Infant & Children’s Vision Resources supported by

The American Optometric Association and

Optometry Cares – The AOA Foundation
 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Introduction
• Major concerns
• Signs and symptoms that may indicate
vision problems
• Types of visual conditions
• Refractive Issues
• Visual Efficiency Problems
• Visual Processing Problems
• What is a vision screening?
• Parents role in vision development

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

What are the major concerns?

 20% of preschoolers are at risk of having eye or vision
problems
 25% of school age children have eye or vision problems
 Students identified as problem learners have high rates
of undetected vision problems

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Signs/Symptoms parents should keep in mind

 Sitting too close to the TV
 Holding a book very close
 Squinting, rubbing eyes
 Head tilt
 Turning of an eye in or out
 Light sensitivity
 Difficulty with eye-hand coordination
 Avoidance of near work

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Types of visual
conditions
• Refractive Issues
• Myopia (nearsightedness)
• Hyperopia (farsightedness)
• Astigmatism

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

General characteristics of Myopia

 Blurred distance vision
 Tendency to bring near work very close or get close to television
 Interest mainly in near activities, less distance work
 Highly motivated readers, best learners

 Interactive Demo:
 use of trial lenses to induce blur

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

General characteristics of Hyperopia

 Blurred vision greater at near
 Eyestrain, headaches
 Difficulty attending to near work

 Interactive Demo:
 Use of trial lenses to induce blur

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

General characteristics of Astigmatism

 Blurred vision at distance and near
 Inability to sustain attention
 Discomfort of the eyes

 Interactive Demo:
 Use of trial lenses to induce blur

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Types of visual
conditions
• Visual efficiency problems
• Eye teaming problems
• Eye focusing problems
• Eye tracking problems
• Strabismus
• Amblyopia

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Eye teaming problems

 Problems with convergence
 Symptoms
 Headaches
 Eyestrain
 Double vision (tendency to close one eye)
 Moving letters or words on a page
 Rubbing eyes frequently
 Poor comprehension
 Demo: Convergence, Vergence facility, Stereopsis

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Eye focusing problems

 Loss of attention to near work
 Headaches and eyestrain
 Poor comprehension
 Avoidance of reading

 Example, demonstration
 Accommodative facility test, clearing plus/minus

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Eye tracking problems

 Inefficient eye movement skills following targets
 Symptoms
 Loss of place when reading
 Poor comprehension
 Decreased reading speed

 Demonstration: DEM, King-Devick

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Amblyopia & Strabismus

 Decreased visual acuity not correctable with lenses
 Tendency for eyes to turn in, out, up or down
 Symptoms
 Blurred vision (or not if only in one eye)
 Double vision intermittent or constant
 Decreased reading speed
 Decreased reading comprehension
 Demonstration: Prism for diplopia, Neutral density filter for amblyopia

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Visual processing problems

• Form perception
• Visual memory
• Visual motor integration
• Laterality and directionality

• Examples, demonstration:
• Form board, circus puzzle
• VMI test/ Winterhaven copy form test
• Parquetry blocks

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Tests of Vision
 Visual acuity
 Refractive issues
 Eye teaming / eye alignment
 Eye focusing
 Eye movements
 Color vision
 Eye health

 Interactive demo:
 Show screening tests (DVA only) and others

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Comprehensive Eye Exams and Vision Screening

 The American Optometric Association recommends a comprehensive eye exam
from an eye doctor for every child between 6 and 12 months, between 3 and 5
years of age, then again before first grade and annually thereafter.
 A vision screening by the school or pediatrician is not the same as a
comprehensive eye and vision examination
 Vision screenings miss most vision problems; a child passing a vision screening
may still need further evaluation

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Comprehensive Eye and Vision Exams Include

 Review concerns, patient and family eye and medical histories, including visual, ocular,
general health, developmental status, leisure and sport activities, and school performance
 Measurement of visual acuity
 Determination of refractive status
 Assessment of binocular vision, ocular motility, and accommodation
 Evaluation of color vision
 Assessment of ocular and systemic health, including evaluation of pupillary responses,
anterior and posterior segment, peripheral retina, evaluation /measurement of
intraocular pressure, and visual field testing

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Keeping children’s eyes healthy

 Comprehensive eye examination can reveal eye health
issues that may interfere with a child’s vision
 Important to evaluate all structures of the eye with
dilated eye examination to rule out any retinal
problems, lens abnormalities, or optic nerve problems

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

InfantSEE®
 Public health program designed to ensure that eye and
vision care become part of an infant’s wellness
examination.
 Participating AOA (American Optometric Association)
member optometrists provide a comprehensive eye and
vision assessment free of charge for infants between 6 and
12 months.

