Early eye examinations are crucial to make sure children have normal, healthy vision so they can perform better at schoolwork or play.
dimanche 23 septembre 2018
The term "vision insurance" is commonly used to describe health and wellness plans designed to reduce your costs for routine preventive eye care (eye exams) and prescription eyewear (eyeglassesand contact lenses). Some vision plans also offer discounts on elective vision correction surgery, such as LASIK and PRK.
But unlike major medical insurance policies that may provide unlimited benefits after a certain co-pays and deductibles are met, most vision insurance plans are discount plans or wellness benefit plans that provide specific benefits and discounts for an annual premium.
In effect, these vision discount and wellness benefits plans offer savings much like a gift card. As such, they can be used to cover much of the cost of basic eyewear, or they can be used to make premium eyewear products and enhancements — such as progressive lenses, anti-reflective coatingand photochromic lenses — significantly more affordable.
When purchasing "vision insurance," be sure you fully understand the costs and benefits associated with the plan(s) you are considering. Also, if you have vision care coverage through a plan at work, be aware that "vision insurance" plans usually operate differently than other health insurance plans or major medical insurance.
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It's always a good idea to ask the business staff at your eye doctor's office to advise you of the specific benefits of your vision plan prior to your exam and eyewear purchase so there are no surprises afterward.
That said, we will use "vision insurance" in this article as a general term to cover wellness and discount plans that offer vision benefits, as well as more traditional health and medical plans that include vision benefits as well as coverage for eye conditions and diseases and treatment of eye injuries.
Where Can I Get Vision Insurance?
Group vision insurance can be obtained through your company, association, school district, etc., or through a government program such as Medicare or Medicaid.
If you are not eligible for a group plan because you are self-employed or for other reasons, most vision insurance providers also offer policies that you can purchase individually.
Vision insurance often is a value-added benefit linked to indemnity health insurance, health maintenance organizations (HMOs) and preferred provider organizations (PPOs) that have contracted with managed vision care networks to provide eye care services.
An HMO is a group of healthcare providers — doctors, laboratories, hospitals and the like — employed to provide health care to plan members at discounted rates. Usually, plan members are required to access health care (including vision care) only from HMO providers.Indemnity health insurance is traditional health insurance that allows policyholders access to medical providers of their choice.
A PPO is a network of healthcare providers organized to provide healthcare services to health plan members at a fixed rate below retail prices. Plan members may opt to access out-of-network providers, but usually at a greater cost.
When you buy vision insurance, you receive the following benefits:
- Access to a network of providers, including optometrists and ophthalmologists, eyewear stores, optical laboratories and LASIK surgeons
- Routine, preventive eye care services at reduced rates
What Kinds Of Vision Insurance Plans Are Available?
Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan.
Typically, a vision benefits package provides free eye care services and eyewear within fixed dollar amounts in exchange for an annual premium or membership fee and a relatively small co-pay (fixed dollar amount) each time you access a service.
Vision insurance may be a vision benefits package or a discount plan.
A discount vision plan, on the other hand, provides eye care and eyewear at discounted rates after you pay an annual premium or membership fee.
In some cases, a vision benefits package or discount vision plan may also include a "deductible" — a fixed dollar amount you must pay your eye care provider out-of-pocket before the insurance benefits take effect.
Both kinds of vision insurance can be custom-designed to meet the requirements of a wide range of customers, including school districts, unions, and big and small companies.
Vision plans generally cover or provide discounts on the following products and services:
- Annual eye examinations
- Eyeglass frames
- Eyeglass lenses (including lens coatings and enhancements)
- Contact lenses
- Discounted rates for LASIK and PRK
Also, reputable vision insurance providers should have quality assurance and member satisfaction services to answer your questions and help you resolve any disputes or issues you have with an eye care practitioner in your plan's network.
What Does Vision Insurance Cost?
Vision insurance costs vary, depending upon how the program is designed. Costs also may vary based on your state of residence.
As a general example, Vision Service Plan (VSP), the largest vision plan provider in the United States, lists the following cost savings associated with a typical VSP vision plan for individuals, compared with purchasing an eye exam and eyewear without vision insurance.
