why the vision screening at the pediatrician’s office wasn’t good enough

Zoe had her 4 year old well-child visit a month and a half ago.  At that visit, they did the normal preschool vision and hearing screenings.  I was pretty interested to see how they differ from the actual exams, as Zoe’s had full exams of both her eyes and ears in the past 6 months.

The hearing screening seemed pretty good, not a lot of room for subjective calls by the nurse or for Zoe to cheat on it, though I’ll readily admit, I know a lot less about hearing tests.  The vision screening was another story, though.

The nurse led Zoe to a hallway and had her stand at a mark on the floor and read lines on the Lea chart (square, circle, house, and apple shapes) with one eye covered.  She did fine with her left eye, but when she tried to read the chart with her right eye, I watched her try to cheat by moving the paddle away from her eye, and moving forward a foot or so past the line to see better.  She still couldn’t read the same line that she did with her left eye.  The nurse said nothing and I was not referred to get her vision checked out further.  Now it may well be that the nurse figured that since Zoe wears glasses, she is already seeing an eye doctor and didn’t need a referral, but I was still pretty annoyed at not getting any feedback.  Still, I knew her regular eye appointment was coming up, and thought (hoped) that there was maybe a chance that she was seeing fine.  So I decided to wait until her regular visit to see what her eye doctor thought.

That visit was today.  Sadly, it was again clear that her right eye just wasn’t seeing nearly as well as her left, and according to her ophthalmologist, a stronger prescription wouldn’t do anything to help it.  In other words, we’re now looking amblyopia square in the face.  Zoe did her first patching session this afternoon.  Tonight when we read Fancy Nancy Spectacular Spectacles, she asked whether Bree needed to patch, too.  She’s worried about kids laughing at her at daycare.

Knowing now that Zoe really was struggling to see with her right eye, I’m even more upset by the casualness of the vision screening.  In our case, it ended up not having horrible consequences, we still caught it and we’re treating it.  But what if Zoe wasn’t in glasses and didn’t have regular full eye exams?  What if I didn’t know how to spot her cheating and what that might mean?  Not treating amblyopia has serious implications.  I strongly recommend that all parents get full eye exams (not screenings) for their kids at least before they start school if not earlier, and not rely solely on a screening.

Oh, and I’m happy to take any patching wisdom that any of you have to offer.

14 responses to “why the vision screening at the pediatrician’s office wasn’t good enough

  1. Ann, I’m so sorry to hear this! I would be very upset, too, about how the exam was handled, and about the bombshell of amblyopia in general. When Stella first got her glasses, we got used to it, and thought, “Well, this is it, we took care of it.” And then we were told to start patching at the very next appointment and it hit me really really hard. BUT, I can also say that we are seeing amazing results with patching and vision therapy.

    Patching with tape really works for Stella, and is preferred by our developmental optometrist, and I’ve rigged it so that she can’t peek. It just looks kind of like one of her lenses is fogged up. So if the other forms of patching aren’t working (though I suspect Zoe will be great, as she has been with her glasses), or if you’re interested in an alternative, I’d be happy to fill you in more on this. (Though I suppose all this is redundant since I wrote a post about it and you know our deal.) Just wanted to offer some support and encouragement–since you’ve given so much to everyone else here. It’s clear that you’re already doing an incredible job helping her adjust. Zoe will be just fine–it’s great that you caught it early, since just a few months ago she passed her exam without this issue. Hang in there!


  2. My grandson has been patching for about a yr. now. He is 5 and there were many struggles. He likes wearing the patch in the morning, so he does his 4 hours at preschool. His parents were a little hesitant about this but it has worked out fabulous, and NO ONE teases him. In fact, the other kids were just curious. His teachers are wonderful, and often do the patching. Finding the right time for Zoe is important. He likes to pick out his own patch, so that helps too. They make adorable patches for both boys and girls. Try the ortopad website. They are great and you can order them on-line or call and talk to someone.


  3. Hi Ann,

    My son has been patching for over a year now- he just turned three. We started with the traditional band-aid patches (ortopad). They worked okay, but taking them off (and we tried all the tricks) still was like taking off a band-aid. So I did a little research on patches that go over the glasses- by recommendation from his eye doc. We didn’t go with the one he recommended, but with ‘Frame-huggers’. The maker makes the patches according to the measurements of his glasses. We’ve bought two and I can say my son can’t peek or cheat while wearing this patch. It was been the best thing we have bought him. Even his eye doc was surprised at how well the patch was made. Some kids are curious and will ask him about it, but no one has ever teased him. His eye sight has improved over the year. We now only patch two hours of the day (for a year we patch 4 hours a day). We stop patching in a month then will return two months later to see if he will have to continue. Good luck & thank you for all your post about this topic. My husband and I enjoy reading them.


  4. I think what made our son so accepting of the frame hugger patch, is that we could customize what was on it. We started with a pooh bear one, which he was excited to get, and now he wears his Thomas the Tank Engine patch. I have yet to hear him complain about wearing it. The frame huggers are extremely tough and seem like they’re comfortable for him in the summer and winter.


