Following a new Alcon Student Vision Survey examining the extent to which US parents perceive how vision issues impact their children' s educational lives, The Ophthalmologist reached out to Dr. Amanda Nanasy for comment.
Dr. Nanasy, director of the Florida Institute of Sports Vision and team optometrist for the Miami Dolphins, details how the survey, which interviewed 1,000 parents of American teens and young adults aged between 13 to 25, reveals a troubling disconnect between the value parents place on their children’s vision and how often these young people are actually attending regular comprehensive eye exams.
While almost nine in 10 parents recognize that vision affects school success and performance, less than one in four teens have had a comprehensive eye exam in the last year – what do you think explains this disconnect?
The disconnect is usually for a combination of reasons. First off, parents have so many priorities that they have to juggle in order to get their kids ready to go back to school. From school supplies to haircuts, there are things that have always been on the list. Unfortunately, many kids don't know that they have less than perfect vision or that there is a hidden vision condition limiting their full potential in school or sports. I’m sure most parents would agree that if their child was complaining of blurry vision they would put that comprehensive exam at the top of the list. The truth is they may not know what they're missing until we do the exam.
What conditions or visual problems can be missed by a basic school screening but identified during a comprehensive eye exam?
The big misses on these tests are often near point problems. Even if they have them read a near card, they might have low facility or inadequate tracking that would deteriorate near vision over time. Convergence isn't always being tested and, depending on the scrutiny of the test, I've even seen myopia and astigmatism missed because they squint through the distance VA or just memorize the line for the second eye. Ocular health evaluation is also not assessed.
How can clinicians determine whether behaviors in these teens and young adults – such as frustration, stress and low confidence – may be related to an undiagnosed vision problem?
This is where there's no substitution for that full exam. Checking overall refractive condition is imperative as well as not missing an accommodated issue. Clinicians could easily see a small amount of hyperopia and assume they don't need help. A quick test like BCC along with some careful histories can uncover easy ways to make a big difference in a child's academic career.
The survey suggests some teens may not disclose their vision problems. Why might young people be reluctant to speak up, and how can practitioners encourage more honest conversations?
When it comes to teenagers, the possibilities are endless! They may not want to have to wear glasses due to the aesthetics and fear of social scrutiny. They may simply not know that they aren't seeing as clearly as everyone else. Often, clinicians need to find a common ground and proper motivation for them to have better vision. They may be more interested in athletic performance or gaming than academics. The win for everyone is if you correct vision for their hobbies, you will be correcting it for academics as well. Explain they're working harder than they need to and that the glasses or contacts can be somewhat of a cheat code. I will often tell my athletes it's the difference between seeing “normal” versus seeing in HD.
How can eye care professionals introduce contact lenses proactively without making the conversation feel commercially driven?
Honestly, I've never considered a contact lens conversation being commercially driven. As a clinician, I feel like it's my job to introduce all the best options I have for my patients, which oftentimes includes contacts. Take yourself out of an eye care provider’s shoes and put yourself in a different industry. If your child needs braces, would you be frustrated if the orthodontist didn't tell you all of the alternative options now available other than the classic metal braces? I know I would!
Parents want their children to have confidence, and contacts are an easy way to add visual improvement without the burden of a frame and lens. To be mindful of parents’ wishes during an exam, I will not directly ask the teen if they are interested in contact lenses. I will turn to the parents and ask if they're interested in learning more about contact lenses that I recommend for other patients the same age as their teen. Any hesitation a parent shows may be related to their previous knowledge of contact lenses. I explain that lenses like Precision1 daily disposable contact lenses are easy to handle and can be thrown away at the end of every day. Having a fresh pair every morning resolves concerns about the child taking proper care of the lenses. I talk about the fact that they stay well hydrated during high amounts of screen time and how oftentimes they're used for part-time wear. Many kids will wear glasses in school and use their contact lenses for sports.
How should practices adapt their communication when speaking with Gen Z patients rather than communicating only through their parents?
I would say these teens and young adults rely heavily on the opinions of their peers and reviews, rather than just what they're being told by healthcare providers. Discussing how the recommendations you have made are because patients in their same situation have loved them or found benefits from them will go a long way!
Dr. Amanda Nanasy is co-owner of The Eye Center, Pembroke Pines and Florida Institute of Sports Vision, a partner of Sports Vision Pros, LLC (sportsvisionpros.com), and reports being a speaker and consultant for Alcon and an advisory board member for ABB.