NOTE: Benefits associated with VSP plans vary from plan to plan. Most plans also include benefits for purchasing contact lenses — either as an alternative to glasses or in addition to them, depending on the plan. For more details and specifics about your own VSP benefits (if covered) visit vsp.com or speak to your HR representative at work.
| Savings Example | What You Pay Without Insurance | What You Pay With VSP | You Save |
|---|---|---|---|
| Eye exam | $163 | $10 co-pay | $153 |
| Eyeglass frames / single vision lenses | $150 / $90 | $25 co-pay | $215 |
| Anti-reflective coating | $113 | $69 | $44 |
| Photochromic lenses | $109 | $70 | $39 |
| Polycarbonate lenses | $57 | $31 | $26 |
| Annual premium for VSP plan (employee only) | -0- | $90 | -$90 |
| Total | $682 | $295 | $387 |
| Comparison is based on national averages for comprehensive eye exams and most commonly purchased eyewear brands. Chart represents typical savings for VSP members when they see a VSP eye doctor. Plan above may not be available in all states and plan costs vary by state. Data published at VSP website; accessed January 2017. | |||
It's a good idea to comparison shop several vision insurance providers to make sure you get the best value for the eye care benefits you desire.
Typically, you pay for group vision insurance through payroll deductions or flexible spending accounts (FSAs).
An FSA, sometimes called a cafeteria plan, allows an employee to use pre-tax dollars to purchase selected health benefits such as vision insurance. You save money because you pay for the policy with income that has been set aside for health costs and is not subject to taxation.
If you purchase an individual vision insurance plan because you are self-employed or your employer does not offer vision insurance, you can expect to be billed monthly or annually. AAV
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A children's eye exam is an expert assessment of your child's eye health and vision performed by anoptometrist (OD) or ophthalmologist (eye MD).
A brief examination of your child’s eyes by a pediatrician or family practice doctor is not a substitute for an eye exam performed by an optometrist or ophthalmologist. Only ODs and eye MDs have the advanced training and clinical tools to perform a thorough evaluation of your child's eyes and vision.
Early eye examinations are crucial to make sure children have normal, healthy vision so they can perform better at schoolwork or play.
Why Children's Eye Exams Are Important
Eye exams for children are very important to insure your child's eyes are healthy and have no vision problems that could interfere with school performance and potentially affect your child's safety.
According to a study funded by the National Institutes of Health, approximately 35 percent of American preschoolers have nearsightedness(myopia), farsightedness or astigmatism. Also, the risk of myopia and progression of myopia continues through the school years.
Early eye exams also are important because children need the following visual skills that are essential for optimal learning:
- Excellent visual acuity at all distances
- Accurate and comfortable eye teaming skills
- Accurate eye movement skills
- Accurate and comfortable focusing skills
When To Have Your Child's Eyes Examined
According to the American Optometric Association (AOA), infants should have their firstcomprehensive eye exam at 6 months of age. Children then should have additional eye exams at age 3, and just before they enter the first grade — at about age 5 or 6.
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For school-aged children, the AOA recommends an eye exam every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or as recommended by their optometrist or ophthalmologist.
Scheduling Eye Exams For Your Child
When scheduling an eye exam for your child, choose a time when he or she usually is alert and happy.
Specifics of how eye exams are conducted depend on your child's age, but generally the exams will include a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health evaluation and, if needed, prescription of eyewear.
After you have made the appointment, you may be sent a case history form by mail. Some eye care practices even have forms on their website that you can download and print at home, before your visit. Or you may not receive a form until you check in at the doctor's office.
The case history form will ask about your child's birth history (also called perinatal history), including birth weight and whether or not the child was full-term.
Your eye doctor also may ask whether complications occurred during the pregnancy or delivery. Other questions will concern your child's medical history, including current medications and past or present allergies.
