Note to readers: This is Part 1 in a four-part series this month on kids and vision screenings. Check back later this week for Part 2.
I’d muc
h rather be playing four square at recess, but I’m standing with my scuffed-up KEDS sneakers on the black floor tape, facing the far side of the room. A few of my classmates wait next to me. I tuck my curly hair behind my ears and shift my weight from one foot to the other.
“Alright, Susan. Your turn.” The nurse says without looking up from her clipboard. As instructed, I cover an eye and start reading the chart even though I know the outcome already. Every year I fail it. Every year the school notifies my parents. Every year I think what a waste of time. I visit the eye doctor annually. He does way more testing than reading a chart. Soon, the dreaded vision screening ends. As I leave the nurse’s office, I adjust my thick glasses on my now sweaty nose and hope the other kids won’t make fun of me the rest of the week.
Years passed, but vision screenings last. The tests may uncover problems in areas like eye focus and direction. In America, kids may receive vision screenings at school. Primary care doctors provide them during well baby and/or well child visits. Even some community organizations offer screenings. I’m not a parent, but many of my friends have school-aged children attending pre-K and kindergarten programs, so I asked them about their experiences. Many cited testing at doctor visits or schools. As one friend said, her five-year-old son was, “screened in the nurse’s office at his elementary school.” Sounds familiar.
However, school regulations vary by state, according to this recent NPR Education article. The differences surprised me. For example, Alabama does not require pre-school screenings while Illinois does, but both periodically screen in various school grades. Georgia only requires students to be tested upon entrance to a school system. Wyoming and South Carolina do not require any school screenings. Data shows in Wyoming, the percentage of students screened lands above the median share of all students tested. In contrast, the percentage of students screened in South Carolina falls below median shares. Why does location in the US become a factor in determining if a child is regularly screened for vision issues? Children in school deserve to learn and vision problems can affect a student’s ability to learn. School location shouldn’t be a factor in regular checks, but it is.
Teachers must deal with diagnosed and suspected vision conditions. As educators, some of my friends adapt lessons, observe behaviors and address negative attitudes to encourage learning. One woman who taught a pre-K program in Massachusetts explained, “we learn to pay close attention to the children and take note when we see something that is not typical. When these behaviors present themselves, there are multiple ways to communicate them to the parent. This includes progress reports, parent-teacher meetings and private conversations at drop-off or pick-up. I will always direct the parent to the child’s pediatrician.” Communication fosters attention.
Another friend who worked in mathematics in Pennsylvania and later in Virginia said she received IEP reports notifying her of students with vision impairments. She modified her lessons with, “enlarged print, writing only in white chalk, seating near the board, extended time to read/take notes, etc,” in order to accommodate the needs of her students. It takes time, but the effort is worth it.
It’s not easy to change attitudes though. In America, we have cultural stigmas when it comes to disability and being perceived as different. The desire to blend in can increase when we hit the teenage years. A friend who teaches language courses to high schoolers recounted how one of her students resisted wearing glasses after his parents would not buy him contacts. She felt frustrated as reading without glasses, “would give him headaches. Yet he refused to wear his glasses.” And then there’s the problem of when glasses are lost or broken, and her students “don’t always replace them promptly and some never replace them. ” Unlike the professors at Harry Potter’s fictional wizarding school Hogwarts, American teachers cannot produce materials from thin air.
Within the school system, many children receive vision screenings. This led me to wonder, what if you’re homeschooled? So I talked to another friend who lives in Michigan and teaches as part of a small group of parents in a “hybrid” homeschool program. She said her state does not regulate homeschooling. Instead, she felt since, “everyone is required to have [health] insurance now, and almost all insurance covers well-child visits in full or with very low co-pays, this is probably the best method for vision screening for homeschoolers. Their primary care physician could then recommend further testing if they noticed a problem.”
She’s right. For students outside the regulated school systems, well child visits provide services. The Affordable Care Act, or Obamacare as many people call the legislation President Obama signed into US law in the spring of 2010, mandates that free, preventative care be provided in-network to children. It includes free screenings for conditions like lazy eye (amblyopia) and crossed eyes (strabismus) and refractive errors (near or farsightedness) as well as immunizations and monitoring of developmental milestones. A full list of covered care can be found at the Preventative Care for Children page at Healthcare.gov. Vision screening begin with a well baby visit and more comprehensive eye testing starts at age 3-4.
If a child misses out on school screenings, he or she can be screened by a doctor. But what if reliable, affordable transportation is a problem? Living far from a doctor is not a barrier to service. If the family member qualifies for Medicaid, your state may pay for transportation. Google ‘transportation to doctor visit’ plus ‘State Name’ plus ‘Medicaid’ and review the results. For example, here is the result for Texas. Transportation options exist.
As a kid, school vision screenings embarrassed me. As an adult, I understand the importance and even the privilege of regular screenings. My childhood eye care was not average; most kids don’t travel yearly to an ophthalmologist from the age of 2 and get screened annually like me and my classmates in Pennsylvania. Frankly, some kids in America haven’t been seen by an eye doctor ever. Yikes. Don’t let transportation, school choice or location be a barrier to a vision screening. You live, you learn.
Did you receive vision screenings as a child, and if so, where? What was your experience like at school or at the doctor’s office? Have the children in your life received vision screenings or more comprehensive eye exams? Do you think all kids should be screened for vision issues at a certain age? Tell me about it.
In the next part of my kids and vision screening series, I’ll share how a primary care doctor discovered a possible vision issue in 9 month old child during a well baby visit. Also, I’ll explain how you can identify the problem, too.
Adventures in Low Vision 
What a coincidence! My family member and I were just discussing this very thing over the weekend. We both attended the same elementary school years apart. We both got yearly hearing and vision screenings but our understanding now is that the same school no longer does any screenings. I found this very sad. So many vision and hearing problems can be dealt with if caught early. I figure it is about money. The good news is that for poor children there are some screening programs available along with transportation if needed. I remember when every school in the area had a nurse and now one nurse must divide his or her time among several schools.
Cuttings costs leaves out services for kids.
I remember being tested in elementary school. Though I barely saw the chart, I memorized 0 f l c 3, which was the 20/20 line, and also the big E. In 5th grade, a savvy nurse asked me to tell her what the 2nd line said. I couldn’t do it.
One of the thing that doctor’s didn’t take into account was that a growing child may have better vision at one time and worse vision at another. But my vision was so bad that we weren’t talking about 20/30 vs 20/20. It was 20/200 and, thus, not up for discussion. Back then, parents didn’t want to put glasses on a child (“boys don’t make passes at girls who wear glasses”) and it wasn’t until 7th grade that my parents took me to an eye doctor for my first pair of glasses.
We had a yearly hearing test, too. One of the girls had so much wax in her ears, the nurse had to dig it out. She was laughed at by the students about it for weeks. That’s the downside of having so many kids in one room when doing testing.
You were sneaky to memorize the line on the chart! And you included details so well I’m cringing a bit now like I just witnessed that hearing test. Ew.
As floridaborne mentioned, having all the kids in the room as the exams were done definitely leads to plenty of teasing. I would hope nowadays we would be a little more sensitive to privacy. Kids can be so cruel.