Cycloplegic refraction vs. limitations of school eye vision test programs

Dr Manish Shyamkul Eye doctor & Child Eye Specialist in Mumbai
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Cycloplegic Refraction and Vision screening in schools

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Limitations of school eye vision test programs

What does Cycloplegic refraction mean?

  • Cycloplegic refraction is a procedure which is done by pediatric ophthalmologist.
  • Cycloplegic refraction is used to get details of the complete refractive status (power) of the eye.
  • Cycloplegic refraction is done with the help of cycloplegic eyedrops,which leads to temporary paralysis of the focusing muscles of the eye called as ciliary muscles of the eye.
  • due to the temprory paralysis of the ciliary musles ,patient is not able to exert any strain on the eye.
  • when the eye strain is absent your doctor is able to get the complete refractive status of the eye as the eye strain is not able to interfere with the results.
  • Cycloplegic refraction is a commonly performed procedure and must in kids for eye glass power checkup.

Before learning about the Cycloplegic refraction ,let us learn about the School eye vision test,and the accuracy of School eye vision test and pitfalls of School eye vision test.

What is school screening test?

School eye vision test is just a screening procedure and marks the beginning of children’s eye exam, and parents should not consider it, as the final end step. school eye vision test  screening program is not a substitute for children’s eye examination by performed by children’s eye specialist doctor.

“School screening eye vision test program is just the beginning of the child’s eye exam and not the final step”.

If you want to read “children’s eye examination by children’s eye specialist “ or continue reading to learn more about short comings of school eye vision test, in this article.

we recommend you to read,

If your child, is able to read, that does not mean, his or her vision is normal. This is a common misconception which is, prevalent in our community.

Are school vision screenings accurate?

Most of the parents take school screening eye vision test, as the final word and relax, in spite of the child’s eye problem. And on further questioning, the most common answer received is “but the school eye vision test is normal “report said child’s vision is fine, and hence we did not sought help from children’s eye specialist  doctor.

If your child is able to be read, what’s written on the board and what’s written in the book, this does not mean, that eyes are working optimally. As in this case, reading is only one aspect, which is taken into account and all the other parameters, are not considered and are not the part of school eye vision test program. This results in incomplete examination of the child’s eye.

I am sure; everybody feels that seeing (READING) is the function of eye. But as far as children’s eyes specialist’s opinion, is concern that is not true. Seeing is only, one of the functions of eye. There are numerous other functions which our eyes perform and we are not even aware about it.

The aim of this article to, educate and inform parents about the school screening eye vision test, and the need for complete eye examination of the child, from a children’s eye specialist doctor.

Apart from visual acuity, there are many parameters, which need to be examined and confirmed, and only after doing so; one can say that your child has undergone a complete eye examination. Otherwise, in the absence of cycloplegic refraction and the other parameters, your child’s eye examination cannot be called as a complete eye examination.

The aim of article is to educate and inform parents and society in general, about the numerous functions, which your eye performs. The health of your eyes is commented, only after examination of all the functions of your eyes, and not by measuring only one aspect of vision.

A good initiative of “school eye vision test” or “children’s eye vision test in schools” is been performed in schools and this marks the beginning of the child’s eye exam ,but it is a screening procedure and not a substitute for complete eye exam done by children’s eye specialist .

Once the screening of your children’s eyes is done in school, parents tend to relax, thinking all is well !  Very sorry, you are under the false impression, that your child’s eye examination is over and is normal.

But mind it ,if you read it carefully- what your child has undergone in school, is a “children’s eyes screening “ and not “children’s eye examination”.

There is a huge difference between children’s eye screening performed by available school administrative staff, and children’s eye examination performed by children’s eye specialist doctor.

During children’s eye vision test  in schools, children and made it to, read the vision screening chart, from a particular distance, and if the child is able to do it, then it is considered that the child’s vision is a normal. And as parents you are also informed about the same, and we are all very happy about it.

Let’s clarify this, in detail so that, we become very clear in our understanding, and will also be able to spread the same awareness among others.

If a child is able to read, till the last in line on the eye vision test reading chart, that means, vision is 6/6 or 20/20 as per American medical standards, designating normal visual acuity.

But, visual acuity is just one of the parameters, which is considered during the eye screening in schools. This does not mean, it is the only parameter. There are several other parameters which need to be fulfilled, and must be under normal limits in accordance with the defined accepted criteria and only then, can we say that the child’s eye exam is within normal limits. This can never be achieved, only by doing vision test.

