Rupa Wong: If parents are interested in getting an idea of how well their child sees, have the child stand 20 feet away from an oven or microwave, cover one eye at a time, and have them read the numbers on the clock. If one or both eyes has a problem seeing these numbers, it's time to make an appointment for a comprehensive eye exam. Donna Mazyck: I'm Donna Mazyck, National Association of School Nurses Executive Director. Welcome to school nurse chat today. We'll be talking about vision screening and myopia in students. Donna Mazyck: Our guests are school nurse leader, Ms. Mary Nasuta, and pediatric ophthalmologist, Dr. Rupa Wong. Welcome, Mary. Welcome, Rupa. Donna Mazyck: Thanks for having me. Donna Mazyck: Thank you, Donna. It's wonderful to be here. Donna Mazyck: Mary, I'd like to start with you. In this time of increased screen reading and computer use with students who are doing school virtually and in person, what concerns for student health and wellness do school nurses have? Mary Nasuta: Well, school nurses, I think, all over the world are sharing similar worries about student health and wellbeing. School nurses have always sought to help families to provide balance in their children's lives, and this has been such a challenging time. Even the provision of outdoor play and physical activity may be affected, and we know that all of this is essential for normal growth and development, even related to vision care. Mary Nasuta: We also know that virtual, and even hybrid learning, impose the unfortunate consequence of increased screen time. And coupled with the fact that we're not able to run our vision screening programs in the same way, it becomes really important to engage families in learning about symptoms related to vision concerns, so that they can consult their healthcare providers. Mary Nasuta: The Prevent Blindness resource on the NASN website's got some great tips for school nurses to share with their families, teaching families to observe those behaviors and the physical symptoms that may require referral to an eye care professional. Donna Mazyck: And Rupa, as a physician, we need to hear your perspective on this. School safety protocols are calling for increased screen time and distanced learning, and that can put a strain on students' eyes. What are some signs and symptoms parents and caregivers should look for when it comes to students eye health? And how can parents safeguard their children's vision when virtual learning is the common way of learning right now? Rupa Wong: We are in such a tough situation. As a mom of three kids, I've got... one of mine is still distance learning right now. It's hard because previous recommendations from the Association of Pediatric Ophthalmologists and Strabismus and the American of Pediatrics were all to decrease screen time and to be very cognizant of how much time your children are on computers or devices, or doing any kind of near work. And that's just not possible right now. Rupa Wong: So signs to look out for would be if your child is squinting, if they seem to be bringing the tablet or the computer really close up to their face, they might be adopting kind of abnormal head postures, tilting to one side, or even just closing one eye. Some kids just rub their eyes because they don't really understand that it's not something surface related. They know they don't see well, and they just rub their eyes to try to get rid of the blurriness. Rupa Wong: And previously, parents would always ask me as they see the near-sightedness worsening in their kids... And it has been linked to all of these near kind of activities. Not just screen time, but reading and the like. But with distance learning, they're on an up-close device so much more than they were in classrooms. Rupa Wong: Like Mary mentioned, school nurses are often the first line of defense when it comes to detecting vision issues in children. If nurses are able to conduct vision checks in school, those are extremely helpful at catching problems early on. For children not in school this year, simply knowing the telltale signs of vision problems, like squinting complaints of headaches, et cetera, should prompt parents to connect with an eyecare provider for a comprehensive eye exam for their children. Rupa Wong: My eyecare provider colleagues often note the top reasons parents typically bring their kids to see us are in school eye screening, 92%, and the child's having trouble reading the board at school, 89%. So childhood myopia is usually diagnosed when kids are around 5 to 10 years old. Often vision gets worse during the eyes rapid growing years, and starts to level off at about age 15 to 16. Rupa Wong: We should also be reminding parents to make sure their children get adequate outdoor time when schoolwork is completed each day. Studies show that more outdoor time per week is protective against a child becoming near-sighted. Additionally, kids are usually engaged in more distance vision activities when they're outside, which places fewer strenuous near vision demands on young eyes. Donna Mazyck: Mary, what are some tips that you have for schools on vision screenings during this COVID pandemic? Mary Nasuta: Well, I think it's essential that anytime we screen, we're relying on evidence-based practice recommendations. And the NASN site's included some great resources from Prevent Blindness to help plan that vision screening this year, which will look different. There, resources discussed those mitigation strategies for COVID, and they also give some practical advice and tips to help. Mary Nasuta: Some of my favorites are making sure that you have disposable occluders and lab cards, ensuring you have those hand-washing resources available, using those floor intake markings for that very important social distancing. I also like that they included that you should probably use virtual training for your volunteers, and to limit those numbers of volunteers this year. Mary Nasuta: And one of my favorite tips is to have a dry run of what your screening's going to look like that way. You can be sure that you've thought about all of those details. Where are the entrances and exits are, the distancing, the