Johns Hopkins Gazette: October 30, 1995

On The United Way:
Saving Sight Focus Of Preschool Effort

Mike Field
Staff Writer

     Once, not long ago, blindness in one eye was not all that

     Doctors screening recruits during World War II were startled
to discover how many otherwise healthy individuals could see in
only one eye. They concluded that nearly 5 percent of the general
population fit within this category, an enormous number,
especially considering they could name no etiological or
environmental agent responsible for the condition.

     Science now knows that partial blindness of this sort is
caused by amblyopia, or "lazy eye," a condition that affects
nearly one in 20 children, regardless of sex, race or income.
Caused by unequal vision (in which one eye is considerably weaker
than the other) or by a muscle imbalance that pulls one eye
either toward or away from the nose, the resulting blurred or
double vision causes the brain to literally "shut off" the vision
from the weaker eye. Consequently the neural pathways from that
eye--which normally continue to develop until around the age of
7--fail to develop. Eventually, the visual loss is irreversible.

     This loss of vision can be prevented, as long as the
amblyopia is caught early. That's why for many years the United
Way of Central Maryland has funded Maryland Society for Sight's
preschool screening program.

     "Early detection is the way to go, because after age 5 or 6
it's no longer correctable," said Michael Repka, associate
professor of ophthalmology at the Wilmer Eye Institute and chair
of Maryland Society for Sight's pediatric advisory committee.
Repka believes that amblyopia has always been widespread. "There
are references to this condition going back to the 15th and 16th
centuries, but it was not until the war that people understood
the scope of the problem."

     Because amblyopia is a painless reactive process that is
noncommunicative there is no simple way to predict who is at risk
for the disease, or even which children are suffering from it.
The only way to find out is to conduct vision screening tests at
a very early age to gauge visual acuity as the neural pathways

     Children identified with amblyopia are generally treated by
putting a patch over the stronger eye until the weaker of the two
is sufficiently developed to prevent atrophy. Although the
treatment was devised in the mid-19th century, it was not until
the 1930s that its use became prevalent. Most recruits for World
War II went untreated because it was not understood how
widespread the need nor how effective the treatment could be.

     Each year for 35 years now, Maryland Society for Sight has
screened hundreds of preschool children for amblyopia. "It takes
a lot of skill to administer a vision test to 3- to 4-year-olds,"
said executive director Katrin Starratt. "Most of these children
don't know the alphabet yet, so the conventional vision test is

     Instead, the tester works with an inverted E chart that
pictures a capital E in a number of different positions. The
children are asked to cover one eye and then tell whether the
letter is standing upright, facing backward or lying on its side;
of the 7,000 or so children screened each year, about 10 percent
are referred to professional ophthalmologists for further
testing. Starratt estimates that three-quarters of those referred
will have serious vision problems, including amblyopia.

     "We've been doing these screenings for 35 years now, thanks
in part to the United Way of Central Maryland," Starratt said.
"That's a lot of children we have touched, and a lot of people
who would have suffered a lifelong disability were it not for
this program. Thousands of Marylanders can see just fine, thanks
to the United Way."

United Way 
Pledge Numbers

     The university and hospital faculty and staff have reached
53% of their $800,700 goal.
     The university has reached 65.7% of its $573,700 goal, with
pledges totaling $377,122. In that campaign, Homewood Student
Affairs has surpassed its goal of $16,000, with pledges totaling

     To date, the hospital has received $50,000 in pledges.

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