Experts say eye exams performed at schools can catch vision problems early. Catherine Falls Commercial/Getty Images
  • Experts say at-home learning during the COVID-19 pandemic is limiting at-school eye exams for children.
  • They say vision problems may be going unchecked due to the lack of exams.
  • They note that additional screen time from remote learning may be making the problems more serious.
  • Experts say there are apps that can be used to measure a child’s basic vision. They also urge parents to encourage children to take breaks from looking at screens.

COVID-19 related homeschooling is creating some less obvious disadvantages for students than lack of socialization, routine, and direct contact with teachers.

It’s also taking schools out of the loop when it comes to giving children basic health screenings, such as those for vision.

“School provides children with much more than the obvious tools for learning and social and emotional development,” Dr. Hela Barhoush, a pediatrician at One Medical in New York City, told Healthline.

“School is oftentimes the place where learning and hearing deficits are first identified, as well as issues with mental health, substance abuse, and child and adolescent abuse,” she explained.

“Additionally, screening tests such as vision testing and scoliosis exams are typically performed on an annual basis by school nurses,” Barhoush added.

“Virtual schooling runs the risk of delaying the diagnosis of child health issues, many of which early diagnosis and treatment is important for optimal prognosis,” she said.

In March, the Centers for Disease Control and Prevention (CDC) recommended people postpone routine eye and dental exams and instead prioritize visits to urgent care or emergency rooms, if necessary, to minimize exposure between patients and personnel in doctors’ offices.

Those guidelines have since been rolled back.

The importance of eye exams

School shutdowns have eliminated an effective way for parents to provide children with basic eye screenings.

“Many schools offer students a general vision screening, but not an eye examination. The COVID-19 pandemic has even reduced those examinations, since so many students are attending school virtually,” Glen Steele, OD, a professor at the Southern College of Optometry (Pediatric Service) in Tennessee, told Healthline.

“Not only are parents apprehensive about getting out and about, many offices in health-related fields have reduced patient loads and reduced hours, which limits the number of daily appointments available for such examinations,” Steele said.

“Parents, teachers, and students are in a very different world now. Even before the pandemic, I have called kids between the ages of 6 and 10 a ‘half-generation’ — a generation of kids with issues we have not seen before,” said Steele. “The modifications necessary due to COVID-19 have amplified my concerns.”

School screenings are only a first-line indicator of problems, yet can be critical in getting parents to take children to the doctor for a more thorough exam.

“Schools only perform vision screenings, which is not a comprehensive eye examination,” Brad Brocwell, OD, the vice president of clinical operations for Now Optics, told Healthline. “It is used to screen for potential vision problems. However, the AOA [American Optometric Association] reports up to 75 percent of schools’ vision screenings miss vision problems and 61 percent of children with a found vision issue never see a doctor.”

“Remote learning and no access to school vision screenings could make it more likely that a vision issue might be missed,” he added.

The issue of screen time

Compounding potential problems is increased screen time inherent in online learning.

“I have been seeing young patients with larger pupils, indicating a persistent sympathetic response (stimulating the body’s fight or flight response),” Steele said.

“My assumption is that the engagement in gaming and social media causes excitement in the entire process, which also includes acceleration of heart rate and widening the bronchial passages, among other full body processes,” he said.

“The eye is merely a reflection of those potential changes, not a cause, but certainly a cause for concern,” Steele added.

The effect on low-income families

COVID-19 has also disproportionately affected families of color and those typically struggling more with economic hardship.

Dr. Joel Leffler, a pediatric ophthalmologist at Children’s Eye Care of North Texas, told Healthline those parents often lack access to examinations.

“Another sad reality is that, even in pre-COVID times, children living below the poverty line, those whose parents are without higher education, and Hispanic children, were less likely to receive vision screening services compared to children of college-educated parents, as well as Caucasian and African American children,” Leffler said.

“It is safe to assume that these at-risk children have even less access to essential services like vision screenings and assessments during the pandemic, as availability of health and community services are even more limited,” he said.

Some alternatives

There are ways around in-person screenings, according to Dr. Benjamin Ticho, an associate professor of ophthalmology at University of Illinois at Chicago Medical School.

“Remote visual acuity testing (20/20 equivalent) is relatively simple on a computer or even a smartphone,” Ticho told Healthline. “There are many apps for a regular vision check.”

Those apps also have the ability to check color vision and other issues.

Parents may need to get more involved than usual, using patches or tape to cover eyes for testing, or take flash photos of a child’s eye to send to doctors to estimate eye alignment.

If a child needs glasses

There are still limitations to at-home checks, Ticho said, especially when a child needs glasses.

“The big limitation in remote vision testing of children, however, is accommodation,” Ticho said. “Accommodation refers to the eyes’ ability to change focus. If a child is focusing, even a small amount, this changes their glasses measurement. Eye doctors get around this problem by putting in dilating eye drops, which temporarily limit the patient’s ability to change focus.”

“Any attempt to assess glasses prescription in young children, without controlling accommodation, is suboptimal,” he said.

What parents can do at home

Parents can help avoid vision problems in children learning from home.

Having them take frequent breaks from devices is key, Steele said.

“The 20-20-20 rule — take a 20-second break every 20 minutes and look 20 feet away — was first coined in 1996,” Steele noted. “I recommend more frequent breaks, and parents should take breaks themselves and begin setting an example.”

“Working distance is important. Hold the device in the lap or around 12 inches away when doing schoolwork,” Steele said.

“Good seating posture should also be encouraged,” he added. “Workplace furniture does not have to be expensive. Simply a chair that allows the child to have their feet on a solid surface and the computer at eye level — not looking up or down at the screen.”

Parents can spot issues before they become problems, Brocwell said.

“Parents need to watch for some of the signs and symptoms of possible vision issues, like complaints of eye discomfort and fatigue, frequent eye rubbing, avoiding reading, holding books close to the face, poor reading comprehension, losing their place when reading, head tilting, an eye turning in or out, and frequent headaches,” he said.

“Any of these signs or symptoms, or just a family history of eye issues such as lazy eye, eye turn, or nearsightedness, etc., should warrant a trip to the eye doctor,” he added.

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