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Suggested activities to help with

infant vision development
 Keep reach and touch toys within baby’s focus about 8”-12”
 Select toys with bright and contrasting colors
 Allow baby to touch, pull, hold, kick toys
 Provide toys with different shapes and textures for baby to explore
 Encourage tummy time
 Stimulate both sides of the body to develop laterality and binocularity
 Encourage crawling and creeping to develop eye-hand coordination
 Alternate feeding from right and left sides

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Suggested activities to help with

preschool vision development
 Encourage Outdoor play
 Sports
 Encourage activities/games involving puzzles or patterns, problem solving
 Play simple memory games
 Games requiring eye hand coordination skills
 Read aloud to children, allow them to see what is being read, ask questions,
encourage interaction and conversation
 Maintain good eye contact with children

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Selection of toys
 Stimulate visual development, hand-eye coordination,
spatial relationships

 Perceptual Toys:
 Eye-hand (ex: lite-brite, mazes)
 Spatial relations (ex: parquetry blocks,
battleship, tic-tac-toe)

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Selection of toys
 Visual Memory
 Concentration

 Directionality
 Directional arrows with stepping stones

 Visual Motor Integration

 Puzzles, sketching, bead stringing

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Selection of toys
 Eye Hand Coordination
 Wooden building blocks, mega blocks

 Gross Motor skills

 Twister, table tennis

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Conclusion
 Early detection and treatment are essential to preventing or reducing the
development of vision conditions that have the potential to cause vision loss or affect
visual development
 Early detection of visual problems is important in a child’s development
 Early care  Preventable vision loss
 Comprehensive pediatric eye and vision examinations are essential for timely
diagnosis and treatment of eye disease and maintenance of good vision

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Statistics for OD information
• NOT INTENDED FOR PRESENTATION TO COMMUNITY

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Background
 Of the three to four million babies born every year in the United States
 1 in 20,000 has retinoblastoma (cancer)
 1 in 25 will develop strabismus (cross eye)
 1 in 30 will develop amblyopia (lazy eye)
 1 in 33 will show significant refractive error (prescription)
 An estimated one in five preschool children has eye and vision problems and these
problems are reported to occur at an even higher rate in children living in poor urban
environments
 One in four school-age children has a vision problem

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Background
 Vision disorders are the 4th most common disability in the U.S. and the MOST
prevalent handicapping condition in childhood
 Below the age of 6 years, only 14% of children are likely to have had an eye and vision
examination
 If left untreated, eye and vision problems can lead to difficulties in development,
education, and potential permanent vision loss
 Majority of learning in school is done through reading, especially after 3rd grade
 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Visual development
 Basic visual functions develop rapidly during the first year of life. By 6 months of age,
vision has become the dominant sense and forms the basis for later perceptual,
cognitive, and social development
 Objective testing (visual evoked response) demonstrates that the visual cortex is
capable of achieving 20/20 visual acuity by 6 months of age

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Refractive Errors: Hyperopia

 Hyperopia has a high prevalence among young children, with over 20% estimated to
have ≥2.00 diopters (D). Significant hyperopia (≥2.00 D) is commonly found in
association with the development of strabismus and amblyopia, and learning
difficulties.

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Refractive Errors: Myopia

 One in six children ages 5 to 17 (Asian, Hispanic, African American and White)
developed myopia during their school-age years. More than 75% of the new cases of
myopia occurred between the ages of 9 and 13.

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Access to Care
 The Centers for Disease Control and Prevention report that less than 15 percent of
preschoolers receive an eye examination by an eye care professional and fewer than
22% receive some type of vision screening

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 Infant & Children’s Vision Resources supported by
The American Optometric Association and
Optometry Cares – The AOA Foundation

Limitations of Vision Screenings

 Although both laws and guidelines exist for the screening of pre-school children, only
about 21% are screened for vision problems
 Untestability of preschool children at a screening can be as high as 42%
 Of the children who fail the screening, only 20-40% of the children receive
examinations – failing the needs of these children even further
 Low screening rates and inadequate referral and follow through with a comprehensive
eye examination by an eye doctor indicate that screening children in a school, a
pediatric care setting or other primary care setting is not an acceptable method to
evaluate a child’s normal visual function

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