Illinois Kindergarten Eye Exam: Visual Readiness for School

As parents prepare their children for kindergarten, one of the requirements in Illinois is to have an eye exam performed by an optometrist or ophthalmologist prior to starting the school year. Even though it may be a challenge to add one more item to the school preparation list, an eye exam is very important. The eye exam is designed to look for hidden visual delays that could compromise learning. Most often, this is the first time a child is receiving an eye exam, even though it is recommended at 8 months and then at 2 years of age.

Unfortunately, only 2 other states in the United States require an eye exam before entering school; they are Kentucky and Nebraska. The Illinois Kindergarten Eye Exam Law (Senate Bill 641) went into effect on January 1, 2008, requiring all incoming kindergarten students to have a vision assessment performed by a licensed optometrist or ophthalmologist. This law was introduced to address the alarming prevalence of undiagnosed and untreated vision problems in young children.

Parents are required to submit proof of this exam to their child's school by utilizing a specific vision form. The form is to be completed and submitted prior to school starting, or no later than October 15th of that Fall/school year. The form is designed to ensure visual readiness for the upcoming academic year and includes these 5 key elements:

Eye Tracking, Eye Teaming, Eye Focusing, Visual Acuity, and Visual Health.

Eye Tracking

Generally speaking, eye tracking is a conscious eye movement. The eye movements can be when moving eyes from spot to spot or when following (tracking) a slow-moving object.

In children with reading and other learning difficulties, it's common to find a high prevalence of tracking disorders. In a study including 50 children ages 6 to 13, it was shown that 96% of the children had visual tracking delays (1).

Most symptoms associated with eye movement disorders involve reading and writing. Eye movement disorders are not related to the ability to read; more so it often has to do with reading efficiency, i.e. skipping words or lines, slow reading speed, or poor reading comprehension. If eye tracking delays are suspected, it's important to pursue an eye exam and ask specifically for tracking to be assessed.

Eye Teaming

Eye teaming, or the ability to use both eyes together, is an important visual skill. There are multiple diagnoses that qualify as eye teaming delays. One of the most common conditions to note is something called convergence insufficiency, and this generally tends to receive the most attention. To give perspective, the prevalence was reported by Scheiman et al to be approximately 5.3% when analyzing 1,650 children age 6-18 (2).

Most children will not specifically complain about convergence insufficiency, rather symptoms may be present which are often noticed by parents or teachers. Some of the common symptoms include: resistance or lack of willingness to perform near point tasks (such as school work or reading), eye rubbing, eye strain, handwriting that doesn't always follow on the line, or even reading comprehension difficulties.

An eye doctor is shown assessing a child's eye teaming, specifically Near Point of Convergence.

Children attending school rely on their visual skills to be efficient learners.

Convergence insufficiency, like other common underlying vision delays, can go undetected for long periods of time. Unless specific tests are carried out, it is difficult to assess due to symptoms alone.

The near point of convergence test, conducted by an eye doctor, is the best way to screen for this condition. The test consists of the patient wearing red-green glasses and having the patient follow a near point light as it is brought up to their face. If two lights are seen at any distance greater than 4 to 6 inches, it is considered below normal limits.

Eye Focusing

Visual accommodation is the clinical term used to define eye focusing. Eye focusing dysfunction is more common than someone would anticipate.

When someone uses their focusing system, there is a lens inside the eye that changes shape (similar to that of a camera lens). This makes the near point object clear and in focus. Eye focusing delays make it difficult for someone to make an image clear when looking at objects up close. Eye focusing delays can also make it difficult to sustain focus (insufficiency), meaning it can be accomplished initially but not for long periods of time. It can also mean that someone has difficulty switching focus multiple times (infacility), as when looking from the whiteboard in school and then down to the paper on the desk. Another type of accommodative delay is when someone focuses too much (excess), which means that they may have difficulty seeing in the distance after looking at objects up close.

A doctor assesses eye focusing on a pediatric patient

In a study conducted by Hokoda in which a sample of 119 patients was reviewed, it was found that 25 of the 119 had accommodative or binocular vision disorders. Furthermore, 80% of the 25 individuals did have accommodative delays (3).

Visual Acuity

Visual acuity or sight is often what is associated with an eye exam. Myopia (nearsightedness), hyperopia (farsightedness), and astigmatism are all types of what are called refractive error and can most often be corrected with glasses.

Amblyopia, however, is a hidden condition that doesn't always show signs of being present. This condition can happen for several reasons, but one common reason is due to unequal prescriptions in each eye. If the prescription is unequal, that means that one eye can see better than the other. This leads to the brain favoring or using primarily one eye and ignoring the other. Usually, children (or adults) with this condition report that they can see just fine; however, that may be true, but they are essentially only using one eye. When one eye is being ignored, this is called visual suppression and drastically reduces depth perception. It can also lead to other difficulties with eye-hand coordination and reading efficiency.

Eye Health

The vision exam also checks to ensure the integrity and health of the visual system is within normal limits. The front of the eye (cornea, iris, anterior chamber), along with the back of the eye (vitreous, retina, and optic nerve) are all also examined in addition to color vision.

The Illinois Kindergarten Eye Exam Law underscores the critical need to prioritize vision health in the early stages of a child's educational journey. By mandating eye exams, Illinois has taken a significant step towards preventing vision-related learning difficulties that could impact a child's academic success and overall well-being.

It's important to remember that even though the Illinois school exam form specifically requires the aforementioned visual skills to be assessed, they often get missed or skipped over. Be sure to ask the eye doctor about each item if there is doubt. Early detection and treatment of vision issues can make all the difference in a child's educational experience.

1. Hoffman LG. Incidence of vision difficulties in children with learning disabilities. J Am Optom Assoc. 1980 May;51(5):447-51. PMID: 7391513.

2. Scheiman M, Gallaway M, Coulter R, Reinstein F, Ciner E, Herzberg C, Parisi M. Prevalence of vision and ocular disease conditions in a clinical pediatric population. J Am Optom Assoc. 1996 Apr;67(4):193-202. PMID: 8888829.

3. Hokoda SC. General binocular dysfunctions in an urban optometry clinic. J Am Optom Assoc. 1985 Jul;56(7):560-2. PMID: 4020010.

The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.