Preschool Vision and Hearing Services

Little children do not know how well they should be able to see. Therefore, they cannot express any vision difficulties they may be experiencing. The BCABVI conducts a preschool vision screening program to locate, at the earliest possible age, children who may have vision problems. These children are referred for a complete eye examination and recommended treatment so they may begin their formal education with the best possible sight. We screen for visual acuity and for amblyopia.

Visual acuity of preschool children cannot be measured in a manner appropriate for adults since, with few exceptions, they are not yet able to read. A method has been devised that uses a symbol chart. The chart used by the BCABVI has an "apple", a "house" and an "umbrella since these are symbols easily recognized by preschool children. The symbols on the chart are exposed one at a time for the children to identify. To put the children at ease, the children are told that this is a game.

The preschool program focuses on children age 3-5.

Signs of Possible Eye Trouble in Children

If your child shows one or more of these signs, he or she should see an eye doctor without delay.

Appearance
  • Crossed or misaligned eyes
  • Red-rimmed, encrusted or swollen eyelids
  • Inflamed or watery eyes
  • Recurring sties (infections) on eyelids
  • Presence of white pupil in color photo
Behavior
  • Rubs eyes excessively
  • Shuts or covers one eye
  • Tilts head or thrusts head forward
  • Has difficulty with reading or other close-up work; holds objects close to eyes
  • Blinks more than usual or is irritable when doing close-up work
  • Is unable to see distant things clearly
  • Squints eyelids together or frowns
Complaints
  • Eyes itch, burn or feel scratchy
  • Cannot see well
  • Dizziness, headaches or nausea following close-up work
  • Blurred or double vision

A professional eye examination for every child, including those who do not show any signs of eye trouble, is recommended shortly after birth, at 6 months of age, before entering school Cage 3 or 4], and periodically throughout the school years. Regular eye exams are important, since some eye problems have no signs or symptoms.

Children's Eye Problems
  • Amblyopia (Lazy Eye) An eye that does not see clearly, even with corrective lenses and even though it has no disease, is said to be "lazy" or amblyopic. Amblyopia occurs mainly among children who have a different amount of farsightedness or nearsightedness in one eye than in the other. Strabismus (see below) is another common cause of amblyopia.
  • Astigmatism Astigmatism results primarily from an irregular shape of the front surface of the cornea, the transparent "window" at the front of the eye. Persons with astigmatism typically see vertical lines clearer than horizontal ones, sometimes the reverse.
  • Color Vision Deficiency (Color Blindness) Children with so-called "color blindness" are not blind to color but have difficulty identifying certain colors.
  • Hyperopia (Farsightedness) With this condition, the eyeball is too short for the normal focusing power of the eye. Therefore, images of near objects may appear blurred.
  • Myopia (Nearsightedness) With myopia, the eyeball is too long for the normal focusing power of the eye. As a result, images of distant objects appear blurred.
  • Strabismus Strabismus is a misalignment of the eyes that prevents them from looking at the same object together.
What is Amblyopia?

Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. It is sometimes called "lazy eye."

When one eye develops good vision while the other does not, the eye with poorer vision is called amblyopic. Usually, only one eye is affected by amblyopia.

The condition is common, affecting approximately 2 or 3 out of every 100 people. The best time to correct amblyopia is during infancy or early childhood. Parents must be aware of this potential problem if they want to protect their child's vision.

How does normal vision develop?

Newborn infants are able to see, but as they use their eyes during the first months of life, vision improves. During early childhood years, the visual system changes quickly and vision continues to develop.

If a child cannot use his or her eyes normally, vision does not develop properly and may even decrease. After the first nine years of life, the visual system is usually fully developed and usually cannot be changed. The development of equal vision in both eyes is necessary for normal vision.

This is why amblyopia must be detected and treated as early as possible.

When should vision be tested?

It is recommended that all children have their vision checked by their pediatrician, family physician or ophthalmologist (medical eye doctor) at or before their fourth birthday.

