Views on Vision - by Dr. Charles A. Boulet

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Great Skater, Dull Skates

When is it appropriate to prescribe prescription lenses for children? By far, most children grow and appear to be just fine by the time they start school. Only severe and debilitating visual dysfunction is easy to spot, but still is sometimes missed by parents and teachers. Unless a child is squinting all the time, has crossed eyes or sits close to books and TV to see, they will likely never be taken in for a comprehensive visual function assessment.

Consider a hockey analogy, one I've used before. A child may be a mediocre skater or a great skater, but if the skates are dull, both will have trouble playing. With dull blades, the poor or mediocre skater will have greater difficulty developing stick handling skills. For the strong skater, slightly dull skates won't make too much of a difference, but it's best to just keep the skates sharp. The weak skater might even find it so frustrating that they simply quit or express this frustration through anger. Sharp skates help in grabbing the ice to provide better thrust and control so the player does not have to think about it or spend too much energy simply moving about.

Vision is very much the same. No two children have exactly the same eyes and all eyes must do some work in order to see easily and move with dexterity across a page of print. With poor vision (that is, poor motor control or clarity), the child will struggle to a greater or lesser degree, especially when learning to read.
In the world of hockey, sharp skates means the player can focus on the play and skill development. In the classroom, strong effortless vision means the child can concentrate fully on the task of learning and paying attention. The specific needs of the child varies greatly: In some cases, vision is so bad, the child quickly falls behind and exhibits other medical problems including dyslexia, ADHD and depression-like syndromes. However, the problem does not have to be so severe to be a real obstacle. For a child who already has trouble reading, a small visual problem can represent a greater obstacle.

My approach to prescribing glasses is simple. I have a number of cut-off limits, and if the glasses prescription goes beyond those numbers, I will recommend glasses every time. For those who fall below those cut off limits, I will consider the overall circumstances. If I feel vision represents even a mild impediment, it is an impediment that should be addressed. Going back to hockey, if sharper skates will make a 10% improvement in performance, then why would you not give the child the benefit of the boost? In the classroom, where the child spends many hours with visually intensive tasks and must keep up all the time, even small obstacles can become big problems over time.

Some people are surprised when I suggest glasses to assist their children who seem to be fine otherwise. Sometimes it is the cost, other times it is the social stigma of wearing spectacles (yes, for some people, glasses still represent 'nerdiness' or some sort of weakness) and part is the difficulty of 'seeing' the benefit. Eyes and vision are very complex and must operate with great accuracy in the classroom. Children, for their part, find it difficult to express in words what they feel when they find dealing with text difficult. To the child, the struggle is just 'normal'; in the absence of a complaint, parents wonder if anything could be wrong. Nonetheless, in the average classroom, 25-30% of children will have some sort of addressable visual impediment to sustained near-point work, that is, classroom learning. For those affected (including parents, teachers, support staff and the child) it is a simple matter of leveling the playing field to avoid unnecessary grief and expense.

When I'm on the fence when deciding what to do, I will often recommend a 'better safe than sorry' approach and this is sometimes more difficult to understand than a simple term like 'need'. When I feel there is a benefit but no strong 'need', I will notify parents, usually using a percentage to explain things more clearly: One child might have a 10% benefit from lenses and therapy, while another might have an overall 90% benefit or more (that is, they 'need them'). There's a nuance here that is difficult to grasp, but this does not change my recommendations. Children cannot simply be placed into the 'need' and 'don't need' camps. Things just don't work that way anymore, not in the classroom, not in a world of pervasive electronic media.

Glasses in school, like sharp skates on the ice, can ensure a child is not held back for something very easy to address. It's all a matter of having the right tools for the job and eliminating unnecessary obstacles so the child can focus on more important things - like learning to read.

Dr. Boulet is a former teacher and now operates Diamond Valley Vision Care in Black Diamond where he continues to work with children with learning difficulties.
Call 403-933-5552.
www.dvvc.ca and www.LearningManagement.ca.