary approach to treatment had a
positive effect on the rate of recidivism.
Specifically, with this approach, the learn-
ing disabled juvenile delinquents were six
times less likely to return to the court sys-
tem. “The authors feel that it is time to take
the question of juvenile delinquency be
-
yond the correlation phase that has been
dealt with long enough. There appears to
be significant evidence that remediation
incorporating various educational and ac
-
ademic programs, along with traditional
means of dealing with delinquent youths,
has greatly reduced recidivism and helped
many learning disabled children. Al
-
though the delinquent child with a learn
-
ing disability presents a formidable
challenge, this challenge can be met with a
multidisciplinary approach in diagnosis
and remediation.”
17
Further research showed: “The results
of the study indicate a decrease in emo
-
tional involvement after a visual training
program. It appears that for children who
are experiencing minor emotional diffi
-
culties associated with learning difficul
-
ties, forms of academic therapy and
educational remediation, such as visual
perceptual training, are very therapeutic
in alleviating some of their minor
stress.”
18
We are seeing the efficacy of a
team approach, but one that respects the
area of expertise of each of the involved
professions. As the authors noted: “This
is not to indicate that visual training or ac
-
ademic therapy be a substitute for psycho
-
therapy or any other psychiatric
intervention for those children requiring
psychiatric care. The results of this study
seem to confirm some of the early workers
in the field who felt that social-emotional
problems resulted from a child’s learning
difficulties and that with proper
remediation and intervention much of the
social-emotional difficulty would sub
-
side.”
18
Vision and Illiteracy
It became evident in the late 1980’s
and the early 1990’s that illiteracy was a
significant problem in the United States.
Functional illiteracy is the inability of an
individual to use reading, speaking, writ
-
ing and computational skills in everyday
life. According to the United States De-
partment of Education, one in five Ameri-
can adults is functionally illiterate.
19
This
means “there are at least 20-30 million
American adults who have major difficul-
ties with basic reading, writing, calculat-
ing, solving problems, and/or
communicating well enough to function
effectively on the job and in everyday liv-
ing.”
20
So the children of twenty years ago
whom we missed in the inner city—the
children of twenty years ago who had
frustrations in the classroom, the children
of twenty years ago who had antisocial be
-
havior and who dropped out of school—-
became a part of these statistics. A signifi
-
cant number of them were found in the
adult illiterate population.
Research in the early 1990’s showed a
link between undetected vision problems
and illiteracy. This is not to say that every
illiterate adult has a vision problem; how
-
ever, a significant number of them were
failing vision screening tests being con
-
ducted throughout the country. In New
York City, 66% of the illiterate adults, in
one study, failed one or more parts of an
optometric evaluation.
21
In Norfolk and
Virginia Beach, Virginia, 74% of an illit
-
erate adult population failed one or more
parts of a visual screening program.
22
The
illiterate adults failed not only tests mea
-
suring distant visual acuity, but they also
failed a significant number of tests mea
-
Volume 12/2001/Number 3/Page 68 Journal of Behavioral Optometry
suring other visual skills. The largest
number of failures in the New York City
study was in the near acuity portion of the
test. In the Norfolk-Virginia Beach study,
a significant number failed the tracking
and near acuity parts of the vision screen
-
ing tests. This confirms what has been said
for four decades: there is more to good vi
-
sion than just seeing a standard eye chart
clearly. This research has indicated that
the children of yesterday who had these
undetected visual problems, whether they
were teaming, tracking, or focusing, grew
up to become part of today’s population of
illiterate adults.
Recent Research
In 1996 it was determined that
700,000 students drop out of high school
each year.
23
Dropout rates for minorities
are twice that of non-minority students.
The vast majority of academically at risk
students are from low social economic
backgrounds and often display character
-
istics such as poor school attendance and
antisocial behavior.”
24
Although many ef-
forts are made to address this problem,
and despite the implementation of various
programs, The Education Commission of
the States estimates that 30% of our na-
tion’s youth fail to acquire sufficient edu-
cation to obtain adequate employment.