Be sure to tell your eye doctor if your child has or displays any of the following:
- A history of prematurity
- Delayed motor development
- Frequent eye rubbing
- Excessive blinking
- Failure to maintain eye contact
- Inability to maintain a gaze (fixation) while looking at objects
- Poor eye tracking skills
Also, be sure to mention if your child has failed a vision screening at school or during a visit to his or her pediatrician.
Your eye doctor also will want to know about previous eye problems and treatments your child has had, such as surgeries and glasses or contact lens wear.
And be sure to inform your eye doctor about any family history of refractive errors, strabismus,amblyopia or eye diseases.
EYE EXAM NEWS
Free E-Book Helps Kids Get Ready For An Eye Exam
Howard the Hedgehog visits the eye doctor for the first time. Initially he's doubtful, but he ends up having a great time and seeing much better thanks to his new glasses! During show-and-tell, he shares with his classmates what he learned about vision tests.
Eye Testing For Infants
Babies should be able to see as well as adults in terms of focusing ability, color vision and depth perception by 6 months of age.
To assess whether your baby's eyes are developing normally, the doctor typically will use the following tests:
- Tests of pupil responses evaluate whether the eye's pupil opens and closes properly in the presence or absence of light.
- "Fixate and follow" testing determines whether your baby's eyes are able to fixate on and follow an object such as a light as it moves.
Infants should be able to fixate on an object soon after birth and follow an object by the time they are 3 months old. - Preferential looking involves using cards that are blank on one side with stripes on the other side to attract the gaze of an infant to the stripes. In this way, vision capabilities can be assessed without the use of a typicaleye chart.
[See also: infant vision development]
Eye Testing For Preschool Children
Some parents are surprised to learn that preschool-age children do not need to know their letters in order to undergo certain eye tests, even when they are too young or too shy to verbalize.
Some common eye tests used specifically for young children include:
Trained vision screeners may be able to detect certain eye problems in preschoolers. (Image: VIP Study Center, The Ohio State University College of Optometry)
Your child's eyes should be examined early for vision problems such as "lazy eye" (amblyopia), in which one eye usually is weaker than the other. With amblyopia, eye patching often is used to help strengthen the weaker eye. (Image: Eye-Lids Custom-Made Patches)
- LEA symbols for young children are similar to regular eye tests using charts with letters, except that special symbols in these tests include an apple, house, square and circle.
- Retinoscopy is a test that involves shining a light into the eye to observe the reflection from the back of the eye (retina). This test helps eye doctors determine your child'seyeglass prescription.
- Random dot stereopsis testing uses special patterns of dots and 3-D glasses to measure how well your child's eyes work together as a team.
In addition to nearsightedness, farsightedness and astigmatism, common vision problems of schoolchildren include:
Lazy eye (amblyopia). Your eye doctor will want to rule out amblyopia, or "lazy eye," which is decreased vision in one or both eyes without detectable anatomic damage. Unfortunately, amblyopia is not always correctable with eyeglasses or contact lenses and may require eye patching to strengthen the weaker eye.
Misalignment of eyes (strabismus). Crossed or misaligned eyes (strabismus) can have different causes, such as problems with muscle control in the affected eye or eyes. Strabismus is a common cause of amblyopia and should be treated early in childhood so vision and eye teaming skills can develop normally.
Inability to maintain eye alignment when viewing near objects (convergence insufficiency). Eye doctors will assess the ability of eyes to pull inward (convergence) and maintain proper alignment for comfortable reading.
Focusing ability, depth perception and color vision. The eye doctor also may test your child's focusing (accommodation) ability. Depth perception or ability to gauge distances between objects also may be examined, and color blind tests may be used to assess your child's color vision. [Read more about color vision and how the eye refracts light.]
Anterior eye and eyelid health. Your eye doctor will closely examine your child's eyelids to look for abnormal or infected eyelash follicles, bumps, eye discharge and swelling (edema). The doctor also will examine the cornea, iris, and lens to look for cloudiness (opacities) or other irregularities.
Vision Screening And Your Child's Performance In School
Remember that appropriate vision testing at an early age is vital to insure your child has the visual skills he or she needs to perform well in school.
