May 20, 2015

“Do you know how well your kids can see? Are you sure?"

"I’m a mother of three with access to top pediatricians and a network of neurotic moms, yet I was never advised to get my children’s eyes checked. Last summer I took my 4-year-old to an optometrist with an air of confidence that I was just being overprotective. Much to my sickening surprise, he could barely see, as it turns out. One of his eyes was giving up, a nonreversible condition if not caught early. My son’s eyes lit up when glasses were put on and he could see properly. (Insert mom guilt.) His whole demeanor changed; he would cry, scream and nap a lot until that point. We had taken him to many specialists, and no one had suggested that we get his eyes checked...."

A letter to the editor of the NYT in response to an op-ed titled "Kids Who Can’t See Can’t Learn." The op-ed, by an ophthalmologist, stressed the need for getting free vision screening and free glasses to less affluent children. The letter writer's point is that even where there is excellent access to health care, a child's vision may go uncorrected for too long. I wonder how many specific health problems in children go untreated because we expect random misbehavior and orneriness from them.

46 comments:

SJ said...

My parents took me from traditional school when I was 8 years old.

They brought me home, so that my Mother could educate us at home. ("My mom? She is teacher and administrator at a small, selective academy for the gifted.")

Two years later, my Mom saw me walking across the room to read something that she'd posted on the wall.

So she had my eyes checked.

It was nothing serious. Just that I had become short-sighted during those two years.

MadisonMan said...

I *still* remember the exhilarating feeling in 5th grade when I put on my glasses for the first time.

Asking kids if they can see things is the best way to test for vision, in my experience. Road signs, especially, because what else can you do while driving with them?

MadisonMan said...

Let me just add that this line:

yet I was never advised to get my children’s eyes checked

jumped out at me.

A parent should never be relying on the advice of others for what is best for their kid. Trust your instincts.

Maybe I write that as the chief worrier, and I'm often catastrophizing what might be happening to my kids. Still....

Ignorance is Bliss said...

I wonder how many specific health problems in children go untreated because we expect random misbehavior and orneriness from them.

I wonder that about a number of our commenters.

GRW3 said...

Our son nearly died. We had been having "issues" with him in school and elsewhere. We had been going to a variety of specialists to try and find out what was going on. The helpful people at school kept pushing Ritalin as the answer, to the point of calling CPS, Texas's Child Protective Services, on us because we would not comply. Then, one Saturday, he went into a coma.

Turns out he was a Type 1 diabetic. The doctor who saved him, a nationally known juvenile diabetes expert, said on a scale of 1 to 10, with 10 being dead, he was at 8. It was a rough go. That was twenty years ago.

We're not medical professionals but, dammit, that school nurse who instigated calling CPS on us should have been trained in the warning signs for juvenile diabetes. I should have sued the school district...

So it is important to check off all the boxes. This was another behavioral problem with non psychological roots. As his pancreas failed intermittently, he would act out. When it quit completely, he nearly died.

On a personal note, I had/have vision problems as a kid. The practice, in the '50s, was group testing. Well my right eye was good so I would just memorize the eye chart. Make sure any test to which your kids are subjected cannot be gamed by their natural cleverness.

MayBee said...

My son got glasses at 4 because his pediatrician gave him a routine vision test.
It's hard much before that, because kids don't always know what they do see vs. what they are supposed to be seeing, and their communication isn't fine-tuned enough to tell us.

This is a normal part of the annual check up, no?

rhhardin said...

My Doberman watches hawks.

Skyler said...

Madison Man has it right. This is another NYT mommy article designed to foster guilt and simultaneously superiority in mommies. Any parent that doesn't do simple things, like being aware of whether their child can see somewhat clearly, is a moron.

It's not the school's or the givernment's job to diagnose your kid.

Harold said...

The day that I showed up at school in my new glasses was the day my Algebra grades tanked. Up to that point I was so near sighted I had to sit in the front row and even walk up to the overhead projector to see the examples, because everything was fuzzy I had no choice but to pay attention to everything the teacher said and take notes. The glasses let me sit in the back with the gathering of hoods I called my friends and my days as an A level math scholar were gone for good.

Larry J said...

I remember getting free vision screening in the first grade, and that was 1963 rural Alabama. I have no idea if they still do that. The eye chart didn't consist of the normal letters but instead a capital "E" turned in different directions. We pointed which direction the "E" pointed, which let kids who couldn't yet read get their eyes tested.

There are new techniques such as retinoscopy that can test the ability of very young children to focus their eyes. All children should have their vision tested and it can begin as young as 6 months.

I do have a quibble about one statement in the article. Children that have vision problems or who are blind can learn. They do have a harder time of it but they can most definitely learn.

exhelodrvr1 said...

Teachers should also be trained on what signs to look for.

