New guidelines urge better eye screening for preschoolers

WASHINGTON -- Few preschoolers have their eyesight thoroughly checked, although up to 20 percent have some eye problem that, if uncorrected, could delay learning or even cause permanent vision loss.

New guidelines are urging pediatricians and health workers to better screen children under 5 for lazy eye and other disorders -- even as a major study of preschoolers' vision shows many of those screening tests are far from perfect.

It's part of a growing debate over whether all youngsters should see an eye doctor before starting school, or whether improving routine vision screening could spot more tots who need help.

"It's a very touchy topic," says Dr. Susan Taub, a Northwestern University ophthalmologist who chairs the Better Vision Institute. "The key message is kids are getting lost in the system the way it exists."

Until the controversy's settled, she advises parents to watch for warning signs, even when playing peek-a-boo with babies, to help ensure their children's eye problems aren't missed.

Youngsters born with nearsightedness, farsightedness, focus problems or lazy eye seldom complain because they have no way to know they're not seeing properly. To parents, symptoms can be subtle.

Yet the earlier vision problems are corrected, the better -- and if lazy eye in particular isn't fixed soon enough, one eye becomes blind. Plus, vision and learning are inextricably linked. Some studies suggest 80 percent of children who have trouble reading have eyes that don't properly coordinate or focus.

About 15 percent of preschoolers receive a comprehensive eye exam, the kind done by eye doctors that usually involves dilating the eyes. One state, Kentucky, requires such an exam to enter school.

Vision screenings to spot signs of eye problems are offered by pediatricians, schools and volunteer groups, but the National Eye Institute says few preschoolers get screened.

Guidelines issued last month urge pediatricians and other primary care providers to do more by making age-appropriate vision screenings part of regular checkups for every child under 5.

The advice from the U.S. Preventive Services Task Force, a government-appointed group, reflects evidence that more problems may be detected early if children are checked more often, starting as babies, says Dr. Ned Calonge, the task force chairman.

Here's the rub: No one yet knows which of 11 commonly used screening tests work best, says Ohio State University optometrist Paulette Schmidt.

She's heading a major study, funded by the federal eye institute, to compare vision screening with comprehensive eye exams in several thousand 3- to 5-year-olds enrolled in Head Start programs in five cities.

Early results, published in April, are startling: The best four screening tests detected only two-thirds of eye disorders in children -- when the screenings were performed by pediatric eye specialists.

Which worked best? The Lea symbols eye-chart, where preschoolers, using one eye at the time, identify such symbols as a square or circle; retinoscopy, where vision is measured based on light reflection; and two handheld machines, the Retinomax Autorefractor and SureSight Vision Screener.

The Vision in Preschoolers study didn't examine how well different tests worked in combination, Schmidt cautions, which could increase accuracy.

More importantly, vision screening seldom is done by eye professionals. So the study's next step is to see how effective screening tests are when given by nurses or volunteers. Those results are due next year.

Meanwhile, many eye-doctor groups continue to urge a comprehensive eye exam by age 3 even as other organizations work to improve vision screenings.

Regardless, "check your kids' eyes at home," Taub advises.

Watch for vision warning signs, including: an eye that slightly turns in or out; squinting; closing one eye or turning the head when focusing; avoiding coloring or books; and clumsiness or becoming easily frustrated during play or, for older children, study. Parents noticing any of these symptoms should have their child examined by an eye professional.

"I tell all my moms to play peek-a-boo" to check for lazy eye, the disorder most easily missed, Taub says. Watch if the baby responds equally when one or the other eye is covered.

If your child gets vision screening, ask what test is being used, adds Schmidt.

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EDITOR'S NOTE -- Lauran Neergaard covers health and medical issues for The Associated Press in Washington.