25
The concept of the at-risk student be-
came significant in the 1990’s. Evalua-
tions of students indicated that significant
numbers in an academic and behavioral
at-risk population have undetected and
untreated visual problems. One of the
most significant findings of the research
was an 85% failure rate on one or more
sub tests on a comprehensive vision
screening performed in elementary, mid
-
dle, and high school populations. Once
again, the tests performed were not just
distance acuity tests; also included was a
screening vehicle that evaluated the track
-
ing abilities, the convergence abilities,
and the focusing abilities of the eyes at
near point, as well as the very important
visual motor integration task. The authors
concluded in this 1996 publication that,
with at-risk populations, “it is essential
that classroom teachers work closely with
vision care professionals, community vol
-
unteers and organizations in order that
each pupil receives a comprehensive vi
-
sual screening and appropriate follow up
care.”
24
Research done in 1999 indicated that
74% of a population of adjudicated ado
-
lescents failed at least one of the sub tests
utilized to screen for vision problems.
The authors stated: “Although adjudi
-
cated juveniles have received various psy
-
chological, educational, and vocational
treatments, most of these treatments have
had limited effectiveness. It is difficult for
a treatment program, particularly an aca
-
demic one, to be effective if the adolescent
lacks adequate visual skills. Unless at-risk
adolescents with visual impairments are
properly diagnosed and treated, many of
-
fenders, such as those in the current study,
may end up in the criminal justice sys
-
tem.”
26
Today there are many programs
around the country that are designed to
help at-risk children. Title I of the Federal
Elementary and Secondary Education Act
allocates money to local school districts in
order to improve the basic literary skills of
children from low-income families. Title
I was the first major federal aid program
designed specifically for children in
low-income areas. A vision screening re-
search project found that 85% of the Title I
students who were evaluated failed at
least one sub test of the comprehensive vi-
sion screening battery. Specifically, the
Title I students had a much higher failure
rate on tracking, visual acuity at near, vi-
sual acuity at far, fusion, convergence, vi-
sual motor integration, and color vision
sub test. “It is only thought such mutual
cooperation that compromised vision can
be ruled out as a contributing factor in stu
-
dent learning difficulties. Without such
cooperation, academically at risk students
such as those enrolled in Title I reading
programs may become the school drop
-
outs, juvenile offenders, and/or the illiter
-
ate adults of tomorrow.”
27
Conclusions
Toward the common goal of solving
those problems found to be involved in
children’s vision and its relationship to
learning problems, delinquency, illiter
-
acy, and social and emotional problems, a
multidisciplinary approach from all re
-
lated professions is recommended. Vision
should be considered an academic tool for
children. I recommend the following,
based on research cited above:
1. Prior to entering kindergarten, or by
age five, every child should have a
comprehensive vision examination
performed by an eye care professional.
2. Each year thereafter, it is recom
-
mended that every child should have
an annual vision examination from
K-12th grade.
3. If it is not feasible to provide annual
vision examinations to every child,
then a comprehensive vision examina
-
tion should alternate with a vision
screening every other year, through
12th grade.
4. The vision screening program should
thoroughly investigate visual abilities
at the near point, as well as vision abil
-
ities for distant viewing.
5. The appropriate grades for vision
screenings start with the first grade,
followed by the third, fifth, seventh,
ninth, and eleventh grades.
Children should not be sent to school
without having all the proper tools—good
vision, paper, pencils, and books.
Acknowledgements
The author would like to acknowledge
Roger A. Johnson, Ph.D., Assistant Pro-
fessor of Education at Old Dominion Uni-
versity, Norfolk, VA, who collaborated
with him on many of these research pro-
jects and publications. In addition, the au-
thor would like to thank the Vision
Council of America for their support.
This paper was presented at the April
4, 2001, conference, “Visual Problems of
Children in Poverty and Their Interfer-
ence with Learning” held at the Harvard
Graduate School of Education.
References
1. Lerner J. Learning disabilities, theories, diagno
-
sis and teaching strategies. Boston: Houghton
Mifflin Co., 1981:17.
2. Hallahan D, Cruickshank W. Psychoeduca
-
tional foundations of learning disabilities. New
Jersey:Prentice-Hall, 1973.
