little four eyes

Thanks to Bright Eyes Tampa for posting this article on facebook!  Cortical visual impairment (CVI) is a disorder that stops the interpretation of visual information.  Parents of children with CVI had noticed that their children interacted with the devices much more than with other objects, but there had never been any formal studies.  More recently, a researcher at University of Kansas, Dr. Muriel Saunders, who was studying adaptive switches, gave 15 toddlers an iPad to play with in an attempt to gauge the children’s interaction.  Most people with CVI will look directly at objects only briefly, though they will look at lights much more.  The bright screen on the iPad and similar devices can provide much more visual contrast to objects, making them easier to process visually.  Those children that were given the iPad interacted with the objects on the screen in ways that astounded the researchers and their parents.  Dr. Saunders is currently working on writing a grant proposal to study ways that the iPad could be used to help children with CVI learn to interact with and control objects on the screen, and possibly even give rise to new early intervention strategies that may help the children learn to better interpret visual information.  The full article from Tech News Daily is here.

I’m fascinated by the advances in technology and the ways that these technologies can open up new avenues for helping people with disabilities overcome them.

A friend sent me this link after reading my last post about whether or not glasses = nerdy.  The story is a piece from National Public Radio that ran this past April, you can listen to the program at the link above, or read the transcript there – they’re the same.  The program talks about a study that was done in a poor, rural area of China.  Two researchers found that while 10% of the kids there in the primary school needed glasses, only 2% were wearing them.  So as an experiment in educational interventions, they offered free glasses to all the kids in one school that needed them (1,500 pairs of glasses).  After a year, compared to children in a nearby school that didn’t receive glasses, the kids that got glasses learned 25 – 50% more.  But the big surprise to the researchers was that 462 families turned down the free glasses, though the researchers aren’t sure why.

The whole article is really quite interesting.  For one, it’s clear that for children with poor vision, having that vision corrected is extremely important for learning.  (Encourage your friends to have their children’s vision examined if they haven’t done so already, especially if their kids are starting school).  And I’d love to know more about why some families refused the glasses.

The biggest surprise to me was that the radio program then brought in an optometrist who claims that “eyeglasses are the coolest thing you can put on your face right now.”  He sells around 300 pairs of glasses with clear, non-prescription lenses.  I don’t know if that coolness translates to how kids feel about glasses, but I’m certain it doesn’t hurt.  The final thought, from the optometrist was that “any hip-hop star to any idol of a sports star that wears them [glasses] influences children’s perception of eyeglasses.”

What do you think?  Are glasses the coolest thing for your face these days?  Is that coolness factor only for adults, or does it also hold true for kids?  I expect that it is true that seeing sports icons and other celebrities in glasses makes them more attractive for older kids, but what about for our younger kids?  Does your child in glasses notice or point out when they see a character in glasses?  Does it seem to make a difference in whether they wear their glasses?

I ran across a very interesting article the other day while perusing the recent literature on kids and glasses (yeah, I regularly read through article about kids and glasses, makes me a hit at the parties…).

“Spectacle wear in children reduces parental health-related quality of life,” published in the Journal of the AAPOS, Feb., 2011 (read the abstract here).  I’ll jump straight to the conclusion before getting in to the details: when it comes to questions about vision and their eyes, parents of kids in glasses worry more than than parents of kids who don’t wear glasses.  Our kids with glasses do not worry any more about their vision than their peers who don’t wear glasses.

So the details…

This was a small study, only 49 children between the ages of were 5 and 13 were recruited.  The children all either had normal vision with no glasses (29 of the children) or refractive error that was corrected with glasses (20 of the children).  None of the children had strabismus or other vision issues – the researchers just wanted to look at the impact of glasses on a child’s quality of life.

Each child and their parents completed two questionnaires, the Intermittent Exotropia Questionnaire, a questionnaire that asks specifically about how vision impacts their quality of life – though there are no questions about wearing glasses; and the Pediatric Quality of Life Questionnaire, which is a more general questionnaire about how kids are functioning physically, emotionally, socially, and in school.  For the Intermittent Exotropia questionnaire, the child answered  a set of questions, the parents answered a set of questions for the child (proxy), and then the parents answered questions about themselves.  For the Pediatric Quality of Life Questionnaire, there was no questionnaire for the parents to answer for themselves.

The Intermittent Exotropia Questionnaire  included things like (you can see the full questionnaire here – scroll down to the bottom of the page.) …

For kids:

• Do kids tease you because of your eyes?

For parents to answer for their child (proxy):

• My child feels different from other kids because of his/her eyes.

For parents, about themselves regarding their child’s vision:

• I worry that my child will be less independent because of his/her eyes.

(There were no significant differences in answers between the two groups of children or their parents in the Pediatric Quality of life Questionnaire, so we’re not going to worry about that one.)