Let us first try to understand,

  • the meaning of “school screening eye vision test (cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor )”.,
  • who are performing school screening eye vision test, and
  • what is the aim of performing of school screening eye vision test (cycloplegic refraction is not included in this school eye vision test  vision program).

School screening vision test

What is the vision screening?

(cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor )

school screening vision test, is a welfare program which was initiated, so that oblivious and manifested ,children’s eye problems can be picked up and then such children are referred to children’s eye specialist for complete eye examination and eye treatment.

Mark my words here “oblivious and manifested”……what about all those problems which are not yet oblivious or have not manifested……and unfortunately  all such scenarios are missed , or  not even looked for ,by the untrained staff ,and truly speaking it is not even expected out of school screening eye vision test (lacking cycloplegic refraction), as the motto of school eye vision screening  program is entirely different and it was never ever meant to be a substitute, for a complete eye examination by a children’s eye specialist doctor.

What does Cycloplegic refraction mean?

The motto of the school screening eye testing program (lacking cycloplegic refraction) is –to screen out those children with already existing severe vision difficulties and send them to children’s eye specialist for further examination.

But this screening is only limited to gross distance vision difficulties. Other aspects of eye vision tests like retinal diseases, ocular movements etc. were never part of this testing. And what if your child was suffering from one such problem, which was not checked and still on the basis of distance reading he or she was passed in school eye vision test  (cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor )… Think about it !!!

The basis of school eye vision testing program is simple and very basic-“to screen out ,children with eye disease “suspicion”…and refer to children’s eye specialist for further examination and confirmation “and not to prescribe glasses on the basis of eye vision test chart.

It is wrong to prescribe glasses in children, without doing detailed eye examination of the child and cycloplegic refraction.as the decreased eye vision could only be a warning sign of some other eye disease and other retina problem ,which will be missed completely if only glasses are given that too…without cycloplegic refraction and fundus examination. Without cycloplegic refraction, your child will get wrong prescription of glasses, and hence cycloplegic refraction is must for complete eye examination in addition to other tests.

It is only a screening, and not complete eye check-up.

For example…in blood pressure check-up camp ,if your blood pressure is normal …does that mean your heart is disease free…..no !!! Your heart might still be diseased, with normal blood pressure .if you consider you are normal, you are at the risk of having a full blown up heart disease which will only be picked up at later date and unfortunately it is called as “delayed diagnosis” .

So now have you understood …normal blood pressure does necessarily mean… .Heart’s functioning is normal. And like wise. Normal vision does not necessarily mean normal eyes.

Limitation of school screening eye vision test:

(cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction )

There are lot of limitations, as far as school screening vision test is concern. All the gross problems of children’s eyes might be sometimes picked up by school screening vision test.

But that does not mean that “all the eye diseases and eye problems” are picked up by school screening vision test (cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction ).

Lot”s of eye problems are missed during the school screening vision test due to lack of cycloplegic refraction.

And all those school children who pass the school screening eye vision test, are under the impression that their eyes are normal. This leads to a false sense of security among parents, and they ignore, further evaluation for their child’s eye problem.

School screening vision tests are able to pick up very high refractive errors,(high power in  kids- glasses) and few other gross eye problems. But think about all those problems which were never dealt by school screening vision test and yet the child was, passed in his school screening vision test((cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction )

All the finer aspects of vision, ocular movements, micro-movements, watering ,eye strain ,headache ,retinal disease, vitamin deficiency signs, optic nerve diseases and the list is endless…all such eye problems and  other functions of the developing eyes and developmental eye problems are missed or are never checked during the school screening vision test ((cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction )..

So it is very important for parents to understand, that they should not rely on this false sense of security and this should not hamper them from taking consultation from the children’s eye specialist doctor for children’s eye problem.

There are lots of limitations of school screening vision test (cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction ), and are as follows,

Who performs school screening vision tests ?

(cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction )

In most of the schools, school screening vision test (lacking cycloplegic refraction). s are being performed by the school staff, admin personnel, optician (eye glasses seller agency). But the qualification of the individual performing the school screening vision test(lacking cycloplegic refraction) is inadequate and does not mean that he or she has done a complete eye examination of the child.

Insufficient equipment’s while performing school screening vision test ?

(cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction )

When school screening eye vision test is performed (lacking cycloplegic refraction), it is usually done in the classroom setup or an administrative cabin setup. And mind it, this is not the clinical setup where the tests are performed and all things are calibrated according to the clinical guidelines including the lighting condition of the room and all other minor aspects in examination is taken in to consideration.

