Pediatric Optometry

Pediatric Vision Care
Dr. Carol S. Main

Dr. Carol S. Main is an associate of Family Eye Center. Dr. Main completed a pediatric residency at Illinois Eye Institute and is the area’s only trained pediatric optometrist.

Most parents understand how critical quality vision is to their childrens development process especially as they enter the school years. As children grow and mature, over 80% of what they learn is processed through their eyes.  However, most people have a limited understanding of what good vision means.  Good vision involves much more than just seeing clearly without glasses.  Dr. Carol S. Main has the education and training to review pediatric vision and help children see better. 

Facts About Children’s Vision (provided courtesy of family eye care brochure)

• Up to 25% of all school-aged children have vision problems significant enough to impair academic performance.

• Traditional testing for 20/20 visual acuity does not detect learning related vision problems.

• 80% of all learning is performed through vision

Children’s Vision
A learning related visual problem directly affects how we learn, read, or sustain close work. Visual problems in any of the following areas can have a significant impact on learning.

• Eye Tracking Skills

• Eye Teaming Skills

• Binocular Vision

• Accommodation

As vision and learning are intimately connected, a vision problem can be easily mistaken for a learning problem. Youngsters with visual problems can be misdiagnosed as having learning disabilities, ADHD, or dyslexia. Children who have learning related visual problems cannot sustain their close work at school, children who ADHD also cannot sustain attention on their work. Same behaviors, different diagnosis.

Common Diagnosis

Astigmatism
Astigmatism is the inability to focus clearly at any distance. With astigmatism the cornea is shaped more like a football than a basketball. LASIK corrects this oval shape, making the cornea more round and achieving clear vision.

Nearsightedness
Nearsighted people see close objects clearly – but not distant objects. In nearsightedness, the curve of the cornea is too steep and images are focused in front of the retina. LASIK corrects this condition by flattening the curve of the cornea.

Farsightedness
Farsighted people see distant objects clearly, but all other objects are blurred. In farsightedness, the shape of the cornea is too flat and light rays are focused behind the retina. LASIK corrects this condition by shaping the cornea so that it focuses correctly. 

Amblyopia
The loss or lack of development of central vision and is not correctable with lenses. This can result from a failure to use both eyes and a large difference in the degree of nearsightedness, or farsightedness before age 6. And it does not affect side vision.

Eye Coordination
Eye coordination is simply the ability of both eyes to work together as a team. Each of your eyes sees a different image and your brain by a process called fusion, blends the images into one three dimensional picture. Good eye coordination keeps the eyes in proper alignment.

Color Deficiency
This is about the inability to distinguish some colors and shades. This happens when the color sensitive cone cells in your eyes do not properly pick up or send the proper color signals to your brain.

Signs and Symptoms
Vision problems can elicit a wide range of signs and symptoms. Some, like eyestrain or blurred vision can actually be attributed directly to a visual dysfunction. Other problems, such as poor attention span at school, clumsiness in sports, or reduced productivity at work may not be immediately recognized as a vision problem.


Physical Signs of Vision Problems in Children

• Frequent headaches or eyestrain
• Blurring of distance or near vision, particularly after reading or close work.
• Avoidance of close work
• Poor judgment of depth
• Turning of an eye in or out
• Tendency to cover up one eye
• Double vision
• Poor hand – eye coordination
• Dizziness
• Difficulty following a moving target.

“Current research shows that about 20% of school-aged children have undetected vision problems, which are hindering their school performance. Many of these children have passed their school's vision screening, which is only designed to check children's distance vision as measured by the 20/20 line on the eye chart. Unfortunately, school screenings don't check to see if children can coordinate both their eyes as a team, track print across a written page without losing their place, or comfortably adjust focus when looking from near to far away. Children can have 20/20 eyesight, meaning normal distance vision, and still have vision problems in other areas.” Facts Courtesy of Children’s Vision Information Network

A complete eye exam by a pediatric optometrist trained to diagnose and treat vision-based learning problems can determine for certain if vision is the basis of a child's struggle to read.


Common Questions

Why is an eye exam important before my child starts school?

A vision exam is a very important step in preparing children for the first day of school. During the school years good vision is essential in the ability to read to learn. Any vision problems need to be detected and treated before they lead to a learning problem. Once in school, children need a comprehensive vision exam every year.

My child passed the school screening - is that sufficient?

Screenings can identify children with reduced visual acuity, however, screenings do not test important visual skills, including eye teaming (binocular vision). This can be identified in a comprehensive eye examination.

At what age can a child have an eye exam?

The American Optometric Association recommends that a child receive their first eye exam at 6 months of age. If development is normal and no problems are found during that exam, it is recommended that their next well child exam be performed at three years of age and then before starting school.

How does an optometrist check a child’s eyes when they don’t know the alphabet?

While letters are preferred, there are many ways to assess a child’s vision. We are able to accurately measure a child's vision through naming or matching pictures. In very young children that are not able to match pictures, we ensure that a child is able to fixate and track an object equally with both eyes and are able to reach and grab for age appropriate objects. (These assessments can be performed from infancy through early childhood).

How do you determine eye health and prescription in young or non-verbal children?

There are many objective methods that can be done to ensure that a child has healthy eyes and determine if there is a need for glasses. A glasses prescription can be accurately measured with a test called Retinoscopy, in which a mild intensity light is used with various lenses to determine the child’s prescription. This is how children with farsightedness can be identified as often times they don’t have good visual acuity despite a high prescription. Various opthalmoscopes are used to examine the health of children's eyes. These techniques can be preformed on individuals ranging from infancy to adulthood.