Findings

As I mentioned at the beginning, there was no difference in scores between kids with glasses and those without when it came to their quality of life.  Basically, the kids with glasses were no more worried about their eyes or vision than those without glasses.

But when you looked at the responses by the parents, that’s where the differences stood out.  First, if you looked at the proxy questions – where the parents answered for their child, four of the questions showed lower scores (lower quality of life) for kids with glasses:

• Q2. My child is bothered by people wondering what is wrong with his/her eyes;
• Q4. Kids tease my child because of his/her eyes;
• Q8. My child feels different from other kids because of his/her eyes; and
• Q9. My child worries about what other people think of him/her because of his/her eyes.

The really interesting thing here, is that the kids did not report feeling different or teased or worried about what others think of them because of their eyes.  The parents were the ones who felt that their kids were encountering those things.  It’s an interesting (and unanswered) question as to who is right in this case, though I’m inclined to guess that parents are projecting their own fears into their answers.

When answering for themselves about their concerns for their children, parents of kids in glasses had lower scores (p <= 0.03 for the stats people)  – meaning they were more concerned – for the following statements:

• Q3. I worry the my child will have permanent damage to his/her eyes;
• Q6. I worry that my child will get hurt physically because of his/her eyes;
• Q7. I worry about the possibility of surgery;
• Q8. I worry about my child becoming self-conscious because of his/her eyes;
• Q14. I worry about my child’s eyesight longterm;
• Q16. I worry about whether or not my child should have surgery.

(Let me tell you, I can totally relate to every one of those statements there.  If someone asked me to list my biggest fears when it comes to Zoe and her eyesight, it would sound really similar).

So, when you hear someone tell you that this is harder on you than it is on your child, there’s probably more than a bit of truth there.  Our kids are tough, and they know that their glasses help them see, and they don’t worry about their eyesight the way we do.  Which I guess is as it should be, since that worrying is our job as parents.

(this post was originally meant as a Monday morning link round up.  Life happened, and now it is neither Monday, nor is it morning.  So while I was at it, I dropped the link round up part, too, as I think it stands on its own as a regular post).

It’s likely that if you’re reading this, your child has had an eye exam, and you understand the importance of catching and treating vision problems early.  But a 2009 survey by VSP and Prevent Blindness America found that almost two thirds of American children under the age of 6 have never had an eye exam by an eye doctor.  I don’t know what the numbers are for other countries, if anyone has numbers, I’d love to see them.

Given the number of questions that I’ve fielded from complete strangers about Zoe’s vision and her glasses, I think those of us with young kids in glasses are in a great position to get the word out about the importance of eye exams and treatment for our children.   Simply talking to other parents about why our children wear glasses, and how eye exams work for young children can help others see why they’re important.

Recently, though, I’ve come across a number of examples of larger organizations helping parents to get the word out to a wider audience.

• InfantSEE, a program run by the American Optometric Association, provides free eye exams to infants age 6 – 12 months.  Suzi, whose son Emory’s cataracts were caught at an InfantSEE appointment, has given interviews to a local newspaper and news station (her segment is right after the part about car seats, about 1 minute in to the clip) about the InfantSEE program and importance of catching vision problems early.  Other parents who have experience with InfantSEE and who would like to share their story are encouraged to email JMMahoney @ aoa . org (remove the spaces) with their story.
• Children’s Eye Foundation, the foundation of the American Association for Pediatric Ophthalmology and Strabismus, is dedicated to eliminating preventable childhood blindness.  They have a “Little Ambassadors” program to help raise awareness for early detection and treatment of vision issues.   The current featured video is Jack’s story (Jack’s mother, Lindsay shared her son’s journey with us this past October, and she blogs at Jack’s Journey).  Children’s Eye Foundation is also happy to help other parents create ambassador videos to share their stories.(and I’ll pause here to take a moment to note the cuteness of both boys featured in those two links above)
• Vision First Foundation – The Vision First Foundation is committed to children’s eye and vision examinations.  They are looking for short stories (125 words or less) that they will post on their website.  Go here for more information.
• Little Four Eyes – and I’ll just do a little self promotion here.  We are always happy to publish your story about your child’s vision, in fact, I love sharing our stories here.  And I know that people find our stories here when searching the web for information about children and vision issues.

I’ve come across a pretty random assortment of links recently, on topics of vision therapy, cataracts, and a do-it-yourself iPhone app for vision testing.

• Questions for doctors – Stewart Snippets recently learned that her 2 year old son has lamellar cataracts.  She wrote a wonderful list of questions for her son’s doctors.  The questions are worth checking out and keeping in mind for doctor’s appointments, no matter what your child’s diagnosis.
• Red Eye Reflex – Jack’s Journey has a great post – with lots of pictures – about red eye reflex in photos, which can be a sign of cataracts (it can also be a sign of a really good camera with red eye reduction).

