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Examining children is simultaneously one of the most rewarding and challenging components of optometric practice. Unlike adults who are able to verbalize their specific concerns, children are often unaware or unable to articulate when something is amiss with their eyesight.

Given the fact that vision accounts for as much as 80 percent of the learning process for children, it is imperative to ensure that as a child starts the new school year he or she is equipped not only with a new backpack and sneakers but also with the best visual skills possible. Parents are shocked to discover that undetected vision problems are often misdiagnosed as ADD/ADHD or dyslexia because they share similar symptoms of fatigue, fidgeting, and frustration in the classroom.

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Seventeen visual skills are needed for success in school, sports, and everyday life. Vision screenings by a pediatrician or school nurse only address one of them – whether your child can see 20/20 or not. Seeing 20/20, however, is no guarantee of adequate visual proficiency.

This is where the re-education of parents, educators, and healthcare professionals begins. Instead of waiting until there is an apparent problem, the American Optometric Association recommends that all children have a routine eye examination starting at age three. (Incidentally, practitioners who are part of the Infantsee program check infants from ages 6-12 months for gross visual deficits; they can be found by accessing www.infantsee.org.)

Parents are understandably skeptical about the ability to check a three year old in a meaningful way. Many youngsters don’t know letters yet, can’t sit still, or are frightened. Parents can be reassured that a large number of the tests done at this age are objective, not subjective, and there are ways of figuring out the status of the child’s visual system without any verbalization at all.

Picture charts fill in the gap for those unfamiliar with the alphabet, and sometimes it will take two or three visits to get all the information needed, but that’s O.K. Starting eye exams at a young age has the extra benefit of familiarizing the child with the doctor and the nature of the eye exam, and each year it becomes subsequently easier to get essential information, as the older the child becomes, the higher the academic stakes are in terms of having good vision.

Children’s vision care is one of the essential health benefits under the Affordable Care Act. In some states children are eligible not only for the eye examination but for eyeglasses as well. This new benefit will hopefully be a game changer by allowing more children access to vision care.

There are roughly three types of pediatric consults I do on a regular basis. The first is a child coming in for a routine eye exam, either on the recommendation of the pediatrician as a component of preventative health care or because a well-informed parent thought it was time for a routine evaluation.

The second consult is a child referred either by the pediatrician or the school after failing a vision screening or because the parent noticed the child was not seeing things in the same way as his or her siblings or friends.

The third consult and decidedly the most complex is a child referred either by the school’s child study team or by the parents to rule out vision deficits because he or she has been performing poorly in school or having behavioral problems.

Allow me to introduce you to Racheli (not her real name), a sweet eight-year-old girl in third grade with a shy smile and a big problem. The third child in a family of five, she attends the local Bais Yaakov and was referred to my office by her teacher for a comprehensive eye evaluation.

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Dr. Chani Miller, the mother of two daughters, is the chief optometrist at Park Eye Center, a private optometric practice in Highland Park, NJ.