An Interview with Steve Galanter: Vision in the Classroom

Aug 10, 2011 by

Michael Shaughnessy
Eastern New Mexico University
Portales, New Mexico

1) Steve, what is your exact title and what exactly are you trying to accomplish?

I am a Doctor of Optometry, practice primary care and am President of Visual Technology Applications, Inc., a company which is trying to elevate the awareness of vision in educational settings via our two tiered VERA (Visual Efficiency RAting) vision screening program. The fact that school vision screening is quite variable and misses up to half of vision problems is a large and costly problem in education.

We’re providing an accurate, standardized way of dealing with this. VERA’s general screening component is designed to identify more students with common vision problems, to better communicate these issues to parents and teachers and to facilitate getting these students to visit an eye doctor. Then our unique vision skills assessment determines which underachieving students struggle to learn because of abnormal focusing, eye tracking and/or eye teaming even though they can see the board clearly. These problems have previously required identification by a vision specialist.

2) Now, it seems to me that more and more kids are wearing glasses nowadays any ideas as to why this is?

There are many reasons. Vision care is more accessible than in the past, is funded by many insurance plans and is promoted through outreach from the vision care industry and associations of eye doctors. The stigma associated with wearing glasses is less of an issue as well; glasses suggest intelligence and can be a fashion accessory as well as an assistive device. In addition, some children can become nearsighted as an adaptive response to the ubiquitous near vision demands of our technological society.

If you think about it, our concept of good visual acuity is all distance based; i.e. seeing the eye chart from across the room. Successfully adapting to lots of close work can leave you nearsighted since your eyes no longer have to focus as hard to see close. Perhaps that’s why glasses are casually associated with intelligence?

3) Most teachers are brilliant observers they notice kids squinting at the board, rubbing their eyes, etc. What steps should they take?

If a teacher suspects a vision problem, they should follow any protocol to refer students to the school nurse. But many teachers correctly sense that it’s not uncommon for students with vision problems to pass the school’s vision screening. Since teachers see a lot of the vision based learning difficulties that nurses and even parents won’t, they should consider encouraging parents of symptomatic, underachieving students to have their child’s eyes examined in any case. They should also inform personnel involved with individual educational planning if the student is being considered for special educational services. We have a behavioral checklist on our website if teachers would like to see a complete list of symptoms.

Teachers can try to accommodate these students in class by adjusting seating, reducing visual demands and providing auditory learning support if time permits. We offer information on how to do this in our program’s “Teacher Guide”. It’s important to remember that when underachieving children manifest symptoms other than not seeing the board clearly, the difficulty is often with sustaining clear focus, eye tracking and how easily both eyes are used together.

As per your question, Michael, you may find it interesting that a recent article in the journal of the American Optometric Association performed a survey of some teacher’s observations of these vision problems. While 69% noticed squinting, only 13% noticed rubbing of eyes! 46% noticed inability to see the board, 33% associated reading skills with vision and only 6% associated attention difficulties with vision. If this limited survey is any indication, there’s a lot of work to be done in terms of raising awareness.

4) Sadly, a lot of kids come to school without their glasses when should a teacher be contacting a parent?

After reinforcing the need to bring their glasses to class to the student, a teacher should contact a parent when they notice visual symptoms. They should also encourage parents to let any teachers know when glasses are prescribed and to request a call if they’re not being used. Most eye examination referral forms ask eye doctors when any prescribed glasses should be used (i.e., constant wear, reading only, distance only) but I doubt this information makes it to many teachers. This is another example of the importance of communication of vision issues along with proper screening.

5) Steve, you have sent me some information about vision screening- can our readers access this on line?

Michael, thank you for this opportunity for shameless promotion. To the delight of your readers, I’ll keep this short.

The VERA program, along with information for school nurses, teachers, occupational therapists, eye doctors and parents can be found at www.visualscreening.com Much of the VERA program is free, can be downloaded from the site and will run on most any Windows PC or laptop. If everyone used only the free version, there would be far fewer undetected and uncorrected vision problems.

6) You may have been asked this a lot but what about excessive computer use? Does it damage the eyes? Cause kids to need glasses?