• Vision Therapy Video – This is a short video giving a concise explanation of vision therapy, with particularly good explanation of how visual problems can lead to difficulties with reading.  If you’re looking for a quick introduction to VT, this is a good place to start.  Via Bright Eyes News.

• Vision Testing App, iSight Test – There’s a new app available for the iPhone/iPad that allows you to assess visual acuity at home.  The app was developed by ophthalmologists and a pediatric orthoptist.  The app gives parents the ability to track their child’s visual acuity during amblyopia treatment in between  eye doctor visits.  Obviously, this app would not take the place of vision exams, but rather give parents a tool to use in between visits.  Quick note, the app uses and was created by Kay pictures, which were developed in part by Hazel Kay, author of Hoppity Frog has Two Clever Eyes, and a pediatric orthoptist.  Watch for a more detailed review of the app.

If your child has amblyopia and/or strabismus, you’re going to want to check this out: ”Do You See With Your Eyes Or With Your Brain and … What Difference Does It Make?” on The VisionHelp Blog.

I know about it thanks to Stella’s developmental optometrist, who emails relevant vision-related news and helpful educational opportunities and resources to her patients and colleagues. Tonight she shared a link to an engaging discussion between Dr. Press, a developmental optometrist and Board Certified Fellow of the College of Optometrists in Vision Development (COVD) who contributes to The VisionHelp Blog, and Dr. Granet, a prominent ophthalmologist. Really! They communicated with each other! And did a wonderful job of it, too. Though some of their chat is very expert-level, and therefore hard to follow, I was able to glean interesting points and find references to studies worth checking out. Hope it’s helpful to someone out there!

Dr. Press’ review (on The VisionHelp Blog) of Dr. Granet’s appearance on TV’s “The Doctors“ sparked this online dialog. Dr. Granet should be applauded for taking the time to respond to the (relatively mild) critique of his comments on amblyopia treatment, along with the optometrists who continued to engage him diplomatically yet honestly. You may’ve seen the video segment from the show, in which Dr. Granet tests a young toddler  for vision problems due to a family history of amblyopia. I really felt for the mom and dad, who found out in front of a live audience that their child likely does struggle with her vision. I remember that moment hitting me hard in the privacy of a small exam room. But as pointed out by “The Doctors,” early detection is something to be thankful for, and they’ve got it on their side.

In the comment section you’ll find an interesting conversation in which the disconnect between ophthalmologists and optometrists is taken on directly and in a very civil fashion. I couldn’t help but chime in (possibly coming across like a hysterical idiot parent, but hey, I tried!) and I hope you will, too. After all, it’s been talked about here on Little Four Eyes frequently. The lack of clarity many of us face in making decisions about our children’s care would be alleviated greatly if the two fields could find a way to collaborate or at least communicate. This comment section interaction seems like a step in the right direction. Stella’s doctor thought it was great and I agree.

One last time, here’s the link to the post and ensuing discussion:

Do You See With Your Eyes Or With Your Brain and … What Difference Does It Make?

(P.S. The video seems worth sharing, if only to convince other parents that eye exams are a great idea for all little ones and to show them how accurate testing can be even on babies as young as six months.)

The American Library Association announced its 2010 Youth Media Awards this week.  One of the awards, the Schneider Family Book award “honors an author or illustrator for the artistic expression of the disability experience for child and adolescent audiences.”

This year’s Schneider Family Book award for children’s books was awarded to “The Pirate of Kindergarten” by by George Ella Lyon, illustrated by Lynne Avril (find it at a library or buy it from Amazon).  The book is about a young girl, Ginny, who struggles in kindergarten because she is seeing double.  Glasses and an eye patch help her to see better, and become the pirate of kindergarten.

I have not read this book, but will be seeking it out from our library to read with Zoe.  Has anyone else read it?

Thank you to Joanna for posting this on the Little Four Eyes facebook group.  And congratulations, and thank you to George Ella Lyon and Lynne Avril!

Nintendo 3DS, expected to hit stores in March, comes with a vision-related warning

Jessica Gottlieb is a prominent blogger known for sharing strong opinions on motherhood, social media, and other assorted and engaging topics. Her son happens to have strabismus and amblyopia. He visited regularly with a pediatric ophthalmologist from age four months until earlier this month. Now nine years old, his vision has come a long way. He continues to wear an eye patch for a couple hours each day.

I thought the Little Four Eyes community would be interested Jessica’s recent thoughts on a piece of tech news: Nintendo’s 3D Gaming Device Comes with a Warning for Children Under Six. The soon-to-be-released gadget will come with a warning about potential injury to the eyes of children under age six, whose vision is still developing. Jessica has a valid concern about the device and its warning. The reason her son still wears a patch is because, at age nine, his eyes are still growing and changing (per the renowned doctors charged with caring for his vision).  So why does Nintendo set the cut-off age at six when we know that eye development continues beyond then? What is the real risk?

