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Keeping an eye on baby's sight can prevent a host of problems

  When Dr. Christopher Clark prepared for Kazuki Betzler's eye exam last week, Clark knew he wouldn't be asking the patient any questions.

As a 5-month-old, Kazuki — known to mom and dad as "Kaz" — can hardly tell him which lens is better or which way the E on an eye chart is pointing. But sitting on his father's lap in the exam chair, he can communicate with his eyes.

Clark holds a small stuffed animal up to the baby's eyes then slowly pulls it away. He moves it up, then down. And left to right. This simple test lets the doctor know whether Kaz can follow the object with his eyes. If not, there could be potential eye-alignment problems.

The whole exam, which includes other tests, takes only about 20 minutes, but to Clark the importance of such routine checks on young children are immeasurable. That's why he specializes in infants, and that's why he is participating in a nationwide effort to get parents to have their babies' eyes checked.

Launched in June by the American Optometric Association, the InfantSEE program provides one free eye assessment for any baby 6 to 12 months old from participating doctors around the country, including more than 200 in Washington state. The program does not cover additional costs if problems are found.

The target age range is critical, said the state's InfantSEE co-chair, Dr. Karen Preston, because parents often wait too long to bring their children to see the eye doctor. And the longer they wait, the harder it is to treat problems.

"People don't come in until there is an obvious problem," Clark said. "But if the problem is they are nearsighted in one eye, to the kid they think it's normal, and [they] get along fine using the other eye. They won't say anything."

Most parents also assume that their children's eyes are checked when they are brought in for regular pediatric exams, Clark added. But the pediatrician is looking at the whole body and won't be able to provide the more focused screening of the eyes that an optometric physician can.

Clark recommends a child's first screening be between 6 and 12 months old, the next at 3 years, then at 5 years and then every year after that.

While some critics may suggest eye doctors will benefit from the program with increased business, Dr. Christopher Barry, of Bellevue, sees the exams as a public service.

"It's free. I'm not a pediatric specialist so it's not like I'm trying to build up a practice," Barry said. If problems show up in a screening, he refers them to another doctor, he said.

As a pediatric eye specialist, Preston said screening more children would create more patients for specialists, but the whole point of the program is to catch problems that could have gone undetected and treat those in need.

Before sponsorship of the InfantSEE program, the American Optometric Association found in a 2002 study that one in 10 children are at risk from an undiagnosed vision problem including amblyopia (lazy eye), strabismus (cross-eyes), nearsightedness, farsightedness, astigmatism and eye diseases such as glaucoma.

Once, after giving a presentation on symptoms of eye problems to teachers at a Seattle elementary school, a kindergarten teacher told Clark one of her students might have an eye problem. The girl was always rubbing her eyes.

The teacher sent the parents to Clark who discovered the child had an obvious eye turn and that she was rubbing her eyes in an attempt to keep from seeing double.

"That was fairly easily treated, and now she's going through vision training," Clark said, adding that early screening can prevent eyesight-related behavioral problems. "Early detection can prevent the loss of that zeal and love of learning. Critical years can be lost if left undiagnosed."

No one knows this more than Wilma Schunke of Mountlake Terrace. Four years ago, her two sons, Adam and Erik, were diagnosed with eye-teaming and eye-tracking problems, meaning they had problems coordinating both eyes to work together — a skill important when learning to read.

Information

To find an InfantSEE doctor:

www.eyes.org

www.infantsee.org

But before the diagnosis, Adam, who is now 17, spent years struggling through school and being teased by classmates. School officials even suggested his mother get him tested for attention deficit hyperactivity disorder (ADHD).

Adam had seen an optometrist and had been prescribed glasses at an early age, but the doctors never tested for eye-tracking and eye-teaming problems. When he was finally diagnosed at age 13, he was reading at only a third-grade level, Schunke said. He underwent visual physical therapy and is now reading at a ninth-grade level and is entering his senior year, his mother said.

"That is huge compared to where we were at. It still makes me cry," said Schunke, her voice cracking. "When you think about all those years lost."

Her other son, Erik, was diagnosed much earlier, at age 7, and is reading at his grade level at age 11.

Nancy Torgerson, the boys' eye doctor at the Alderwood Vision Therapy Center, said any optometrist could have checked them for eye-tracking and eye-teaming problems during a regular eye exams, but not all doctors choose to do so.

Stronger legislation

Last year the Optometric Physicians of Washington helped draft proposed legislation that would require children referred to special-education programs to have eye exams, but the proposed bill was moved to the Board of Health for further study, Preston said.

The Vision Council of America released a report last month reporting that many states fall short of protecting children's vision. Only Kentucky requires all children to receive an eye exam before entering elementary school.

In Washington, children are required to be screened for visual acuity in kindergarten and grades one, two, three, five and seven, but doctors say acuity or the 20/20 test won't detect many other eye problems. The Vision Council report also found that Washington was among 29 states that require a vision screening but do not require follow-up eye exams for those who fail them.

Meanwhile, back at Dr. Clark's Belltown office, little Kaz gets a clean bill of eye health. His father, Ken Betzler, said he only heard of the InfantSEE program because Clark is also his next-door neighbor.

"I think the program is great," Ken Betzler said. "Sometimes we're overly cautions, but I think that's progress. The more we can prevent disease in a child and uncover something sooner, I'm all for it."