Already raising three children, Sharon Mofield-Boswell wasn't worried when her youngest, Hollyn, seemed to struggle with some everyday tasks.
Mofield-Boswell knew that children learned at their own pace, so what if Hollyn, at 3, couldn't get her beloved Barbie dressed all by herself?
But an eye exam exposed a potentially serious problem. Although Hollyn's eyes looked normal, a screening showed she had a degenerative form of "lazy eye" called amblyopia which, if not treated, could lead to permanent damage and possible blindness.
"I was devastated," said Mofield-Boswell, who has two teenage stepchildren and another daughter, 9.
"I didn't know what I was going to do. I felt horrible."
She felt that, somehow, as a mother, she should have known there was a problem.
But detecting a problem is difficult, said Dr. Julia Stevens, a pediatric ophthalmologist at the University of Kentucky. Three to 5 percent of all children have amblyopia or the more obvious form of lazy eye, strabismus, where the eye muscles actually shift and cause one eye to look different from its mate.
In cases of children like Hollyn, the eyes may look normal but they struggle with brain signals that don't interact properly with the eye, making vision blurry.
But young children "don't know they are supposed to see out of both eyes," said Stevens. They figure they are viewing the world just like everyone else and don't have the vocabulary to explain what is happening with their sight.
In both types of lazy eye, she said, the earlier the treatment is started the more successful it will be. If not treated at a young age, while the brain is still able to adapt and create the proper circuits to improve eyesight, the damage can be permanent, she said.
Kentucky requires mandatory eye exams when a child enters public school. Ideally, a child should be tested by age 3, she said.
A basic vision screening — the standard kind with a chart and figures of diminishing size — during routine physicals is a good place to start, she said. But, often, parents don't think to include an eye exam along with other routine medical care.
If a basic screening indicates a potential problem, a pediatric ophthalmologist would be the next step, she said.
It's especially important to act promptly if the child is already in elementary school when a problem is detected. The older the child, the harder to correct damage. By age 9 or 10, the damage could be irreversible, she said.
Mofield-Boswell is glad Hollyn was tested early. By wearing an eye patch — albeit a pink, sparkly one — and undergoing vision therapy, Hollyn's sight has changed tremendously. Now 41/2, she has 20/20 vision when she is wearing glasses.
It wasn't easy to get there, Mofield-Boswell said. The therapy was intensive and Hollyn had to wear the patch sometimes for four hours a day and didn't like it, no matter how festive it looked. But it worked.
Dressing Barbie is now a snap. Plus, her mom said, Hollyn seems more willing to communicate and more playful.
That success has led Mofield-Boswell to become an advocate for early screening.
"I lie awake at night worrying about what happens to kids who don't get tested," she said.
Last spring, she and Hollyn went to Washington, D.C., along with a group from the national non-profit Prevent Blindness and lobbied Kentucky Sens. Mitch McConnell and Jim Bunning and U.S. Rep. Ben Chandler to make early testing mandatory at the federal level. This fall she was awarded first place and four tickets to anywhere in the United States for an essay she wrote for the "See America" contest sponsored by Prevent Blindness.
"We need more people like her," said LuAnn Epperson, chief operating officer for Prevent Blindness Kentucky.
Some 50 percent of causes of blindness are preventable, she said.
Her group promotes taking a high-tech image of the eye and training volunteers to accurately interpret the results. (Stevens said a low-tech, primitive method can be done by parents by taking a digital picture. If the "red eye" effect is markedly different between each eye, it could point to a problem.)
As for how the family is going to use the prize, they are going to the American Girl Doll Museum in Chicago and Hollyn is getting the Molly doll. She's the one who wears glasses.