This area of concern seems likely to grow as gaming systems evolve without much regard to their impact on young eyes. As if we didn’t have enough on our parental minds, ay? Extra caution certainly seems warranted, especially when it comes our children with visual issues such as strabismus and amblyopia. Thanks for the heads up, Jessica.

Parents/experts, what do you think? How much do you worry (or not) about the effects of video games and emerging forms of 3D entertainment, and screen time in general?

My daughter is only two and her screen time is generally limited to 30-60 minutes of TV (age-appropriate videos) a day, only while wearing her patch as it helps with compliance to our regimen, but I know this will get trickier as time goes on. What guidelines do you have in place for your child? How have viewing/gaming habits and limits changed or become harder as they’ve gotten older? What have optometrists, vision therapists, or ophthalmologists told you about the impact of TV, computers and video games on your child’s vision?

I’ve run across quite a few mentions of children’s vision online recently, so it’s clearly time for another round up of links:

• Girl’s life saved due to facebook photo – A post on Bright Eyes News about how a person on facebook notices something wrong with a girl’s eyes when her parent posts a photo of her.
• Children really do see things differently – an article on a study of how children perceive objects.  This doesn’t have anything to do with vision problems per se, but it’s interesting to note how children’s vision develops.
• What’s new in children’s eyeglasses – a page on All About Vision that collects news on children’s glasses frames, particularly in terms of fashions.
• Children’s Eye Foundation’s calendar photo contest follow up – the “I Care for Eye Care” calendar photo contest is done, winners have been chosen and the calendar is available for download.  Three of the photos submitted by Little Four Eyes readers are featured in the calendar (Big Sister Love, Like Dad like Daughter, and Brotherly Love).  Congratulations!
• Children’s Eye Foundation’s “See by Three” program – the Children’s Eye Foundation has received a grant to launch a national “See by Three” program, starting in Fort Worth.  The most interesting – and really quite concerning – point in the linked article for me was the fact that they’d found that when a pediatrician told a parent that their child had a vision problem, the parents followed up with an eye doctor only about half the time.  There’s a lot of work to do in terms of awareness of how important it is to treat vision issues.

In Tami’s story, her daughter Lilly passed the vision screening that their school system required for kindergarten, but was found to have amblyopia at an eye exam at an ophthalmologists   (read the whole story) .  As I was looking in to this, I was surprised to learn that this isn’t all that uncommon.  Children can and do pass the quick vision screenings at their doctors or at school, when in fact, they do have vision problems that need to be treated.  In the United States, most states require some vision screening before a child starts school (though 16 states have no requirement at all), only 3 states require a comprehensive eye exam.  I’d love to hear from readers in other countries about whether they have any vision screenings or exams that are required of children before they start school.

What’s the difference between a vision screening and a comprehensive eye exam?  A comprehensive eye exam is performed by an opthalmologist or optometrist and includes a visual acuity test using one eye, and then the other, cover testing, and then dilating drops and retinoscopy (if you’re reading this because your child wears glasses, this would be the very familiar eye exam).  The screenings, on the other hand, vary from place to place, but most typically involve reading an eye chart or vision acuity cards, though some use refractors that measure the refractive error of the eye without dilating the eye first.  Screenings may be done by pediatricians, school nurses, technicians or trained lay persons.  There is no question that the full comprehensive eye exam is necessary to get the complete picture of a someone’s vision needs.  The question is whether a screening can identify kids with vision issues and get them to an eye exam to figure out exactly what treatment is needed.

The Report of the National Commission of Vision and Health on Children’s Vision that was released this summer does a nice job of compiling and explaining studies that have been done to compare vision screenings to vision exams (the report is here, start on page 9 for the section on screenings and exams).  Vision in Preschoolers, or VIP, is one such study, conducted in 2001-2004, by the National Eye Institute, which compared 11 vision screening tests to see which were the most accurate.  The three best tests still missed more than 30% of kids with vision problems (though they did identify 90% of children with the most severe vision problems).

At least one study cited in the report found that the additional cost of having all children go through a comprehensive eye exam is easily offset by the increase in the number of children whose amblyopia could be detected earlier and treated successfully, compared with the numbers detected and treated with a vision screening program (full text of that study is here).

I know that I’m preaching to the choir here at Little Four Eyes, but please encourage friends and family to have their children’s vision checked out at a full eye exam, rather than relying on vision screenings.  Programs such as InfantSEE (at infantSEE.org) provide exams at no cost for infants, and many insurance programs cover comprehensive eye exams once a year or once every two years.