3. Rappaport S. Public education for children with
brain dysfunction. New York: Syracuse Univer
-
sity Press, 1969.
4. Zaba J. Learning disabilities: optometric con
-
siderations, J Am Optom Assoc 1975 Oct;4(2):
1074.
5. Ciner E, Dobson V, Schmidt P, et al. A survey of
vision screening policy of preschool children in
the United States. Surv Ophthalmol 1999
March-April;43(5):445-457.
6. National PTA Resolution. Learning Related Vi
-
sion Problems Education and Evaluation. June
1999.
7. Your Child’s Sight. Illinois:Prevent Blindness
America, September 1997.
8. Healthy People 2010, Conference Edition.
Bethesda: Vision and Learning Section, Na
-
tional Institutes of Health, November 1999:28.
Journal of Behavioral Optometry Volume 12/2001/Number 3/Page 69
9. “The Case for a Preschool Eye Examination,”
Frankfort, Kentucky:Kentucky Optometric As
-
sociation, 1999.
10. Gesell A, Ilg F, Bullis G, Getman G, et al. Vi
-
sion: Its Development in Infant and Child.
Santa Ana: Optometric Extension Program
Foundaiton, Inc., 1998.
11. Getman G. How to develop your child’s intelli
-
gence. Santa Ana: Optometric Extension Pro
-
gram Foundaiton, Inc., 2000.
12. Zaba J. Solving the mystery of learning prob
-
lems, Rev Optom 1995 July;132(7):42-48.
13. Bachara G, Zaba J, Raskin L. Human figure
drawings and learning disabled children.
Academ Ther 1975-76 Winter;11:2.
14. Dzik D. Vision and the juvenile delinquent. J
Am Optom Assoc 1966;37: 462-468.
15. Hippchen L. Ecologic-biochemical approaches
to treatment of delinquents and criminals. New
York:VanNostrand Reinhold, 1978.
16. Barber A, ed. Optometry’s role in juvenile de
-
linquency remediation: Behavioral aspects of
vision care. Santa Ana: Optometric Extension
Program, Inc., 2000; 41(3).
17. Bachara G, Zaba J. Learning disabilities and ju
-
venile delinquency. J Learn Disabil 1978;11(4):
58-62.
18. Bachara G, Zaba J. Psychological effects of vi
-
sual training. Academ Ther 1976 Fall;12(1).
19. “Facts On Illiteracy In America.” Syracuse,
NY: Literacy Volunteers of America, Inc.,
1991.
20. Zaba J, Johnson R. Literacy: the vision, learn-
ing, and volunteer connection. J Behavi Optom
1992;3(5):128-131.
21. Thau B. Vision and literacy. J Reading 1991;
35:196-199.
22. Johnson R, Zaba J. Examining the link between
vision and literacy, J Behav Optom 1994;5(2):
41-43.
23. Donmoyer R, Kos R. At-risk students: portraits,
policies, programs, and practices. New York:
State University of New York Press, 1993.
24. Johnson R, Nottingham M, Stratton R, Zaba J.
The vision screening of academically and
behaviorally at risk pupils, J Behav Optom
1996;7(2): 39-42.
25. Securing our future: the report of the national fo
-
rum for youth at risk.” Denver, CO: Education
Commission of the States, 1988.
26. Johnson R, Zaba J. The visual screening of ad
-
judicated adolescents. J Behav Optom
1999;10(1): 13-17.
27. Johnson R, Blair R, Zaba J. The visual screen
-
ing of title I reading students. J Behav Optom
2000;11(1): 3-6.
Corresponding author:
Joel N. Zaba, M.A, O.D.
281 Independence Blvd., Suite 105
Virginia Beach, VA 23462
joelzabe@home.com
Date accepted for publication:
May 2, 2001
Volume 12/2001/Number 3/Page 70 Journal of Behavioral Optometry
... Vision in children plays a fundamental role in the acquisition of skills such as language, facial expressions interpretation, and skills requiring hand-eye coordination. [1] Undetected refractive error in children can affect their abilities to make informed choices and to learn from the environment, thus reducing their ability to explore the environment. World Health Organization's Vision 2020 estimated that 12 million children between the ages of 5 and 15 years have undetected visual impairment from refractive error, which could result in low self-esteem and emotional instability. ...
