PHOTO: SHUTTERSTOCK

If a child sitting in class can’t see the whiteboard at the front of the room, their grades are going to suffer.

And if their vision problems aren’t corrected early on, they’re in for a lifetime of problems.

“I would say the best return-to-school gift you can give a child is vision screening,” says Dr. Ken Nischal, chief of the Division of Pediatric Ophthalmology and Strabismus at UPMC Children’s Hospital of Pittsburgh. 

When a child is learning to see, they’re forming neurodevelopment pathways between their eyes and their brain. If they’re not seeing something correctly, they’re not informing their brain correctly.

“If a child reaches 8 and that problem hasn’t been picked up, it doesn’t matter what you do after the age of 8, they will not see because the brain didn’t get the information correctly,” says Nischal, who is also director of pediatric program development at the UPMC Vision Institute and professor of ophthalmology at the University of Pittsburgh School of Medicine.

He says he’s seen probably a dozen children in his career who came in at the age of 9 with vision problems, and by that time, even with glasses, it’s too late.

“A child will come to me at the age of 9 with vision of 20/100, which is poor vision, because they didn’t get glasses early enough,” he says. “And then you give them glasses, and they improved to 20/80 in either eye. Now that child’s never going to drive so … there’ll be certain jobs, lots of jobs, that child is not going to be able to do.

“Vision screening is essential to allow a child to lead a full and normal life.”

Newborns receive vision screening because babies can be born with a cataract or other issues, and babies should be screened again between 6 to 12 months of age. At that point, doctors are looking for any abnormalities, but they’re also looking at eye alignment.

“If one eye is turned in, the other eye is straight, the brain stops taking the image from the eye that’s turned in because it’s causing confusion to the brain.”

That eye will become weaker as the other eye compensates, but children can use an eye patch to correct the problem if caught early enough. 

Between the ages of 12 and 36 months, most pediatricians or family physicians do a photo screening test, where they use an instrument to take a picture of a child’s eyes that can determine if a child has a problem such as astigmatism. 

“That’s where the shape of the eye, instead of being like a soccer ball, is more like an American football,” says Nischal. “That’s a problem, because a child will see things that are skewed. So instead of seeing a zero as a zero, it looks like an egg-shaped object. And that becomes problematic when they start to try and read because things look blurry, because, you know, an E might look like an M or a C may look like a G because it’s been stretched.”

If there is a problem at that time, pediatricians will refer a child to an ophthalmologist or an optometrist for an exam. 

One issue that’s affecting more and more children is nearsightedness, Nischal says. Caregivers should look out for signs — perhaps the child is holding things up very close to their face or can’t see something in the distance you’re pointing out. 

Nischal says schools provide vision screening, but sometimes the environment for testing isn’t consistent, whether it’s lighting or distance someone is holding a card for them to read. 

“But it’s important that schools continue to do vision screening, because sometimes they do pick up something that’s real, and it’s crucial for that child’s normal education and functional development,” he says.