supplies, even the cleaning products. Donna Mazyck: This pandemic really does make a difference on what happens with vision screening. And we're so glad that on the NASN website, folks can find that Prevent Blindness document that guides them. Donna Mazyck: Rupa, what are some of the latest scientific and technological developments that are helping children with their eyesight? Rupa Wong: Until now, traditional eyeglasses and contact lenses available in the U S have only been developed to correct blurred vision, which is a symptom of myopia, while not approved to slow its progression. So it's important to remember that myopia can progress over time. So the earlier it's caught and addressed, the better. Rupa Wong: In my practice, we're now putting children with a new contact lens that can actually slow the progression of myopia in children. One of the questions parents ask when considering contact lenses for their child is whether or not contact lenses are safe, and if their child will even be able to use contact lenses properly. There've been multiple studies on both topics, which have found the incidents of corneal infiltrative events in children wearing contact lenses is no higher than in adults, and that children learn to apply contact lenses quickly. And I've even seen that play out in my own practice. Rupa Wong: Beyond improvements and vision contact lenses can have additional benefits that can impact how children feel about themselves and their overall wellbeing. Studies have shown contact lenses will not only make children more satisfied with their vision correction, the children may also feel better about how they look, or how well they perform activities. Rupa Wong: Additionally, when asked which they liked more or equally, 71.2% of children said that they liked wearing contact lenses a little better, or a lot better than glasses. It's also been shown that children and teens see significant improvements in quality of life within one week of being fitted with contact lenses. This improvement indicates that children should be offered contact lenses. Donna Mazyck: That's progress and care for children who have myopia and who are discovered, through that screening, that they may have some options. This is new. This is different. Thank you for sharing that. Donna Mazyck: Mary, this has been a very trying time as vision screening during COVID requires all these adaptations this year. How do you encourage your school nurses as they focus on the vision needs of their students? Mary Nasuta: I've been encouraging our school nurses to be kind, to forgiving and generous, with themselves this year, because we know that our pace is going to be slowed on vision screening. With our virtual kids, we won't be able to see them. And with our hybrid kids, many of us are in hybrids, we're going to be going much slower because of the distancing requirements. So I always am reminding the nurses that we're doing the best we can. Mary Nasuta: We also look to our partners in the private sector and how they've been functioning since March. Some of our childcare folks, and of course, the Prevent Blindness folks, and how they're doing screenings and learning from them. I tell them it's going to look different this year, but that's okay. And give yourself some slack with all the deadlines that we sort of create in our head, because school nurses like to check those boxes and get this work done. Mary Nasuta: I also encourage the school nurses to be heath ambassadors for themselves, too, because I think these are really trying times. I've been working with my nurses to get those messages out for themselves, getting adequate sleep, eating a nutritious diet, exercising daily, and practicing stress relief, seeking counseling if you need it. I'm always talking about refreshing yourself so that you can be that reliable resource for our students and our staff and our families that they depend upon. Donna Mazyck: And Dr. Wong, we know that because school just ended earlier this year in the spring, and many students are behind yearly exams, including yearly eye screenings. Can you leave us with anything parents can do at home to see if their children need to make an eye care professional appointment, or need some other care for their eyes? Rupa Wong: Of course, nothing can take the place of an annual comprehensive high exam. But one way parents can keep track of their growing children's vision is by doing simple at home activities. Rupa Wong: First of all, many parents might not know how children with myopia, especially if they themselves are not myopic. So if you want to understand what the world looks like to a myopic child, go to coopervision.com. There is a myopia simulator that shows what a classroom or gym might look like to your child if they're near-sighted. On that same website, there's a near-sighted assessment tool where parents can take a quick six question quiz to find out the likelihood of their child developing myopia. Rupa Wong: Finally, if parents are interested in getting an idea of how well their child sees, have the child stand 20 feet away from an oven or a microwave, cover one eye at a time, and have them read the numbers on the clock. If one or both eyes has a problem seeing these numbers, it's time to make an appointment for a comprehensive eye exam. Now again, these three activities can give a parent more information, but the best person to give advice on a child's vision is their eyecare provider. Donna Mazyck: Thank you. This is very, very helpful information. We have activities for parents and caregivers to do, to check out how their child's vision is, and to remind them to take their children to a health care provider. And we heard that from Dr. Rupa Wong. And we heard from Ms. Mary Nasuta all the essentials around vision screening in times of COVID, and what school nurses can do to keep themselves healthy as they're watching out for student vision. We thank you both for being with us today on School Nurse Chat. And we appreciate all the information that you brought to us today. Thank you, Dr. Rupa Wong. Thank you, Ms. Mary Nasuta. Rupa Wong: Thank you so much for having us. Mary Nasuta: Thank you, Donna.