... Among the 20% of school-age children who have learning disability in reading, 70% of them have some form of visual impairment, such as oculomotor, perception or binocular dysfunction, which may be interfering with their reading skills (19). Children with vision-related learning problems reported that they were experiencing feelings such as a lack of direction, a sense of not belonging, an inadequate sense of self-assurance and a feeling of insecurity, inadequacy and inferiority (20). ...
Article
Full-text available
Visual cues are undoubtedly important for children who are in the process of learning. Nevertheless, visual impairments are in fact common among school children, in which proper assessment and intervention strategies should be made available. To achieve the desired academic achievement and quality of life, early detection and intervention of visual impairment is vital. In this paper, the prevalence, incidence, causes and negative effects of visual impairment among school children are reviewed accordingly. The current management strategies for visually disabled children are covered as intended. The important issues in regard to visual assessment are also discussed. Based on the current literature, it appears that more research efforts are required to enhance the current visual-related services at schools. Among other things, conducting a regular visual screening program among preschool children is beneficial to identify those with visual impairments to avoid and minimize the negative consequences of visual disability.
... Hence a more detailed study needs to be carried out to identify the visual profile status of Orang Asli children in Peninsular Malaysia. Recent studies have shown that visual impairment can cause disruption to learning and to a decline in academic achievement [10][11][12][13]. Hence, early detection through vision screening is essential for identifying visual impairments in children [13,14], especially the Orang Asli. ...
Article
Full-text available
Background School children are considered a high-risk group for visual impairment because uncorrected refractive errors and problems such as amblyopia can seriously affect their learning abilities and their physical and mental development. There are many studies reporting the prevalence of refractive errors among school children of different ethnic groups in Malaysia, however, studies concerning the prevalence of refractive errors among indigenous or Orang Asli children are very limited. Therefore, the objective of this study was to determine the prevalence and causes of visual impairment among Orang Asli children. Methods One hundred ten Orang Asli children aged 7 to 12 years old in Negeri Sembilan, Malaysia were selected. 51% of these children were boys while the remainders were girls. They underwent visual acuity test, cover test, Hirschberg’s test, ocular external assessment and ophthalmoscopy. Children who failed the vision screening were then referred for further eye examination. Results Of these 110 Orang Asli children, 46 failed the vision screening and subsequently 45 of them were confirmed to have visual problems (40.9% of the total subjects). The main cause of visual impairment in this study was refractive error (34.5% of the total subjects) where the main refractive error found was hyperopia (28.2%) followed by amblyopia (2.7%), strabismus (1.8%) and ocular abnormalities (1.8%). Conclusion Hence, vision screening and a comprehensive eye examination is very important and needs to be done on all Orang Asli children so that any visual problems can be detect at an early stage to avoid the development of learning difficulties among these already disadvantaged children.
... Paediatric vision screening is an important component of well-child visits to detect and refer vision threatening conditions. Over 80% of a child's learning is based on vision, and good vision is crucial for both physical and emotional development (1). Untreated visual abnormalities in childhood cause permanently reduced visual acuity (VA) (amblyopia) (2). ...
Article
The relationship between vision and academic performance has been discussed for a long time, with special emphasis on visual factors associated with learning problems. The objective of this pilot study is to obtain an initial idea about the evolution and the impact of refractive errors on school-aged children. A visual examination was performed on 252 children between the ages of 6 and 11 years, which consisted of objective refraction, subjective refraction, and accommodative and binocular tests. No significant differences were observed regarding the refractive state when taking academic performance into account (p > 0.05). However, it was determined that academic performance was better among children with a negative spherical equivalent. Studies with a larger sample size must be conducted to verify the results that were attained in this present pilot study, and these must likewise look at possible ways in which strategies can be implemented in schools to reduce myopia progression.