A child who is unable to see print or view a blackboard can become easily frustrated, leading to poor academic performance. Some vision problems, such as lazy eye, are best treated if they are detected and corrected as early as possible while the child's vision system is still developing.
Parents — especially those who are nearsighted and had to wear glasses throughout childhood — are often concerned about the causes of myopia and whether their children are doomed to being nearsighted, too.
If this sounds like you, try not to worry too much.
Myopia is a common refractive error, it's easily treatable with contact lenses as well as eyeglasses, and it's not strictly hereditary.
Also, nearsightedness typically does not affect a child's academic performance or hold them back in any way. In fact, there's evidence that nearsighted children tend to perform better in school than their counterparts with normal eyesight, farsightedness or astigmatism.
What Causes Myopia In Children?
Although the exact reason why some children become nearsighted and others do not is not fully understood, it appears heredity is a factor, but not the only one.
Are bookworms more likely to be nearsighted than other children? Some researchers and eye doctors think so, but the evidence is not clear-cut.
In other words, if both parents are nearsighted, there is a greater risk their children will be nearsighted, too. But you can't predict who will become nearsighted by simply looking at their family tree.
In my case, my parents and both my older brothers had perfect vision. I'm the only one in the family who is nearsighted. Go figure.
I loved to read when I was a kid (still do); my brothers, not so much. Some researchers think focusing fatigue from excessive reading or holding a book too close to your eyes for extended periods can increase the risk for myopia in children. But nobody knows for sure.
The cause (or causes) of myopia may remain a mystery, but researchers recently have discovered something about the progression of nearsightedness that is very interesting: conventional glasses and contact lenses that have been prescribed for years to correct myopia may actually increase the risk of myopia worsening throughout childhood!
Many of these same researchers are investigating new lens designs to see if they can develop contact lenses or eyeglasses that can control myopia and halt or slow the progression of nearsightedness in children. [Read more about myopia control.]
How To Reduce Your Child's Risk Of Myopia
This might sound glib, but perhaps one of the best things to tell your child to reduce his or her risk of myopia is, "Go outside and play!"
A number of recent studies have found that spending more time outdoors may help prevent or reduce the progression of nearsightedness in children. Among them:
CAN LIFESTYLE AFFECT MYOPIA?
Children Who Spend More Time Outdoors Have Less Risk Of Nearsightedness, Study Finds
If you want to reduce your children's risk of becoming nearsighted, it might be a good idea to have them spend more time outdoors under the sun.
- In the Sydney Myopia Study, researchers in Australia evaluated the effect of time spent outdoors on the development and progression of myopia among 6-year-olds and 12-year-olds randomly selected from 51 Sydney schools.
The 12-year-old children who spent more time outdoors had less myopia at the end of the two-year study period than others in the study — even after adjusting for the amount of reading performed, parental myopia and ethnicity.
Children who performed the most amount of near work and spent the least amount of time outdoors had the highest mean amount of nearsightedness. - In Taiwan, researchers evaluated the effect of outdoor activity during class recess on myopia risk and progression among elementary school students.
Children participating in the one-year study ranged from 7 to 11 years of age and were recruited from two nearby schools located in a suburban area of southern Taiwan.
A total of 333 children from one school were encouraged to go outside for outdoor activities during recess, whereas 238 children from the other school did not participate in a special "recess outside the classroom" (ROC) program.
At the beginning of the study, there were no significant differences between the two groups of children with regard to age, gender, and myopia prevalence (48 percent vs. 49 percent). But after one year, the children from the school that spent time outside during recess had a significantly lower onset of new myopia than the children from the school that did not encourage outside activity during recess (8.4 percent vs. 17.6 percent).
There also was significantly lower average progression of myopia among already nearsighted children in the ROC group compared with the group that spent more recess time indoors (-0.25 diopter [D] per year vs. -0.38 D per year).
The study authors concluded that outdoor activities during recess in elementary school have a significant protective effect on myopia risk among children that are not yet nearsighted and reduce the progression of myopia among nearsighted schoolchildren.
- Researchers in Denmark published a study of the seasonal effect of available daylight on myopia development among Danish schoolchildren.