Skyler said...

Of course I meant to say "government" but maybe givernment Is more apt.

MayBee said...

Of course I meant to say "government" but maybe givernment Is more apt.

genius

MayBee said...

My son's pediatrician's eye chart had simple bold drawings like, a cake, a flag, a hand,

This was in midsize city, USA. I can't believe this isn't a normal part of a well child check up. It is, right?

Sebastian said...

"I was never advised"

Didn't Adam say that somewhere?



Deirdre Mundy said...

Most eye-doctors don't want to see the kids before 5 or 6 unless the parents notice problems. (Extreme clumsiness, etc.)

And... if kids are INSIDE more, it's harder to notice. My 9 year old can't see a bird across a field or the soccer ball w/o her glasses (we noticed her eyes had taken a bad turn with the last growth spurt when we were hiking and my normally observant child couldn't see the birds and deer). But, her eyes are good enough that she can read, write, do chores, play on a tablet, etc.....

I'm guessing that in a world of increasingly sedentary and screen-timed kids, more bad vision will go uncaught.

(We were on the lookout with my daughter, because the 9 YO growth spurt is where my eyes turned bad and my husband's eyes turned bad and her sister's eyes turned bad. So.... we had family history on our side!)

Martha said...

Parents somehow do not recognize what is right before them. I was 2 years old when my godfather advised my parents to take me to an ophthalmologist. My parents were initially offended at the suggestion their child was less than perfect. I was farsighted which is relatively rare. I also had strabismus known as lazy eye. My first ophthalmologist missed that diagnosis so the strabismus was not treated until I was 7 years old and the vision in one eye almost lost. As a result I do not have binocular vision.

I had my children checked by a pediatric ophthalmogist
at 9 months of age. Strabismus must be treated early to maintain binocular vision and parents are not trained to pick up subtle problems with binocular vision.

DKWalser said...

Our older two children were born with a problem that prevented their eyes from working together properly. We didn't catch the issue until my wife noticed that the younger of the two wasn't looking at her with both eyes. He was almost five. The issue was surgically corrected.

Neither will ever have "proper" depth perception. Their brains learned to discern depth by other cues. This allows them to drive and participate fully in most activities. Just don't ask them to play the outfield. They can line themselves up with the ball, but have no clue (until it's too late) whether the ball will fall in front of them or go over their head.

Both had regular exams by their pediatrician. Had my wife not noticed our son staring in two different directions, the issue might not have been caught until much later.

Michael K said...

"'m guessing that in a world of increasingly sedentary and screen-timed kids, more bad vision will go uncaught."

It's not just a matter pf "caught." We are in the midst of an epidemic of myopia. (nearsightedness)

Myopia isn’t an infectious disease, but it has reached nearly epidemic proportions in parts of Asia. In Taiwan, for example, the percentage of 7-year-old children suffering from nearsightedness increased from 5.8 percent in 1983 to 21 percent in 2000. An incredible 81 percent of Taiwanese 15-year-olds are myopic. If you think that the consequences of myopia are limited to a lifetime of wearing spectacles—and, let’s be honest, small children look adorable in eyeglasses—you are mistaken. The prevalence of high myopia, an extreme form of the disorder, in Asia has more than doubled since the 1980s, and children who suffer myopia early in life are more likely to progress to high myopia. High myopia is a risk factor for such serious problems as retinal detachment, glaucoma, early-onset cataracts, and blindness.

It's not just Asia. In the US myopia has doubled in the past 50 years.

Bob Ellison said...

Start by doing away with the pathetic, guild-favoring, price-raising, child-hating American ban on eyeglass re-use.

Birches said...

Asking kids if they can see things is the best way to test for vision, in my experience. Road signs, especially, because what else can you do while driving with them?

That's what we've always done as well. My spouse is probably legally blind without his glasses, but so far, all of our kids see really well.

My daughter just had her 4 year old check up. They did the eye chart test with symbols. So yes, it happens.

Jenny said...

I am significantly nearsighted so have been on the lookout for vision problems in my kids from the beginning.

Mine have had an eye exam at the pediatrician from the beginning and any deviation from perfect vision was always treated by the nurses as 'kids being kids' rather than a signal of a further problem. Relying on the ped nurse to refer you is not a good idea.

I brought them on my own accord to the eye doctor and both my two oldest are significantly farsighted. They would have been diagnosed sooner except, their vision problem being the exact opposite of mine, I couldn't pin down exactly what to ask them to tease out the problem.

Martha said...

Not having depth perception also limits career choices--for example I was discouraged from becoming a surgeon. Everything else I did with aplomb including playing tennis though sometimes when stressed I do see double and reach for the wrong image of an object. That is unsettling. The DMV does test for binocular vision but it is easy to fool the test. I have driven since I was 17 and have never caused a car accident.

