Leon Rodriguez, a 3-year-old Latino boy, sat patiently in a small chair in the darkened room. Under a massive crop of fluffy, curly hair, he trained large dark eyes on the young man holding a small camera three feet in front of him.
Leon was one of approximately 40 preschoolers gathered at the Vargas Child Development Center in Sunnyvale. The children were participating in the FocusFirst vision program, which tests the vision of children aged 6 months to 5 years old. The program facilitators visit preschool settings and child care centers throughout San Jose and Silicon Valley.
About 1 in every 4 children has some sort of vision problem, and according to the American Public Health Association, about 10% of preschoolers have eye or vision problems. However, children this young generally will not be able to articulate complaints about their vision.
The young man holding the camera watched the screen on the backside of the camera as it flashed black and white, conducting an optic scan of Leon’s eyes. The camera emitted the sound of chirping birds while it found its focus and then took a measurement of the boy’s eyes.
The whole process took less than a minute. The screen showed that the boy’s eyesight was normal and the volunteer told Leon he was free to go.
“That’s it?” Leon asked, sounding surprised. “Yup, that’s it,” the technician replied.
Tia Williams Sion is the Director of Human Resources and Programs for the Healthier Kids Foundation of Santa Clara County, the organization that heads the FocusFirst program along with funding assistance from First 5. She said the program targets its efforts toward low-income or underserved communities, but the screenings are open to anyone in need of them.
It’s important to address vision issues sooner rather than later. “When they’re little, it’s really easy to correct, and they correct it with patching,” Williams said. “But if we catch it when they’re 8 or 9 yrs old, the outcomes aren’t as good, and it’s a lot more difficult to correct.”
Studies have shown that vision problems vary by ethnicity. Asian and Hispanic children tend to be more prone to astigmatism and nearsightedness than African American children or white children. Farsightedness was more prevalent among white children.
Advocates say that a child’s vision can play a crucial role in realizing academic potential. Experts estimate that learning is approximately 80 percent visual. So a child who can’t see well might not perform well in the classroom or enjoy reading.
Vision problems can make school stressful. Children who don’t see well might avoid reading or try to do their homework without really understating what’s required of them. They might also find themselves uncomfortable or fatigued and may have short attention spans.
A child with underdeveloped visual skills may be misdiagnosed with ADHD or dyslexia.
“I tell parents, probably once or twice a month, ‘Don’t let the school put your kid in a remedial program – it’s a vision issue,” said Optometrist Dr. Michael Fauria. “If we fix his vision issue, he’ll do fine,” he said.
Fauria said he thought the FocusFirst program was a positive step towards catching vision problems, but warned against putting too much emphasis on any screening, whether through the FocusFirst program, in the pediatrician’s office, or at school. “If a child passes the screening, the parent thinks they had an eye exam done so they won’t pursue any further eye care,” he said.
“That’s a potential downside, always, that parents misinterpret the screening as a full checkup,” Fauria said. He said that regular comprehensive eye exams are the best way to identify vision problems.
Some children, he explains, may have poor vision in one eye and good vision in the other. Such a child would pass many of the tests administered by a Medical Assistant at a pediatrician’s office, but would still struggle with reading because they’re only using one eye, Fauria said.
The same is true of kids who have a muscle alignment issue, where there’s an extra strain on the eye muscle system. “Those kids, they don’t read,” he said. When he asks why not, the kids describe getting headaches or getting tired.
“Those kids are potentially failures at school and they don’t even know why,” Fauria said.
The camera used in the FocusFirst screenings is both a camera and an autorefractor, taking measurements to determine if its subjects have any issues with their vision. The camera can detect things like astigmatism or differences in the strengths between each eye, or if the subject has a lazy eye.
The screenings take place in dimly lit rooms to allow the children’s pupils a chance to dilate. Williams, a mother herself, points out that for this young age group, this is a much easier option than using the dilating eyedrops an optometrist might provide.
After the screening, Williams and her team send the results of the reports back to the childcare center. They provide information to parents on how to get care, and they follow up with them to help the child get proper vision correction.
Similar programs exist throughout the state and across the country, but Williams said that what makes the FocusFirst program different is that they make sure the child gets follow-up care.
“So if they have medical insurance, we teach them how to use it. If they don’t have medical insurance, then if they qualify we get them into the county plans,” she said. Her team works to find coverage for the child, and if all else fails, they have vouchers from the Lion’s Club to get a child in to see an optometrist.
Williams said the program will reach its goal of screening 6,000 kids this fiscal year, and aims to push that goal to 9,000 for next year. But more important than these numbers, she says, is getting people in the habit of thinking about their child’s visual health.
“We want people to get in the habit of going to routine optometrist appointments,” she said. “So we try to teach them how to use their insurance. If they’re not enrolled, get them enrolled. If they have insurance or qualify for public programs, show them here’s how to use it so they get in habit of going to the optometrist every year.”