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Get children’s eyes tested, limit screen time, experts say

Dr. Karen Judy, pediatrician at Northwestern Central DuPage Hospital, using photoscreening technology to examine the eyes of Kallie Johnson, 4, of Aurora. | Northwestern Medicine

With a new school year fast approaching, parents should ensure they get their children’s eyes checked — by the pediatrician.

It’s also important to limit children’s time in front of a smartphone or computer screen, and to make sure they spend at least an hour outdoors each day equipped with sunglasses and floppy hats, say Chicago pediatricians, optometrists and pediatric ophthalmologists.

“To have new experiences, children must look beyond their fingertips,” said Dr. Eileen Gable, an associate professor in the ophthalmology department at Loyola University Medical Center.

Gable bemoaned that children are so glued to their electronic devices, they’ve closed off the world around them — to the detriment of their vision.

“They’re not developing good spatial relationships – the depth perception you need to navigate the world,” she said. “Visually, that’s not good. A three-year-old needs to learn how to see – by looking ahead, not just at their device.

Parents should stay alert to subtle cues, too, such as making sure there’s no white in the pupil of a child’s eye.

“Five to 10 percent of pre-schoolers have vision problems,” said Dr. Karen Judy, a veteran pediatrician who works at Northwestern Medicine Central DuPage Hospital. “We want to identify kids (with eyesight problems) long before they go to school so they can learn, pay attention and get the most from their environment.”

At least 25 percent of school-age children have vision problems, according to the American Optometric Association.

A major leap in detecting children’s eye health and preventing early damage is called ocular photoscreening. It lets pediatricians use an iPhone loaded with software to identify vision abnormalities after the camera’s flash is reflected back from a child’s retina.

Pediatricians can use an iPhone loaded with software to identify vision abnormalities| GoCheck Kids
Pediatricians can use an iPhone loaded with software to identify vision abnormalities| GoCheck Kids

Families should ask for photoscreening for babies starting at 12 months and continuing through age 5, according to guidelines by the U.S. Preventive Services Task Force, a volunteer panel of national experts in disease prevention and evidence-based medicine. The technology, which shows a discoloring of a typical photo “red eye” to indicate a problem, is endorsed by the American Academy of Pediatrics.

One of photoscreening’s values is that it uncovers eye problems in infants and toddlers too young to know their letters and numbers or to recognize or tell anyone if something’s wrong with their eyesight.

The technology has another positive outcome: It’s stemming a controversy over what some pediatric ophthalmologists – including those at Lurie Children’s and Cook County Health and Hospitals System — say is some optometrists’ over-prescribing of children’s eyeglasses.

Dr. Lisa Thompson, director of pediatric ophthalmology at Cook County HHS, which includes Stroger Hospital, says a decade-old Illinois law requiring children to get eye exams before they are allowed to enter kindergarten has led optometrists to put profits first by over-prescribing eyeglasses.

The law opened the floodgates for children to visit optometrists, who outnumber pediatric ophthalmologists by a 15-to-1 ratio, charge less for their services and require no pupil dilation for exams, Thompson said. Ophthalmologists have medical degrees; optometrists, who offer services at retailers and eye-care stores such as Costco, Target and Pearle Vision, have four-year professional degrees.

“I’ve taken more 5-year-olds out of glasses than I’ve put into glasses (as a result of the mandatory exam law),” Thompson said.

The American Academy of Pediatrics recommends children who fail a vision assessment or who have a vision abnormality should be referred to a pediatric ophthalmologist or to an eye-care specialist trained to treat pediatric patients.

The head of the American Optometric Association, Dr. Samuel Pierce, says every recent and credible study cites the essential role of doctors of optometry in addressing children’s visual health — a significant and growing public health concern.

As a new school year fast approaching, parents should ensure they get their children’s eyes checked — by the pediatrician.
As a new school year fast approaching, parents should ensure they get their children’s eyes checked — by the pediatrician.

Parents will have to ask their pediatrician whether Medicaid or an employer’s insurance covers the photoscreening technology.

Yet the typical charge — $40 to $60 — proved invaluable for Wheaton resident Jill Baer.

The third of Baer’s four children — 5-year-old Ethan — was diagnosed at age 3 with a serious eye deficiency through photoscreening.

He showed no symptoms; his pediatrician found the problem during a regular yearly checkup.

“He could have lost a significant amount of vision had he not gotten checked (with the photoscreening technology),” Baer said. “He would have probably lost most or all of his vision in his left eye as his right eye tried to compensate.”

The day Ethan put on his glasses, his jaw dropped, his mom said.

“It was the first time he saw clearly,” she said. “He doesn’t complain about wearing them. We even got prescription goggles for swimming.”

Though parents may suspect that their child’s eyesight can be harmed by staring at a video screen, no research has conclusively shown that children’s viewing of computer or smartphone screens hurts their eyesight, the experts said.

But the American Academy of Pediatrics recommends children ages 2 to 5 be limited to one hour of screen-viewing time each day. For children older than five, the pediatrics guidelines call for families to establish “media-free” times, such as while driving, at family dinners and a few hours before bedtime, and screen-free zones, including in children’s bedrooms. The Canadian Ophthalmological Society recommends that children up to 2 years old use no screens at all.

On the other hand, Chinese research has shown that one hour of outdoor activity each day, year-round, leads to a 9 percent decline in children’s likelihood to suffer near-sightedness, said Dr. Marilyn Mets, head of the ophthalmology division at Lurie Children’s Hospital.

Even in Chicago’s bitter winters and violent neighborhoods, parents should try to take their children to a park or the lakeshore when possible, even if for a couple hours during summer weekends, the doctors said.

Parents and caregivers can also beware of these other signs of children’s vision problems:

  • Drooping eyelids.
  • Squinting or itching or rubbing eyes.
  • Sensitivity to light.
  • Tearing up or discharge from the eyes.
  • Inward crossing or outward drifting of the eyes after age four months.
  • Inability to maintain steady eye contact or to track or follow an object after age three months.
  • Redness in either eye that remains for a few days.
  • Quick eye fluttering from side to side or up and down.
  • Inability to see traffic signs or directional signs before the parent does while riding in the car.