Michael K said...

"for example I was discouraged from becoming a surgeon. "

A guy I knew in residency was discovered to have amblyopia, the suppression of vision in one eye because of eyes that are not exactly parallel fields, and he shifted to plastic surgery and had a pretty good career. Not as much depth perception in that field. He was unaware of his problem until the second year of his surgery residency.

That is why kids with tropias (cross eyes) have their eyes patched alternatively until the corrective surgery is done. It should be done by age four. My daughter had two surgeries at ages 18 months and about four.

Mild problems, called "-phorias" can be corrected by the brain and are only found in testing.

Petunia said...

"Ophthalmologist".

Tari said...

I had a friend this happened to. Her younger son had some behavioral problems and his private school wanted him out (this particular school solves its "problems" that way - they wanted my boys out as well). His parents sent him to another private school that specializes in learning disabilities, on the advice of the first school. During his first year there, the teachers helped figure out what was really going on. I'm not sure exactly what the eye problem was - I know it wasn't simple near- or far-sightedness - but most of the problems he was having disappeared when his vision was corrected. He's been in public school and doing fine ever since.

I think most of the problem was caused by the first private school scaring the parents half to death with their speculative diagnoses of what was wrong. The same school misdiagnosed my boys with a host of imagined problems, and ignored the one thing they were struggling with. If I'd trusted them and their hare-brained advice, who knows what problems would have been created. But when you're paying a small fortune to these "experts" to educate your kids, and they come to you with all this serious stuff, many parents feel they have to believe.

Seeing Red said...

Don't schools do that anymore?

Gabriel said...

@Bob Ellison:Start by doing away with the pathetic, guild-favoring, price-raising, child-hating American ban on eyeglass re-use.

I've never heard of this ban so I'm not sure what it refers to.

But if you want to give glasses from one child to another, and you do not know the prescription, then the cost of determining the prescription from the lenses is higher than just having new lenses made.

Gabriel said...

There are machines for testing the eyes of infants and toddlers--the principle is similar to the autofocus on a camera. They usually have to put atropine drops in first because you can't make babies and toddlers look at the wall long enough.

Ann Althouse said...

@Petunia

Thanks.

Even when you know there are spelling pitfalls in that word, there are other pitfalls, too many really. It's a ridiculous word!!

Gabriel said...

@Tari:But when you're paying a small fortune to these "experts" to educate your kids

Almost no one teaching in primary education is "expert" in anything.

As P. J. O'Rourke said (rather more coarsely) anyone who's dated an elementary ed major knows what's wrong with the schools.

CatherineM said...

At my grade school in the 70s we had hearing tests and eye chart reading every year. I loved it. They also checked weight, height and for scoliosis and (seasonally) for lice. I had a lisp (caught by saying Massachusetts in 3rd grade) that was corrected by 2 Sessions a week where I played go fish with cards with lots of S words with a few other kids and the therapist. It was great.

Surprised that's not standard.

Gabriel said...

@Catherin M.Surprised that's not standard.

I had the same testing when I went to school. I don't know how widespread it is, but one reason it shouldn't be standard is because of the high number or false positives generated by testing such large numbers of people.

Kyzernick said...

I was tested in 1st Grade and 2nd Grade. I went to schools in the rougher parts of Schenectady, NY, and was definitely not well-off. Everyone got tested for vision, and some people would get extra testing if problems developed. I had trouble with hearing the difference between letters like B and D - turned out, I had severe earwax buildup. After having them chemically cleaned, it was like I was hearing things for the first time. It never recurred - the buildup must have been a freak happenstance and had to have happened gradually. By the 6th grade, my teacher noticed that I was squinting "just a little" in class, so my parents took me to get my eyes checked and sure enough, I needed glasses (though just barely, and was told that I could take them off outside of school). I liked how they looked on me, so I just kept them on.

Best part about new glasses as a kid? Being able to pick out the individual branches at the tops of trees that are almost a mile away.

Tari said...

@Gabriel, oh, they weren't experts in anything, but they certainly presented themselves as such! I think if someone doesn't naturally have a suspicious mind and innate distrust of authority, they would buy into what these folks were selling. I know many folks did. In fact, when we were in our final year at that particular school, I had parents tell me not to raise the issues I had, because the school would "take it out on my children" if I did. This was said with a straight face, as if it were normal to not question authority and let people do as they wished with your children. Surreal.

Babaluigi said...

Something of the Indian parable of the blind men trying to describe the elephant comes to mind...how can a child express the shortcomings of their vision if they do not understand the wholeness of what it is they are supposed to be seeing?... We moved several times (in the 90's) and cycled through 3 pediatricians, but a little eye chart was always part of the wellness exams. Their vision changed very rapidly, though, and it became apparent the youngest was having trouble seeing. The oldest one was the real shocker, his nearsightedness was actually worse!