Myopia risk was determined by measurement of the axial (front-to-back) elongation of the children's eyes in different seasons. Increasing axial length of the eye is associated with increasing nearsightedness.
The amount of daylight changes significantly with the seasons in Denmark, ranging from nearly 18 hours per day in summertime to only seven hours per day in winter months.
In winter (when the children had access to the fewest hours of daylight), average growth in the axial length of their eyes was significantly greater than it was in summer, when their outdoor sunlight exposure was greatest (0.19 mm vs. 0.12 mm). - Researchers in the UK evaluated the results from eight well-designed studies of the effect of time spent outdoors on the development and progression of myopia among 10,400 children and adolescents.
The researchers calculated a 2 percent drop in the risk of developing myopia for each additional hour children spend outdoors per week. "This is equivalent to an 18 percent reduction for every additional hour of exposure per day," they said.
Compared with children with normal eyesight or farsightedness, children with myopia spent an average of 3.7 fewer hours per week outside, they added.
No particular outdoor activity was linked to the reduced chance of myopia — it was just the state of being outdoors rather than indoors. Also no correlation was found between myopia occurrence and a tendency to do more near work such as studying.
The researchers said more study is needed to determine which outdoor-related factors are most important, such as more distance vision use, less near vision use, physical activity and exposure to natural ultraviolet light.
Take-Home Message
Given the research above, it's a great idea to encourage your children to spend more time outdoors (and leave the cell phone and other electronic devices at home or in their pockets!).
Doing so just might decrease their risk of becoming nearsighted — or slow the progression of their current level of myopia.
Better yet, join them for some quality time outdoors together!
Screen time and related definitions
"Screen time" refers to the amount of time a person spends staring at the digital displays of computers, tablets (iPads, for example) and smartphones.
According to The Vision Council, 72 percent of American parents report their children routinely engage in more than two hours of screen time per day. And it's very likely most kids actually spend significantly more time staring at screens than their parents think they do.
Why might too much screen time be a problem for kids?
The LED screens of computers and portable digital devices emit a broad spectrum of visible light. Most of these light rays are harmless, but a portion of the light emitted by these screens is relatively high-energy visible light called "blue light."
Wearing glasses that filter blue light from digital screens may help reduce your child's risk of eye problems later in life.
Blue light has shorter wavelengths and higher energy than other visible light rays. And laboratory research suggests certain bands of blue light may be harmful to the light-sensitiveretina of the eye over time.
Blue light also plays an important role in regulating our body's circadian rhythm. This basically is an internal clock that's running in our brain and cycles between alertness and sleepiness at regular intervals over a 24-hour period. It's also called our sleep/wake cycle.
Too much exposure at the wrong time of day can disrupt a person's normal sleep/wake cycle, which can have serious health consequences.
Risks of too much screen time for kids
When talking about the risk of too much screen time for kids, we’re basically talking about the potential harmful effects of too much blue light.
And while it's true that staring at the screens of digital devices adds to the amount of blue light exposure kids get over the course of their lifetime, it's important to point out that the sun emits far more harmful blue light than computers, e-tablets and smartphones. So the blue light exposure from digital devices is an added exposure, over and above the larger amount of blue light exposure a person gets from sunlight.
A second important factor to consider is the timing of the exposure. Blue light exposure from the sun only occurs from sunup to sundown. But blue light exposure from screen time can occur at any hour of the day, including well into the night.
Possible risks from too much screen time for kids can be categorized as immediate or long-term.
Immediate risks
Immediate risks from too much screen time generally occur relatively soon after repeated blue light exposure. Many of these risks are associated with circadian rhythm disruption caused by staring at digital screens well into the night, which can make it much harder to fall asleep at a normal time.
Sleep disruption can be especially problematic for children, leading to daytime drowsiness and poor performance in school because of it. Disruption of the sleep/wake cycle also can eventually lead to weight gain and obesity-related health problems.
Research has shown that people who experience disrupted 24-hour cycles of sleep and activity also are more likely to have mood disorders, lower levels of happiness and greater feelings of loneliness.
