NIHB Gets It Right

I’ve been writing for some time on issues of the importance of proper vision management for children in school. Currently, vision and how it affects learning and behavior is largely ignored in schools of medicine, psychology, and education. Not that it’s not important, in fact it’s critically important for young learners, the problem is that visual functional concerns are simply not taught to these graduates who most need know what’s involved.

Those professionals who feel vision ‘might’ be involved in behavior and learning have many sources of information to explore, including the various colleges of optometry such as www.pacificu.edu/optometry, and other websites like oepf.org, aao.org, and my own site, drboulet.com. A more concise but comprehensive overview of some of the issues at hand can be found at ArchiesLaw.com. I personally am happy to oblige any group interested in expanding their scope of care through talks and workshops and continue to speak to varied groups. The more people understand the principles involved, the more they agree that proper vision management is a fundamental need in education.

In a nutshell: Just because a child appears to ‘see’ well, doesn’t mean he is well suited to the intensively visual tasks put before him for hours on end in school. To make matters worse, more and more work is required at near distances or at computer terminals – both of which are well documented as causing significant strain, vision, and health problems. We sharpen our children’s skates for hockey because it helps them skate, but we do not as a rule check our children’s vision prior to beginning 12 grueling years of book work. Vision matters, and ignoring it is a problem for everyone. Simple sight checks in doctors’ offices and schools is tantamount to ignoring the problem.

Happily, there is a growing awareness of the importance of vision in learning through the work and research of developmental vision specialists, and an expanding discussion within and between a growing number of other professional groups, including more progressive practitioners in medicine, psychology and neuropsychology, occupational therapy, and education. Of particular relevance are notions such as:

  • Psychological testing, if it is formulated using text, symbols, and images, will always prefer children whose vision is properly managed.
  • Testing of this kind performed on children whose visual function has not been assessed cannot, or should not, be taken as valid or accurate.
  • Visually unimpeded children also have many fewer medical complaints compared to children with muscle control or focusing problems, or those who are simply farsighted, for example.
  • The visual developmental and functional status of a child is as relevant to the clinician as the child’s emotional health, nutritional status, and if he’s getting enough sleep.
  • Assessing a child’s visual behaviour at a very young age, such as 3 years, provides great insight into the possibility of later reading trouble.

It’s wonderful, then, that more and more professionals are referring children for visual assessment. After all, knowing there might be a problem is meaningless until you look and do something about it. Still, for a great number of our neighbors, vision and eye health services have been simply out of reach.

For aboriginal Canadians however, especially people living on reserves, optometrists are simply absent. Medical clinics offer a very rudimentary assessment that catches most disease issues, but largely missses problems with visual functions that affect learning and behavior. In the end, aboriginal Canadians who live on reserves, especially children, are at a measurable, important, and unnecessary disadvantage. Clinical studies will show that aboriginal populations also have a higher prevalence of high astigmatism, a condition that can lead to headaches and vision loss. Our very own neighbors, then, have two strikes against them and not enough is being done to address this problem. We all need to be concerned about any condition where our countrymen are disadvantaged for preventable causes.

For doctors who wish to address vision needs on reserves, government regulations have been prohibitively complicated, and getting paid can be a real problem when red tape gets in the way. In the end, most doctors make the rational choice and maintain practice in busy rural and urban clinics, as opposed to risk setting in more remote locations. The result is that very few children are ever checked Рand while the children suffer the most, we all pay the price.  For this reason, we continue with research and appeals to a number of stakeholders in education and government to promote more informed management of vision needs for children, especially.

Through a recent decision, the federal government, through NIHB, has great expanded access to vision care for aboriginal students in Alberta. NIHB is Health Canada’s office of Non-Insured Health Benefits for aboriginals. The decision has the effect of greatly reducing the administrative overhead that often left orders for glasses incomplete and unfinished under the previous rules. So, while a child might be suffering headaches, or maybe going blind from his difficult vision, no access to appropriate glasses due to complicated paperwork meant the resources to diagnose the problem and continue to support the child in school were wasted, and the child left without. With the simplified rules, the child is much more likely to get what he needs so he can finally start to participate in school and in life – just like we all do, and likely take for granted. In taking this step, NIHB is in effect¬† adhering more to the requirements of the Canadian Charter of Rights and Freedoms.

The effects of the lack of vision care in remote aboriginal communities continues to plague reservations across the country. It is not uncommon for communities to show rates of child vision assessment as low as 3 or 4%, while the prevalence of significant visual impediments to learning can reach 35% or more. Without proper care and attention, those affected will suffer and the costs to schools to try to set things right can run into the tens of thousands for a single child alone. The new rules go a long way to ensuring accessibility to vision care for children, but with no doctor availability, it is of little value. There are ways of filling this need, but greater awareness is required in government regarding the need and the options.

It’s nice to be able to report on such a great and meaningful step forward. There is no question that when children’s vision is well managed from the start, we all benefit in many ways. Able children can do the work they are given in school, and they also feel better and smile more often. These are children who graduate from high school and become the leaders of tomorrow. This can only happen when they get what they need. NIHB, through it’s streamlined approach to care, has opened the door to boost a whole generation forward.