  5. Ann,
    I’m a big fan of the adhesive patches. Only way to go (in my opinion). You may find the Ortopad line interesting, if adhesive is the route you choose.

    We’ve been patching routinely now for years, much of it upwards of 4 hrs per day. It is an uphill battle sometimes, but very worth the effort. Positive reinforcement, and then act like it’s not there. I think Zoe’s worry about daycare will pass quickly. Kids will be curious for a bit, but otherwise don’t see the patch, just the child.


    • Thanks. We got the Ortopad patches from the eye doctor’s office. Unfortunately, they only had the boy version. Not that we’re pushing Zoe into being all girly, and she’s been happy to wear the pirate and rocket and stars patches, but she does like the occasional butterfly and princess.

      She hasn’t mentioned being worried about kids laughing at her, and today we had two of her friends over while she patched and neither said anything, so I’m hopeful. We’ll see what tomorrow brings. This is the week that they’re moving her to the pre-K room, too, so things will be different anyway. Her teacher asked if we wanted to put off the classroom move, but I’m pretty sure that it would be especially bad if we tried to tell her she wasn’t moving to the new class because of the patch.


      • Check out the Ortopad site. They offer good, speedy service..should you choose to order.

        Best of luck this week. Don’t worry, all will be well…


  6. Hi Ann – C’s been patching since 7 months old, ranging from 1/2 hour to 4 hours, depending on the outcome of her eye visits to the pediatric ophthalmologist. There was a short period where we didn’t have to patch. Currently, she patches for 1/2 hour a day (at 3.5 y.o).

    When C was younger, we used the patches (Patch Pals and Luxeye) that cover the eyeglass. We purchased these via Ortopad’s website. When C switched to her current metal frames (instead of plastic Miraflex frames) and had to patch again, I found that the patches that cover the eyeglasses did not completely cover her eye.

    So, I switched her to use the Ortopad adhesive patches. The Elite Hypo-allergenic patches are great. They come off nicely and don’t leave any red marks on her face.

    To get her used to wearing patches again (after a period of not having patches) and switching to the adhesive patches, we used these to motivate her:

    1. Patch tree. After a few weeks, this didn’t have that much excitement anymore for her.

    2. For a short time, my husband would also wear a patch like C. She enjoyed this tremendously to see her dad in a matching patch.

    3. I gave her a few patches to put on her stuffed animals and dolls.

    It seems a lot of kids patch – last summer at the amusement park, I saw two little kids with patches. And, currently, one other child in C’s preschool wears patches (and patches at home).

    Good luck on the patching!


  7. Ann – Emma was diagnosed just a few months past her 4th birthday and she began patching about 6-8 weeks after she got her glasses. Her birthday is in October too, so she was just about the same age Zoe is when she started patching.

    We used Ortopad patches exclusively the first 3 months of patching….her skin was quite irritated by the patches her PO uses and they recommended Ortopad to us. I let her pick out the patterns and she would often match them to whatever she was wearing. We have also used Anissa’s Fun Patches with success. I will have to say I have been lucky – Emma has always been very compliant when it came to patching and she was not upset when I told her she would have to patch. She was in preschool at the time and sometimes she wore them to school and sometimes she didn’t (we were patching 4-6 hours a day in the beginning). It helped for me to give her some choice as to when she patched during the day.

    I also made many tiny patches out of bandaids to put on her Littlest Pet Shop cats…..she really seemed to like that! We did patching charts (Ortopad sells really neat posters to put the patches on at the end of the day) and recognized big milestones (like when she filled up her first poster).

    We have never had anyone say anything negative to her regarding her patch nor did any of her classmates or neighborhood friends ever tease her. They were curious in the beginning and asked a question or two but that was all.

    My only other advice? To be patient….we had good patching days and bad patching days. We had appointments where she made tremendous progress and others where she didn’t and her vision stayed the same. But I am happy to say it pays off….in December, after patching for nearly 21 months her PO officially told us we could stop (she has a follow up in April to make sure she is doing OK). It’s funny….it was such a part of our lives I still find myself seeing a patch lying around and thinking “oh….we need to patch today!”

    And Emma’s response to being told she didn’t have to patch anymore? “But I want to! I like to patch!”


    Good Luck!


  8. Not all pediatrician’s offices are that lax. The only reason we knew to take our 4 yr. old to the Ophthalmologist is because of the vision screening at the pediatrician. They caught that she didn’t do as well with one eye as she did the other and told me that she needed to see and ophthalmologist not an optometrist. They even had a name to give me that accepted my insurance. We found out that she has astigmatism in one eye so she was heavily favoring the other one. We’re fortunate that glasses to correct the astigmatism did the trick so no patching. I thought I’d share that there are great pediatricians out there. Perhaps a call or note to yours would help them do a better job in the future.


    • You’re right, and I am planning on talking with our pediatrician at our next appointment. She was the one that referred us to a pediatric ophthalmologist when we noticed Zoe’s eyes crossing (our ped. didn’t see Zoe’s eyes crossing, but she believed us when we brought it up, and sent us there), so I know she values vision help. I think that’s part of why I was so surprised at how lax the screening was.


  9. Pingback: 5 years in glasses | little four eyes·

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