School’s not out forever: Why ‘back-to-school’ exams are crucial this year

"Normal" isn't something American schoolchildren have seen since pre-COVID-19 closures, but whatever back-to-school looks like this fall, doctors of optometry can help it look its best.

Nationwide, the ongoing coronavirus pandemic has placed unprecedented challenges on school districts weighing parents' need for safe, effective learning options for their children and the political pressures to reopen in-person classes to jump-start a fettered economy. With so much riding on school reopening plans, not to be lost is the fact that the 2020-21 academic year could be more crucial than ever in setting up schoolchildren to succeed.

At the height of states' lockdown and stay-home orders in April, 83% of American schoolchildren were learning remotely through online distance education with at least 43 states and Washington, D.C., closing schools early. However, more than half of parents say remote learning was difficult with 64% of parents at least somewhat worried about academic slip.

Parents and children have enough on their plates to worry about undetected vision problems hindering education, which is why no matter how students attend classes in the new school year, doctors of optometry will be there to attend to the eye health challenges unique to those settings.

"Many academic difficulties for school-aged children are linked to a vision problem, but an eye exam is often overlooked in the battery of testing to determine the child's learning discrepancies," says Jennifer Zolman, O.D., AOA InfantSEE^® and Children's Vision Committee chair, in the upcoming July/August issue of AOA Focus. "A comprehensive eye exam really should be one of the first things considered, since vision is the way we bring information into our systems and interpret what we consume."

Good vision is crucial for learning, especially in children, yet too often, parents settle for vision screenings provided by schools or pediatricians' offices and children are none the wiser until setbacks occur much later. While a simple visual acuity test may provide some indication that something's not right, only an in-person comprehensive eye examination from an eye doctor can accurately address those issues in a clinically appropriate manner.

"A back to school eye exam will eliminate the concern that vision or eye health could be interfering with the child achieving their highest academic potential," Dr. Zolman says. "It sets them up for a clear focus in their upcoming school year."

Vision challenges of online, distance learning

For students returning to school in an online or hybrid setting, doctors of optometry can help alleviate problems associated with prolonged digital device use. As if children's screen habits weren't already a concern pre-pandemic, data suggest most children ages 6-12 say they're in front of a digital screen twice as much as before COVID-19 closures, or for what feels like "most of the day."

Prolonged viewing of digital screens often makes the eyes work harder, and as a result, these unique characteristics and high visual demands make many individuals susceptible to the development of vision-related problems. Factors, such as screen or font size, glare, definition, luminosity and contrast, viewing distance or angle, all can increase discomfort and exacerbate uncorrected vision problems.

Often, digital eyestrain occurs because the visual demands of the task exceed the visual abilities of the individual to comfortably perform them, while those most at risk are individuals spending two or more continuous hours looking at a digital device. However, doctors can make patients aware of important considerations to mitigate these concerns, including:

• Screen position.
• Appropriate lighting.
• Correct posture.
• Blinking routinely.
• Frequent breaks.
• Disengaging before bedtime.

Eye health concerns for in-person classes

Students returning to in-person classroom settings also could encounter unique eye health challenges, especially related to SARS-CoV-2-the virus causing COVID-19-transmissibility through the eyes.

While SARS-CoV-2 transmission occurs primarily through generation of respiratory droplets-the reason why schools are spacing desks at least 6 feet apart and encouraging face coverings-evidence of alternative transmission modes varies and may include ocular tissue or fluids.

To help limit the spread of COVID-19, the Centers for Disease Control and Prevention (CDC) advises against touching not only the mouth or nose but also the eyes. Such guidance drove many to question the safety of wearing contact lenses during the pandemic, but the CDC states there is no evidence to suggest contact lens wearers are at increased risk as compared to eyeglasses wearers. But there's a caveat-safe contact lens wear and care habits must be followed, and that's where doctors of optometry are crucial.

Back to school eye exams are important for ensuring not only overall healthy visual function but also that students understand the importance of adhering to good eye health hygiene and are appropriately seeking care when issues do arise, such as red or pink eyes.

In the June special edition of AOA Focus, the AOA's Evidence-Based Optometry COVID-19 Response Subcommittee advised doctors of optometry to be wary of conjunctivitis as evidence suggests red eye may be present in COVID-19-positive patients. Likewise, while evidence suggests a low prevalence of SARS-CoV-2 in COVID-19-positive patients' tears, a lack of consistent literature drove the subcommittee by consensus to advise doctors that SARS-CoV-2 may be found in the tears and conjunctiva of COVID-19-positive patients and, therefore, warrants caution.

Nationwide, doctors of optometry are adhering to federal, state and local health directives regarding infection prevention measures and implementing appropriate safety procedures to reduce the risk of COVID-19 transmission within the office. These not only include strict protocols for cleaning and sterilization, but also measures to effectively manage patient flow and encourage social distancing.

Learn more about AOA's COVID-19 eye health care guide for patients.

Importance of routine children's eye care

As children progress in school, they face increasing demands on their visual abilities. When certain visual skills have not developed, or are poorly developed, learning is difficult and stressful. This can lead children to:

• Avoid reading and other near visual work.
• Attempt to do the work anyway but with a lowered level of comprehension or efficiency.
• Experience discomfort, fatigue and short attention span.

The AOA's evidence-based clinical practice guideline, Pediatric Eye and Vision Examination, recommends the frequency of eye exams varies with the child's age, ocular and medical history, and other related risk factors, but generally should follow:

• 3-5 years old - Low-risk children should be examined at least once; at-risk children should be examined at least once or as recommended.
• 6-18 years old - Low-risk children should be examined before first grade and annually thereafter; At-risk children should be examined before first grade and annually, or as recommended.