School screening eye vision test setting (lacking cycloplegic refraction) is a temporary setup, where few things are arranged and vision test is performed.

The lighting of the room, the distance at which the child is reading, the eye vision testing chart, illumination of the chart and there are so many other parameters which are questionable in search temporary environment.

Also when the school screening vision eye test is being performed (lacking cycloplegic refraction), usually children’s distance vision is the only aspect which is checked. If a child is able to read at a distance that does not mean, his or her near vision is good and need not be checked, nor does it mean that the overall eye health is normal.

Distance vision is just one of the aspects of our eye function, and having only this one parameter within normal limits, does not mean that all the parameters of the eye function are within normal limits and definitely does not mean that your eye health is normal. This can only be confirmed by, child’s eye examination in detail by the children’s eye specialist doctor.

Parents should never be under the impression, that the eyes are normal as the school screening vision eye test has passed their child (without  performing cycloplegic refraction). This only generates false sense of security among parents and leads to further delay in consultation with the children’s eye specialist.

In these delayed situations when the child is presented late to the children’s eye specialist doctor, the diagnosis is delayed and the treatment is also delayed.

So it is very important for parents to understand that., school Screening eye testing (cycloplegic refraction is not a part of school eye vision test  vision program and need to performed in clinical setup by children’s eye specialist doctor- cycloplegic refraction ), is just one very minor aspect of eye testing, this cannot be compared or can never  be a substitute for your child’s eye check-up, by a children’s eye specialist doctor.

This brings us to a million dollar question,

what do you mean by child’s complete eye examination?

Let us answer this question, of child’s eye examination in a step-wise manner, so that you understand it, clearly and thereby you will be able to spread awareness to the others about their child’s eye examination.

Now if you have understood, what your child has undergone is a vision screening testing and not children’s eye examination.

This kind of examination is an incomplete eye examination, and definitely does not mean that your child’s eyes examination is complete and your child’s eye examination is normal.

Let us see, what are the different parameters, which are taken into account during the children’s eye exam by children’s eye specialist doctor.

What is a basic eye exam?

And,how does it differ from,

Children’s eyes examination

Vision, ocular moments, cycloplegic refraction, post mydriatic test, eyes alignment, and determining refractive error, vitamin deficiency signs & symptoms, examination for lazy eyes, examination for squint which may not be evident to you, fundus eye examination, examination of the Retina and optic nerve, binocularity, binocular eye moments, examination for causes of headache, examination for causes of eye strain, correction of refractive error, and eye vision exercises.

These are the parameters which are examined by a children’s eye specialist, during your child’s eye examination. And only after, examining all this parameters, one can say that your child’s eye examination is complete and within normal limits for the present age.

Kids eye test in Children’s Eye Clinic and Squint Clinic:

“Within normal limits for the present age “that does not mean that the child will not develop any kind of eye problems in future. As the child is in the developmental stage, his eye are still developing and growing, till the age of maturity.

Examination done at one point of developing age, will reveal that there is no problem at that point of time. But depending on the future development things might change. And hence follow up of children is very important till the development is complete.

So parents should not be under the impression that the eye examination is done last year and everything was fine, that does not mean child will not develop any eye problems or refractive error or any kind of eye problems in future.

So, by now you must have understood, what is the meaning of schools screening, what is the meaning of complete eye examination, what is the meaning of cycloplegic refraction, what is the meaning of post mydriatic test, what is the meaning of fundus examination, and what is the significance of follow-up eye examination in children.

If your child is suffering from any kind of eye problems, make sure that you consult your paediatric ophthalmologist ,children’s eye clinic and squint clinic in mumbai , who will do complete eye examination of your child and will point out the possible cause, future course, and the possible prognosis. And depending on the age of the child, the existing vision, cycloplegic refraction and the fundus examination, he will tailor the treatment for your child.

Each and every child is different and so is the eye problems faced at a particular age, by an individual child. Hence eye treatment of a child cannot be generalized. Eye Treatment for each and every child needs to be tailored as per the age of the child and the eye disease child is suffering from.

In this way your paediatric ophthalmologist ,children’s eye specialist doctor in mumbai will handle the problem of your child’s eye, and will give the safest possible treatment as per the guidelines.

In case of any questions and suggestions ,please leave a comment in the comment box below,we will reply to all the comments as soon as possible.

Child eye specialist in Mumbai

Eye doctor in goregaon ,ladies specialist doctor in goregaon west, child eye specialist in mumbai at Latika Eye and Maternity clinic