I think we can all agree that “excessive” is the new normal. This goes back to your question about more kids wearing glasses computer use is not ipso facto physically damaging, but can create repetitive stress symptoms, among which are acquired nearsightedness, astigmatism, headaches and fatigue from constantly focusing up close. At the risk of over-simplifying, let’s look at this since it’s a very important question. Eye muscles are “skeletal”, meaning they are under conscious control. The muscles working your arms and legs and the muscles turning your eyes and focusing them are all under conscious control.

Think of computer use in terms of how your arms or legs would respond to a physical demand with similar characteristics. If I ask you to lift something heavy and hold it in outstretched arms, your muscles become painful and stiff, resulting in reduced range of motion until they recover. Same for the eyes; “holding something heavy” is maintaining a constant close focus, “painful ” is headache and “stiff” is sluggish adjustment of plane of focus afterward.

Let’s take this a step further. If you go to the gym and work your arms and legs (while you scream the “no pain, no gain” mantra in your head), your muscles adapt to these repeated demands by either becoming stronger or gaining increased endurance.

It’s the same for the eyes; “repeated demands” is the constant close focus of computer use, “stronger” is the adaptation by becoming nearsighted (a nearsighted eye has “near sight” and doesn’t have to focus as hard to see up close) and “endurance” is simply being able to focus up close for much of the day. Since children’s eye muscles are more flexible, some may respond to this scenario aggressively, and so one could say that computer use can cause some kids to need glasses. But not everyone experiences this effect; some people remain asymptomatic or don’t experience prescription changes, some just have occasional mild headaches or eye strain, etc.

We have a continuum of responses as with any other environmental stressor. But luckily for all of us, you can’t actually wear your eyes out or physically damage them from close work.

7) Many years ago, I studied retinopathy of prematurity or retrolental fibroplasia. Does this condition continue to exist?

It does, but is fairly rare. RF is generally associated with too little or too much oxygen supplied to the retinas of premature infants, which causes abnormal blood vessel growth within the eye. Oxygen given to premature infants is regulated to be below threshold for this condition and pediatric ophthalmologists routinely examine these infant’s retinas and intervene when necessary. It’s not something an educator is likely to see. Many sites offer information about RF, including: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002585/

8) Pink Eye or conjunctivitis-what should a teacher look for, and more importantly what should they do?

Michael, the first part of the question reminds me of “What color was the Lone Ranger’s white horse?”

The answer of course, is to look for the white of the eye to appear unusually pink or red. Let’s do a quick primer on this. There are two main types of conjunctivitis: viral and bacterial.
“Pink Eye” is a type of viral conjunctivitis (where the eye has a decidedly pink rather than red hue) that is usually watery but free of any crusty buildup or exudate. Bacterial conjunctivitis has more of a red appearance and frequently associated with a yellowish or greenish discharge. Either can affect one or both eyes and it’s easy to confuse the two at first glance.

Both require professional attention (although pink eye is frequently self‐limiting) and both should be considered contagious. The teacher should discourage the student from rubbing an unaffected eye and encourage vigorous and frequent hand‐washing. Practically speaking, most teachers should and will refer to the school nurse, who will handle the situation properly. If a school nurse is not available, the teacher should call the parent or arrange for a call to be made with a recommendation for the child to see an eye doctor as soon as possible.

9) Do you have a web site where teachers can get more information?

We’ve covered two areas of problems so far; medical and visual. For medical issues, searching the web for sites such as WebMD or by a specific condition is always fruitful. For issues surrounding vision, I’d recommend www.aoa.org and www.covd.org as good places to start. We’ve presented information at www.visualscreening.com that ties together the interests, concerns and perspectives of teachers, parents, eye doctors, school nurses and occupational therapists.

10) What have I neglected to ask?

Your questions were relevant and balanced, thank you, so I’ll offer a quick summary. I think the underlying theme of our discussion is that a coordinated approach involving all the participants we’ve mentioned is needed to address the huge impact vision has on learning readiness and academic performance, not to mention the success and self-esteem of students. Good vision is more than a school health requirement; it’s an educational imperative.

 

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