...one of the times I felt I had truly failed as a parent was when we got outside with the glasses and the oldest said, "Wow! I can see the leaves on the trees!" GUILT GUILT GUILT

richardsson said...

Yes, for heaven's sake, every child should have an eye exam by an ophthalmologist. Children don't know if they have bad eyesight, how would they? My mother, who had 20/15 vision couldn't get it through her head that I didn't.

I didn't have regular eye exams and glasses full time until I was in the third grade. My reading ability went from 2nd Grade to 12th Grade in one year. But, my math never recovered. It was crazy, I could do long division and algebra but I couldn't correctly add a column of numbers. Nor could I spell. At 30, I nearly went blind in my right eye. I went to Jules Stein at UCLA and they restored my vision. At 59, I had cataract surgery in both eyes and now I'm 20/15, but I do require readers.

Delayna said...

"It's not just Asia. In the US myopia has doubled in the past 50 years."

Is that because of more sedentary lifestyles/tv/computers?

Rockport Conservative said...

I too remember the day I got my first glasses. My twin and I were excellent readers with no reason to suspect we could not see far. Texas started checking basic vision that year. We were so near sighted and had never known what other people were seeing. We lived in the middle of oil fields in West Texas and had never seen an oil derrick. This was 1946, they were everywhere. We did not know other people could see individual leaves on trees or blades of grass.
I had cataract surgery 5 years ago, for the first time I could see those things without glasses, imagine it. The downside of that - I could no longer read up close, I had to have readers to read. After almost 70 years the brain takes a while to adjust to that change!

Michael K said...

" I had trouble with hearing the difference between letters like B and D - turned out, I had severe earwax buildup."

My oldest daughter, the same one with two eye muscle surgeries, had speech problems when she was little that were cured by cleaning her ears.

She also had a trigger thumb that I did not recognize until we had an orthopedist friend over for dinner one night. He immediately recognized it and my wife took her to Children's Hospital where the meds arthropod told all his students that this was a are case of "neglected trigger thumb." Humiliating.

Sje is now a lawyer so the harm was permanent.

The causes of myopia are under study. One theory is constant close vision focus. Chinese kids in Australia had much much less myopia than kids in Singapore. Something like 6% compared to 25% at the same age. The Australian kids spend much more time outdoors. About 20 hours a week compared to about 3.

Maybe that effect is a distance focus issue but China is building classrooms with translucent walls to let daylight in. They can't get the parents to send the kids outside more.

Michael K said...

"the Peds orthopod told all his students that this was a rare case of "neglected trigger thumb."

Interesting autocorrect changes.

I've never known a pediatric arthropod.

spaz said...

Golly. I'm also a mother of three with access to top pediatricians and a network of neurotic moms. My children are almost grown up now, but from the time they were in pre-school they had annual vision screening at school and at their annual well-child checks. Our pediatrician, as well as the opthalmologist my husband and I see, recommended that children be seen by an opthmalmologist between the ages of four and six, so we took each of them to a pediatric opthalmologist (not an optometrist)for a screening as well.

Unknown said...

I was fitted with glasses at age 2. Fuck this bitch, hard. Yes lady you're a shit mom.

MaxedOutMama said...

Regarding your last sentence, a lot.

Hearing, blood sugar fluctuations, eyes - a lot! Kids below five often don't really know they are sick - they just know they are miserable.

But part of the problem is that children of that age don't have the same expectations and perspective that we do, much less the ability to understand that what they are experiencing is not normal, even more true with chronic conditions.

MaxedOutMama said...

GRW3 - I wrote my comment before I read yours, but precisely.

You see little kids who go into hyperglycemia - hypoglycemia very quickly without a lot of symptoms. It shows up first as a "behavioral" issue.

Before accepting a diagnosis of ADHD or the like, or accepting behavioral medication, a FULL physical workup is always necessary.

When I was going to school, we had vision and hearing tests routinely each year, plus growth measurements. Also TB tests.

I think we should be doing that on a standard basis. Our schools had school nurses and they worked.

Jameson Campaigne said...

Boys (only) from hunting and fishing cultures are often far-sighted. From East Africa, Scandinavia, some of the mountain regions of Europe, for example.

The great fighter pilot Chuck Yeager (which means "hunter" in German) has 200 over 20 vision, meaning he easily saw most of his opponents long before they could see him.

There were clinics established by a Scandinavian magnate in New York many decades ago--the name of which I forget at the moment-- to deal with this.

A vast program to deal with this was established in Indianapolis in the 1950s, collecting used eyeglasses and optometrists and opthamologists offering free eye exams as part of a private civic initiative.