Monday, October 15, 2012

Back to school – How is your report card?


I am sure you all have that one patient who you remember, no matter how long ago it was. Whether it was a difficult case, a special person you could not help or an ornery patient resistant to your advice, it seems like yesterday. My case actually involves twin brothers.

They, now adult men, know I frequently discuss their situation. I was a recent graduate from ICO and, of course, I alternated between knowing everything to knowing nothing. While I was an employee of another optometrist, I was planning on specializing in children’s vision and vision therapy.

So one day, I found 11-year-old twin brothers, who had traveled 40 miles to see me, on my schedule. Their parents explained to me that the boys were struggling in school. They were bright children, but were having problems reading. They skipped words and lost their place frequently. They understand what was read to them, but could not comprehend what they read. (Hopefully this sounds familiar to everyone.)

BUT, the boys had been examined previously by both optometrists and ophthalmologists who could not find any problem. One ophthalmologist even told the parents that the boys “were faking.” The parents, with no other evidence to disprove this diagnosis, grounded the boys from playing football. As you can imagine, by the time I examined them, they were tuned out to school and very frustrated.

To make a long story short, both brothers had small angle esotropia resulting in amblyopia and decreased binocularity. The parents, and the boys, were so relieved to have a diagnosis. I can’t remember how many weeks they drove that 40 miles – each way – to undergo vision therapy, but I do remember the parents’ dedication to their children (they have 10). The question I kept and still keep asking myself is: How was this diagnosis missed? These boys could have been spared years of failing and frustration.

So what is the point of this story? It is NOT a push to pass legislation requiring eye examinations for children before entering school – although just the other day a patient asked me why her daughter had to have a physical, a scoliosis evaluation and dental exam before starting school, but not an eye examination. If Drs. Marla Moon and Carl Urbanski remember, one of the items I mentioned when being interviewed for a POA Board position was my desire to see legislation passed regarding children’s vision. Unfortunately, the time is not yet here in Pennsylvania. Fortunately, children’s vision is an essential benefit in the Health Care Reform mandates. The AOA has worked diligently so more people are “seeing” the importance of vision care for children at early ages.

 But do we really need legislation? More importantly, are we ready for such legislation?  Are we – as local optometrists – getting out the message to our communities regarding the need for children to have eye examinations? Do you proudly display POA’s Kids Welcome Here® and Vision is Elementary® posters in your office? Do you use POA’s Kids Welcome Here brochures to educate your patients with young children about the need for vision care for their kids? Do you volunteer to present POA’s Children’s Vision: A Guide for School Nurses and Teachers to your school district during inservice days? We all need to be an advocate for our profession and for the children in our school districts. We need to speak to school nurses, educators, pediatricians and others regarding the relationship between vision and learning. We should be their source of information regarding vision issues.

But, even more important, are we – the local optometrists – examining these children for visually-related learning problems, or are we just checking visual acuity, eye health and declaring there is no problem? I frequently lecture to school nurses regarding the vision screening requirements using POA’s education program. With financial restraints, more schools are decreasing the number of school nurses. At the same time, the nurses are required to perform more duties. One of their biggest complaints is when a child fails a vision test and is referred for further evaluation, and the eye care professional says there is nothing wrong and doesn’t know why the child was referred.

Okay, I realize that not all of us are interested in, or cannot, examine children.  But, we all need to familiarize ourselves with the signs and symptoms of visually-related learning problems. We do not need to know if a convergence insufficiency case has a high or low NRA, but we should be able to identify the deficiency and have some ideas regarding remediation of this problem. We cannot fail these children; we can refer them to colleagues who do work with children. We need to help children with or without legislation. Do not let children go misdiagnosed. Prove naysayers wrong. We know vision is vital to learning, why doesn’t everyone else?

Receive a great report card this school year; help the children in your community. Request POA’s Kids Welcome Here materials – they are free to members – and make sure parents understand the importance of pediatric eye care. Contact your school to volunteer to present education to your school nurses and say “yes” when POA calls you with a presentation opportunity.

Does my authority as president of the POA extend to giving Dr. James Spangler, Dr. Marla Moon and the rest of the Pediatric Task Force A+s for their dedication to the visual welfare of the children in Pennsylvania? Absolutely; they have earned A+s.Thank you to these doctors and all of you who work with school nurses, educators, and other professionals to enable children to succeed in school and in life.









Donna M. Buraczewski, O.D.
President
Pennsylvania Optometric Association
http://www.poaeyes.org/