Setting young students up for success

One in 4 school-aged children has a vision disorder.¹ There is a direct correlation between undiagnosed vision problems and school performance.^2-4 Most obviously, we think about distance visual acuity, because if a student cannot see the board or the teacher, they are unlikely to perform well. However, accommodative function and stereoacuity have also been shown to be predictive of reading performance in kindergarten and first grade.² Young students do not always complain about not being able to see. Instead, they may develop headaches or eye fatigue, or avoid reading because they have near-vision or focusing issues. Children with eye-tracking problems may experience that words “jump around” on the page, making reading more difficult and frustrating. In addition to these issues being reflected in classroom grades, they also often manifest as attention or behavioral issues or a lack of motivation. The child may be labeled a “problem kid” when, in reality, they have uncorrected vision problems.

Kids who see a pediatrician annually will typically get a quick vision screening every year or two. Most states also require schools to conduct vision screenings before admitting students to kindergarten or first grade. Although these screening systems are important—they catch many vision problems and lead to referrals to eye care providers—they are not comprehensive eye exams and do not result in a prescription. Vision screenings are primarily designed to make sure the child can see 20/25 or better at distance and to evaluate for amblyopia, with a referral to an optometrist or ophthalmologist if the child fails the screening. Ocular alignment and depth perception may also be evaluated. However, screenings typically do not detect more subtle vision disorders, such as near convergence, accommodative issues, ocular motility or eye-tracking problems, and stereoacuity.

As optometrists, we have a responsibility to encourage families to schedule comprehensive eye exams for their children so we can fully evaluate their ocular health and vision in the office. Here are 4 strategies for setting kids up for success in school—and for a lifetime of good vision:

1. Talk to your adult patients about using their vision benefits for the whole family. Back-to-school season or school breaks for the holidays or summer provide the perfect opportunity to encourage parents to get their children's eyes checked. The American Optometric Association, through its InfantSEE program, recommends scheduling a child's first eye exam between 6 and 12 months of age. Even if parents have missed this free infant visit, I strongly encourage a full exam before starting kindergarten. That is a great time to catch vision issues before they affect school performance and to establish good habits for annual eye exams.
2. Make your practice family-friendly and welcoming to younger children. This might include having an area of the waiting room with smaller chairs and books or toys, and certainly stocking a good range of children’s frames. In our practice, we recognized that it can be challenging for families with several kids to schedule appointments for all of them and deal with siblings during another child’s appointment, so we have implemented a “family day” several times per year when the whole family can be seen at 1 appointment. There are lots of kids there, and we make it a fun event for all.
3. Let families know that you offer multiple services for kids beyond just glasses. For example, for our young patients who are active in sports, we offer sports goggles and contact lenses so that they do not have to worry about breaking their glasses or having them slip around during exercise. Many parents do not realize that kids can wear contact lenses even before the teen years, depending on their maturity. Some kids are embarrassed to wear glasses, so contact lenses can be a welcome alternative. To safeguard against issues with consistent hygiene, a daily disposable lens can eliminate the need for cleaning and handling multiple times. We also offer vision therapy and myopia management for appropriate candidates.
4. Do not forget to talk about UV protection. Most parents know they need to use sunblock on their kids, but they may not be aware that ocular UV exposure has been associated with pterygium, pinguecula, melanoma, photokeratitis, and accelerated development of cataracts and age-related macular degeneration.⁵ The majority of UV damage happens before the age of 18 years, in part because young lenses transmit much more UV radiation than older lenses.⁶ I always recommend that kids wear sunglasses and hats, and I also offer contact lenses with Class I UV blocking. Lenses in this class, which includes all of the Acuvue brand silicone hydrogel lenses as well as a few others, block at least 90% of UV-A and 99% of UV-B radiation. Among these, Acuvue Oasys MAX 1-Day lenses block 99.9% of UV-A and 100% of UV-B rays.

School vision screenings are an important step in directing young people to the eye care they need, but they do not go far enough. Ideally, we should all be reaching out to families in our practices and communities to encourage comprehensive exams and eye care before children start school.

Author bio

Danielle Richardson, OD, is a glaucoma-certified therapeutic optometrist, currently practicing in Los Angeles, California. She specializes in LASIK surgery comanagement, contact lenses, dry eye, and digital eye strain. She is a consultant for Johnson & Johnson Vision Care.

drdaniellerichardsonod@gmail.com

References

1. Evidence-based clinical practice guideline: comprehensive pediatric eye and vision examination. American Optometric Association. February 12, 2017. Accessed January 28, 2026. https://www.aoa.org/aoa/documents/practice%20management/clinical%20guidelines/ebo%20guidelines/comprehensive%20pediatric%20eye%20and%20vision%20exam.pdf

2. Kulp MT, Schmidt PP. Visual predictors of reading performance in kindergarten and first grade children. Optom Vis Sci. 1996;73(4):255-262. doi:10.1097/00006324-199604000-00007

3. Alvarez-Peregrina C, Sánchez-Tena MA, Andreu-Vázquez C, Villa-Collar C. Visual health and academic performance in school-aged children. Int J Environ Res Public Health. 2020;17(7):2346. doi:10.3390/ijerph17072346

4. Krumholtz I. Results from a pediatric vision screening and its ability to predict academic performance. Optometry. 2000;71(7):426-430.

5. Taylor HR. The biological effects of UV‐B on the eye. Photochem Photobiol. 1989;50(4):489-492. doi:10.1111/j.1751-1097.1989.tb05553.x

6. Van Kuijk FJ. Effects of ultraviolet light on the eye: role of protective glasses. Environ Health Perspect. 1991;96:177-184. doi:10.1289/ehp.9196177