My brother doesn’t go to school…

The shy 10-year old girl is very attentive while I check her vision. She follows the instructions very well and does exactly what she is told.

We start by checking her refractive error, that is, the optical properties of her eyes. My regular readers will know by now that only nearsightedness or extremes of farsightedness and astigmatism are obvious to the untrained observer. Everyone else will simply see a child who behaves oddly, perhaps as though they have some sort of developmental problem. We continue by checking her ocular (eye) alignment and movement – many children struggle with difficulties in targeting with both eyes, or with moving the eyes accurately across a line of text – this is often interpreted as ‘dyslexia’, a term with little to no meaning these days; it is what is sometimes referred to crudely as a garbage pail diagnosis, that is, if you don’t know what the problem is, call it ‘dyslexia’. We check her color vision and her ability to perceive depth, or stereopsis, and finish by assessing her eye health, looking at the outside and inside of her eyes to ensure all is well.

“In schools where there is sufficient awareness that vision is somehow important in a reading-based learning environment, there is only a rudimentary check of visual acuity using an eye chart (visual acuity) at 3m – 6m (10-20 feet), even though most important school work is done within 40-50 cm of the child’s nose. This is silly…”

Schools have neither the expertise, nor the tools, nor a clear mandate to assess vision. In the end, the greater majority of children never get checked in a timely fashion. In schools where there is sufficient awareness that vision is somehow important in a reading-based learning environment, there is only a rudimentary check of visual acuity using an eye chart (visual acuity) at 3m – 6m (10-20 feet), even though most important school work is done within 40-50 cm of the child’s nose. This is silly, and leaves most seriously affected children to flounder. It’s akin to checking the tire pressure on a car, and saying the engine is OK. We could say ‘Well, at least it’s something…’, but what it does is give a false sense that we are doing our job.

As I’m working with the polite and cooperative young lady, I get the sense that she has something on her mind. Sure enough, when we’re done, I tell her, ‘You did a great job, young lady. Your eyes are in great shape, and you don’t need glasses. We’ll have another look at you next year, so now you can go back to class.’ She looks at me, swallows hard, gathers her courage and says, ‘My brother needs glasses.’

I smile at her and say, ‘Oh, and what’s his name?’. She replies. ‘I haven’t seen him yet’, I say. ‘He doesn’t go to school’, she says, ‘he can’t see, so he doesn’t go to school’.

My heart sinks. My blood pressure rises. I fight back tears of pathos and frustration. ‘He needs to be in school’, I say, ‘here, give your parents this card and tell them to call me.’ I hand her a business card and a magnet to stick on her fridge, and reassure her that we can help her brother to see. She tells me she will relay the message. I have doubts as to whether she is able to pass along the message without reprisals at home, or whether the message will fall on deaf ears.

Most parents in our schools disregard vision, take it for granted, and assume that so long as children aren’t squinting at the TV, or bumping into walls, there is no problem. This is for a number of reasons. One is the Fonzi Factor: It’s not cool, or a sign of weakness, to wear glasses (Episode 62 of Happy Days, ‘A sight for sore eyes’). (I might be dating myself by using that reference, but so be it.)

The second major reason for the lack of care for vision is a glaring lack of training in this area in schools of psychology, education, and medicine. Even after completing degrees in neural science and education, and teaching for a number of years, I had no idea what was involved. In the end, if professionals are not advising vision care, parents will not be motivated to pursue it. Vision is complex, and it is insufficient to assume that vision is strong if the eyes are healthy.

Thirdly, and to be very blunt, there is sometimes the impression that if an optometrist is advising that you check a child’s vision, it’s because of the optometrist’s desire to sell glasses. Again, this is silly. Do we expect that a family MD is advising check ups and laboratory testing because they want to fill their schedule? Likewise, if your car is not running well and your mechanic says you need a tune up, it is because they want to empty your wallet? Perhaps on all counts, there are occasions when these statements are true – there are certainly unscrupulous doctors and mechanics in this world, this is why it is important to find someone you can trust and build a long-term relationship with them, but to also educate yourself along the way. Clearly, in our clinic, our best clients are educated clients, and we do our level best to provide unbiased opinions based our our collective experience and expertise.

“…our best clients are educated clients, and we do our level best to provide unbiased opinions based our our collective experience and expertise.”

Finally, perhaps most importantly, children are not checked because of a lack of access to adequate care. Small and remote communities do not have ready access to professional vision care. For our part, we go out of our way – way out of our way – to do what we can to bring care to isolated communities. The Federal and Provincial governments currently do very little to facilitate this process, even though they fund schools in these areas at significant cost because the law states that all children must attend public school. To be completely fair, eye care professionals could also do more to push this issue and work towards equal access to necessary care.

“There is a price to be paid when children cannot succeed in school, and we all bear the cost.”

If our legal mandate is to ensure all children attend school, then it also behooves us to ensure that they have the basic facilities in place to handle the tasks we put before them. After all, if they cannot participate, we might as well spend the money to set up movie theatres instead of schools so they can just sit there all day and be entertained. There is a price to be paid when children cannot succeed in school, and we all bear the cost.

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