The school year is progressing along lickety split! We’ve been back to school for 94 days and have 197 left until summer break… including weekends and holidays…not that I’m counting or anything like that. Allergies…CHECK! Immunizations…CHECK! Vision screening… CHECK! What’s next? Follow-ups for sure (with puberty class lingering). You can tell I am a school nurse for elementary school students. Maybe next year I will look at a change and see about middle school or even high school. But wait! I digress…let’s talk about vision screenings.
This is a long article…and Nurse Kevin does a lot of gabbing…if you want to scroll down to see the ailments we are looking for during vision screening, feel free. But, take note: It will hurt my feelings if you miss my rambling…
Na! We’ll digress a bit more…
I remember way back in Army basic training (1998), one of the first things they did to us were all kinds of medical exams There we were all in a line and sporting nothing but our olive-green government-issued briefs (boxers for those who felt they needed a bit more *room*). We were lined up one-by-one to get shots…with this gun-lookin’ injection apparatus. Wait! Did they change that needle? There we were, walking through an immunization assembly line with nothing on but our green BVDs and with both deltoids dripping blood and leaking this clear liquid (immunization juices) from multiple injection sites.
We were ushered along to declare our religious preferences for our dog tags and then to sit on a cold, plastic seat for vision screenings. Getting up from those seats was like having flesh ripped after our bare thighs had stuck to the plastic surface. I remember how my new Velcro wallet sounded when I opened it…yeah…it was a lot like that.
Nothing about the findings of our medical exams were discussed with us. I guess my vision screening went okay; I was one of the lucky ones that didn’t get a pair of those thick black-rimmed glasses like a dozen or so of my fellow soldiers received…and at a complete surprise to many of those in the new vision-impaired club. And what do you think happened to those glasses the first chance those 17- and 18-year-old soldiers got? Yep! Afte rall, it’s kinda hard to think you have perfectly good vision your whole life and then be told to wear the new glasses in an already stressful environment.
WOW! What efficiency! Mass immunizations, health exams, vision and hearing exams, and then out the door to get into formation for the day’s instructions…school systems should take notice…and I am only a little kidding…
Vision screenings
Each year I screen my kindergartners and my third-graders. While I have the equipment, I send out a school-wide message asking the teachers of other grades to provide a name or two of children they’ve notice having difficulty, and I will screen them as well in order to rule out vision issues. Often, based on teacher concerns, I am able to identify an issue that needs to be addressed with an ophthalmologist (eye M.D.) or optometrist.
Review of abbreviations
It’s not surprising that the abbreviations for the medical documentation of the eyes is confusing. There are actually dozens and dozens of abbreviations for the eyes and for conditions of the eyes. But, we school nurses will not be assessing for things like pseudoexfoliation glaucoma, non-arteritic ischemic optic neuropathy, or epidemic keratoconjunctivitis. So, knowing what PXG, NAION, and EKC mean may be a waste of brain bandwidth. But, we do need to know these three for sure:
Oculus dexter (right eye) (OD)
Oculus sinister (left eye) (OS)
Oculus uterque (both eyes) (OU)
For me, I’d just as soon document right, left, and both or bilateral — especially in the school house. There ain’t too many mammas, daddies, or teachers that know what OU, OS, or OD mean. Now, with that being said, I do document “PERRLA.” That’s ‘cause I am too doggone lazy to type out, “Pupils equal, round, reactive to light and accommodation.”
First of all, how do we see?
We all agree that seeing is a pretty awesome deal. I do like to see stuff. We are able to “participate” in the world by the five senses: touch, taste, hearing, smell, and sight. I am not sure how you feel, but of these senses; I think sight is my favorite (I do a lot of photography). Touch is pretty cool. Taste…well…my tight 34s may have something to say about that. Hearing…pretty cool. But, well…did you ever see the movie “Up” when he turned down the hearing aid? Smell is nice…but then again I live with a 12-year-old boy. Yes, I would have to say sight is my favorite.
You don’t actually “see” the object you are looking at. Light is seen either as direct light or indirect light. The phone, tablet, or computer monitor you are looking at is direct light. Your hands on the keyboard or holding the phone or tablet are “seen” due to the direct light hitting the skin, sleeves, rings, fingernail polish, and the like. The direct light becomes indirect light and reflects off the surface and in the color from which the light was reflected. In a pitch-black room, you would not see your hands; they give off no light. But, when the lights are on, the light source (direct light) strikes your hands and the light “bounces” back and into (literally) your eyes.
The light travels through the iris (the colored part of the eye) and into the pupil (the dark center of the eye). Then the light travels through the lens and is “bent” to a pin point. It’s at that exact, sharp point where the light “should” hit the retina (the “film / digital sensor” of the eye).
The basics of the eye could be described like the basics of a camera…only awesome-er! The light enters the eye through the lens, is bent at an angle, flips upside down, and then strikes the surface of the eye at a fine point…norm