Most physicians test vision as part of a child's medical examination. They may refer a child to an ophthalmologist (a medical eye doctor) if there is any sign of an eye condition.

New techniques make it possible to test vision in infants and young children. If there is a family history of misaligned eyes, childhood cataracts or a serious eye disease, an ophthalmologist can check vision even earlier than age three.

What causes Amblyopia?

Amblyopia is caused by any condition that affects normal use of the eyes and visual development. In many cases, the conditions associated with amblyopia may be inherited. Children in a family with a history of amblyopia or misaligned eyes should be checked by an ophthalmologist early in life.

Amblyopia has three major causes:

  • Strabismus (misaligned eyes) - Amblyopia occurs most commonly with misaligned or crossed eyes. The crossed eye "turns off" to avoid double vision and the child uses only the better eye.
  • Unequal focus (refractive error) - Refractive errors are eye conditions that are corrected by wearing glasses. Amblyopia occurs when one eye is out of focus because it is more nearsighted, farsighted or astigmatic than the other. The unfocused (blurred) eye "turns off" and becomes amblyopic. The eyes can look normal but one eye has poor vision. This is the most difficult type of amblyopia to detect and requires careful measurement of vision.
  • Cloudiness in the normally clear eye tissues - An eye disease such as a cataract (a clouding of the eye's natural lens) may lead to amblyopia. Any factor that prevents a clear image from being focused inside the eye can lead to the development of Amblyopia in a child. This is often the most severe form of amblyopia.
How is Amblyopia diagnosed?

It is not easy to recognize amblyopia. A child may not be aware of having one strong eye and one weak eye. Unless the child has a misaligned eye or other obvious abnormality, there is often no way for parents to tell that something is wrong.

Amblyopia is detected by finding a difference in vision between the two eyes. Since it is difficult to measure vision in young children, your ophthalmologist often estimates visual acuity by watching how well a baby follows objects with one eye when the other

How is Amblyopia treated?

To correct Amblyopia, a child must be made to use the weak eye. This is usually done by patching or covering the strong eye, often for weeks or months. Even after vision has been restored in the weak eye, part-time patching may be required over a period of years to maintain the improvement. Glasses may be prescribed to correct errors in focusing. If glasses alone do not improve vision, then patching is necessary.

Amblyopia is usually treated before surgery to correct misaligned eyes, and patching is often continued after surgery as well.

Children do not like to have their eyes patched, especially if they have been depending on that eye to see clearly. But as a parent, you must convince your child to do what is best for him or her.

Successful treatment mostly depends on your interest and involvement, as well as your ability to gain your child's cooperation. In most cases, parents play an important role in determining whether their child's amblyopia is to be corrected.

If the problem is detected and treated early, vision can improve for most children. Sometimes part-time treatment may have to continue until the child is about nine years of age. After this time, amblyopia usually does not return.

If you have additional questions or would like any further information, contact your eye care specialist.

Hearing Screening

The major goal of hearing screening conducted by the Bucks County Association for the Blind and Visually Impaired is to locate children with possible hearing impairments. Results of hearing screening programs have shown that from 5% to 10% of children who are tested do not pass the hearing test. The majority of these children are in need of medical treatment, not necessarily for a hearing loss, but for an ear infection.

Listening and talking are so much a part of us that we very seldom consider the implications of not being able to hear. The most serious effect of a hearing loss is the interference with communication between persons. In a child, some of the consequences may be:

  1. Interference with normal speech and language development;
  2. Development of abnormal social growth and behavior;
  3. Interference with education;
  4. Development of problems of adjustment in the child and his family.

A child's behavior in the classroom may indicate the possibility of a hearing loss. The child may be inattentive or may ask for frequent repetitions. The reported observation of such behavior by the teacher will assist in identifying children in need of help.

If you operate a preschool program and would like to be added to the schedule, please contact us. If you are a parent of a pre-schooler, ask your school director to call us at 1-800-472-8775 .