Also, an intriguing two-year study of more than 2,500 normal Los Angeles high school students found that teens who reported greater digital device use and screen time during the study were about 10 percent more likely to develop ADHD symptoms by the end of the study period. (The researchers pointed out, however, that this doesn't prove a direct cause-and-effect relationship and more research is needed to fully understand the association between screen time and ADHD symptoms.)
The sun emits much more blue light than digital devices. All kids should wear sunglasses outdoors to reduce their lifetime exposure to harmful blue light.
Finally, according to The Vision Council, 30 percent of parents report their children experience at least one of the following symptoms after being exposed to more than two hours of screen time per day:
- Headaches
- Neck/shoulder pain
- Eye strain, dry or irritated eyes
- Reduced attention span
- Poor behavior
- Irritability
Any of these symptoms could potentially affect academic performance and social interactions.
Long-term risks
The simple truth is that the long-term risks of incremental blue light exposure from frequent use of digital devices is not yet known. This is because no previous generation has been exposed to comparable levels blue light from digital devices from childhood on.
It will probably take several decades before the long-term effects of extensive screen time for kids are better understood. But there is already some related research that suggests it may be wise to limit blue light exposure starting at an early age.
For example, researchers in Japan and Switzerland investigated what happened to the retinas of aging eyes from blue light exposure after cataract surgery. In the study, 79 eyes received a clear intraocular lens (IOL) that did not block blue light, and 52 eyes received a yellow IOL that blocked blue light. (Prior to cataract surgery, the retinas of all eyes were protected from blue light by the eye's natural lens that had become clouded by cataracts.)
Two years after cataract surgery, none of the eyes that received the yellow IOL that blocked blue light showed any new or worsening signs of macular degeneration (AMD). However, among eyes that received the clear IOL that didn't block any blue light, 15 percent of these eyes showed new or worsening signs of AMD.
The results of this study suggest that the retinas of aging eyes are more susceptible to oxidative damage caused by blue light exposure. If this is true, then it may be prudent and wise to take steps to reduce premature aging of the retina by limiting the amount of blue light exposure the eye receives throughout life.
The greatest benefit may occur when these protective measures are taken during childhood, because this is when the media of the eye (the lens in particular) are exceptionally clear and allow the greatest amount of blue light to reach the retina.
What to do
So then, what can a parent do to prevent harm to their child's eyes (and overall health) from too much screen time?
It's unlikely kids will reduce their use of digital devices. So the answer lies in taking steps to limit the amount of blue light reaching their eyes while they are using these devices.
One solution is to purchase eyeglasses with lenses that reduce the amount of blue light that enters the eyes from computer, e-tablet and smartphone screens. A number of lens manufacturers produce eyeglass lenses that filter blue light. Examples include Essilor's Essential Blue Series lenses.
Another option is to have an anti-reflective coating that blocks blue light applied to the lenses. Examples include Crizal Prevencia (Essilor) and Recharge (Hoya).
A third option is to purchase glasses with photochromic lenses. These sun-sensitive lenses block some blue light indoors and have the added advantage of automatically blocking additional blue light from the sun outdoors without the need for a separate pair of prescription sunglasses.
Yet another option — and the best option for superior protection from harmful blue light from the sun — is a pair of polarized sunglasses for outdoor wear. Examples include Xperio UV polarized prescription sunglasses (Essilor).
But what if your child doesn't need prescription glasses? The most convenient option in this case is to purchase a protective blue light filter that can be applied to the surface of your child's digital devices. Examples include Eyesafe RPF filters (Healthe).
Also, remember to use the blue light filtering features on certain devices (like Apple's Night Shift), or multi-platform apps that block blue light, such as f.lux and Iris.
And, to reduce the risk of your child disrupting his or her sleep/wake cycle, create a "no-screens" rule at least an hour or two before their scheduled bedtime.
Finally, schedule annual eye exams for your child with an eye doctor near you to make sure she is seeing as clearly and comfortably as possible. And remember to discuss blue light protection with your doctor at these visits.
