Should Eye Exams be Mandatory for School-Age Kids?

Most Canadian children never have their eyes examined, yet one in six may have a vision problem.

Currently only 14 per cent of Canadian children under the age of six receive professional eye care. Since the measles outbreak in North America a few months ago, more school districts and provinces are considering mandatory immunization in order to attend school.

Should eye examination be added to the list of school entry requirements?

It’s been done elsewhere.  Since 2004, all children in Massachusetts entering kindergarten must provide proof that they have undergone a vision screening within the last year. The government explains that school entry is the perfect “safety net” that ensures a proper start to academic life.

Canada only has a partial safety net for eye care for kids at best.

According to the Canadian Association of Optometrists (CAO), one in every six children may have a vision problem that makes it difficult to learn and read. For this reason, the CAO strongly recommends a comprehensive eye examination for every child before entering school. The medical journal, The Lancet, recently published a paper on whole population vision screening in children to detect amblyopia (lazy eye). The authors recommend that there should be screening of all children age four to five years at school entry since this “confers most benefit and addresses inequity in access to timely treatment.”

So if professionals are so clear on the need, why aren’t kids getting eye exams in Canada?

The CAO believes the costs associated with eyeglasses can be a barrier for many families – and many parents are simply unaware that eye examination for children is both recommended and free in most provinces (covered by the publicly funded health system).

Some steps are underway to improve the situation. For example, Ontario has recently joined six other provinces in offering a program that is financed by both public and private purses. The Eye See…Eye Learn program provides no cost, comprehensive eye exams for kindergarten students, and importantly, offers a free pair of eye glasses if the child requires them — something that would normally cost parents around $250.

Initiatives like the Eye See…Eye Learn program are a great step in the right direction, but it’s a half measure. Provinces are already partially funding this program, so why not take it a step further? Why not put in place a comprehensive eye health system so that children of all ages are systematically benefiting from vision care?

We need health ministries to make sure that children who need glasses get them, and have access to professional eye care throughout their education trajectory. And maybe it is time to consider the requirement of documentation that a free eye exam has taken place before school entry.

Children’s education at stake

Vision problems have serious consequences for a child’s development; reading, writing, motor skills and behaviour can all be affected. Bottom line: early detection and timely treatment of eye conditions are effective and cost effective.

Many parents and teachers have mistaken vision problems for behavioural issues or learning disabilities. But a child will not tell a parent if they cannot see properly (if they don’t know themselves). Systematically detecting vision issues in children will not only help them avoid unnecessary academic struggles, but it will also reduce the burden on schools, who must spend huge resources to help students who are falling behind.

The Quebec Order of Optometrists says that 61% of Canadian parents are wrong when they believe they can detect their child’s visual problems without a professional.  It may be highly instructive to know that high-IQ society Mensa’s youngest U.S. member is a two year old girl who was originally misdiagnosed with “unspecified learning delays.”  All she needed were glasses to correct her far-sightedness and amblyopia.

Seeing through the costs

Learning that your child needs glasses can be challenging for a parent with low-income.

Philanthropic initiatives exist across the country to pay for the exorbitant cost of glasses; the Bonhomme à lunettes in Quebec, the Toronto Foundation for Student Success, the Vision Institute of Canada, for example, all provide a helping hand for vision care. But their capacity is often limited and families should not have to rely solely on the good will of such organizations in order to see.

In the coming months, the CAO will meet with Members of Parliament and Senators in Ottawa in the hopes that early detection and treatment of eye and vision problems will become a public health priority. If Canada is serious about education – and serious about the health of Canadian children – it should move to make complete eye care part of the health care system.

Hear an audio podcast on this issue with the authors here.

Elizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, and Professor of Paediatrics at The Hospital for Sick Children and the University of Toronto.

Mélanie Meloche-Holubowski is a journalist intern at EvidenceNetwork.ca and journalist with Radio-Canada.