Article
Importance Despite growing support for early school-based vision screening and eyeglass provision, few studies have rigorously monitored the compliance of eyeglass wear among preschool-aged children who receive eyeglasses through such programs. Objective To assess the prevalence and factors associated with eyeglass wear compliance among preschoolers from low-income families who receive eyeglasses through the See Well to Learn program. Design, Setting, and Participants Longitudinal cross-sectional study of eyeglass wear compliance patterns among 188 children 3 to 5 years of age from 51 Bay Area Head Start preschools in San Francisco, California. The study conducted during the 2017 to 2018 school year included students with a failed vision screening who met predetermined refractive criteria following cycloplegic refraction and received eyeglasses through the See Well to Learn program. Exposures Eyeglass distribution. Main Outcomes and Measures Eyeglass wear compliance, measured by a school-year’s worth of weekly teacher reports, was a longitudinal measure of consistent eyeglass wear, defined by eyeglass wear for more than 50% of every school day (compliance score of 4). Results Of 188 students (91 boys [49%]; 94 girls [51%]; mean [SD] age, 3.89 [0.5] years), 133 (71%; 95% CI, 64%-77%) maintained a mean compliance score throughout the school year of 4 or higher. Compliance prevalence was relatively stable throughout the school year, ranging from 139 students (74%) to 164 students (87%). Baseline uncorrected visual acuity in both the better-seeing and worse-seeing eyes was the only assessed factor that was associated with compliance. In the better-seeing eye, the mean uncorrected visual acuity of students with eyeglass wear compliance was 0.473 logMAR (95% CI, 0.433-0.514) (Snellen equivalent, 20/60) compared with 0.394 logMAR (95% CI, 0.334-0.454) (Snellen equivalent, 20/50) for students with noncompliance (P = .03). In the worse-seeing eye, the mean uncorrected visual acuity of students with compliance was 0.576 logMAR (95% CI, 0.530-0.623) (Snellen equivalent, 20/75) compared with 0.492 logMAR (95% CI, 0.433-0.551) (Snellen equivalent, 20/62) for students with noncompliance (P = .03). In the better-seeing eye, the difference between students with compliance vs noncompliance was 0.079 logMAR (95% CI, 0.009-0.150) (5 Snellen letter difference) compared with 0.084 logMAR (95% CI, 0.007-0.160) (5 Snellen letter difference) in the worse-seeing eye. Conclusions and Relevance This study found that nearly 3 of 4 preschool students consistently wore their glasses at school during their first year of use, supporting the continued implementation of preschool-based vision screening programs. These findings suggest that programs involving school-based screening and eyeglass delivery may lessen disparities in accessing pediatric vision care. Consistent with previous studies, students with poorer uncorrected baseline visual acuity were found to be more likely to wear eyeglasses compliantly.
Article
Résumé Objectif Évaluer la prévalence des troubles visuels dans une population pédiatrique scolarisée en réseau d’éducation prioritaire en France. Patients et méthodes Le projet pilote PlanVue® a été conçu pour détecter et prendre en charge les troubles visuels des enfants scolarisés dans les réseaux d’éducation prioritaire de Nanterre, France. Au cours de cette étude pilote, 515 enfants de 4 à 13 ans ont bénéficié à l’école, entre janvier et mars 2019, d’un examen de la fonction visuelle consistant en une évaluation globale du comportement visuel, une mesure de l’acuité visuelle de chaque œil, une évaluation de la réfraction objective par photoscreening, et la recherche d’un strabisme. En cas d’examen anormal, défini par une vision altérée ou selon un algorithme établi sur les anomalies retrouvées, les enfants étaient adressés à un ophtalmologiste. Résultats Une altération de mesure de l’acuité visuelle a été retrouvée chez 20 % des élèves. Sur les 515 enfants dépistés, 22 % ont été orientés vers un ophtalmologiste. Parmi ces enfants, 13 % présentaient une amblyopie, 73 % présentaient une amétropie sphérique, 57 % présentaient un astigmatisme et 2 % présentaient un strabisme. Sur l’ensemble de la population dépistée, 12 % des enfants nécessitaient une correction optique et n’en étaient pas pourvus. Conclusion Cette étude confirme la prévalence élevée des troubles réfractifs non corrigés chez les enfants d’âge scolaire. Un programme de dépistage réalisé en milieu scolaire par des professionnels paramédicaux peut permettre de réduire considérablement la proportion de troubles visuels non corrigés et leurs conséquences.
Technical Report
Full-text available
This is a follow-up study to investigate the outcome of a training program among teachers and nurses that took place in certain counties in Kenya in the year 2012. The program was undertakenby Seeing is Believing (SIB) in conjunction with the Brien Holden Vision Institute, the ministries of health and education for the development and implementation of a comprehensive Child Eye Health Programme.
Article
We examine the effect of New York City's universal pre-kindergarten program (UPK) on the health and utilization of children enrolled in Medicaid using a difference-in-regression-discontinuities design. We find that UPK increases the probability that a child is diagnosed with asthma or with vision problems, receives treatment for hearing or vision problems, or receives an immunization or screening during the pre-kindergarten year. These effects are not offset by lower rates in the kindergarten year, suggesting that UPK accelerates the rate at which children are identified with and treated for conditions that could potentially delay learning and cause behavioral problems.
Article
Purpose: To determine the prevalence of non-strabismic vergence anomalies and their relationship with age, gender, and school level in children aged 10–16 years Method: A cross-sectional study was conducted among 537 children (255 male, 282 females; mean age 13.0 ± 2.0, years) selected from nine schools using stratified, cluster, and random sampling. The participants completed a Convergence Insufficiency Symptom Survey (CISS) and eye examinations, including the measurement of visual acuity, non-cycloplegic refraction, cover test, near point of convergence, fusional vergences, accommodative functions, and ocular health evaluation. All binocular tests were performed following the subjective refraction with the corrective lenses in place, if prescribed. Results: The prevalence of low suspect, high suspect, and definite convergence insufficiency was 9.6%, 5.8%, and 4.1%, respectively. Other prevalence estimates included convergence excess (2.9%), fusional vergence dysfunction (2.6%), basic exophoria (1.7%), basic esophoria (2.8%), divergence insufficiency (0.8%), and divergence excess (0.6%). The prevalence of high suspect (p < 0.01) and definite (p < 0.01) convergence insufficiency was significantly higher in older than younger children, and as expected, in secondary more so than primary school children (p = 0.01). There was no statically significant association between gender and various vergence anomalies. Conclusion: The study showed that vergence anomalies are common vision conditions among Abia State school children. Given the importance of visual skills in learning and academic achievements, there is a need to develop screening and management strategies that will target those visual conditions to prevent educational and social progress being affected.
Article
Full-text available
35 children with academic problems and 35 children without them were asked to draw a picture of a whole person. Protocols were scored according to the Koppitz Developmental Scoring System. The academically retarded children differed from the other group in emotional indicators and showed more visual problems. They subsequently received visual training for 4-6 mo. Posttreatment emotional indicators were similar for both groups. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The growth of the child's visual function is studied and interpreted in relation to the organism's total action system. Part I presents a sequence of growth stages in the total child from the embryonic period to the age of 10 years. The rôle played by vision in the total pattern of action at each age level is depicted. Part II deals with specific tests of visual functions over the same range of ages and gives detailed data in regard to ocular behavior. Part III shows the relevance of the developmental approach to the many problems of visual care that arise in infancy and during preschool and school years. 55 references. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
2 groups of 35 children each (matched for age and sex), in at least the low average range of intelligence according to the Koppitz Developmental Scoring System and other psychological tests, were asked to draw a whole picture (not a stick figure) of themselves; the drawings were scored for the emotional indicators established by E. Koppitz (1967). Ss in the experimental group displayed difficulty in the school environment and had symptoms of visual problems. A developmental visual examination measuring visual processing was also administered. Drawings of the children with difficult school adjustment presented more emotional indicators than those of the controls. Excessive attention to eyes in the self-portraits of this group appeared to indicate the children's awareness of their own learning problems. (PsycINFO Database Record (c) 2012 APA, all rights reserved)