children's eye health
The WHO initiated ‘Vision 2020’ in 1999 with the aim of eliminating the main causes of avoidable & preventable blindness by the year 2020. One of the strategies it advocates is raising awareness of the causes of avoidable blindness and the solutions that can help eliminate it. We hope that in some small way this article contributes to this goal of raising awareness of vision problems amongst parents so that we can help and protect those in our society at their most vulnerable age – childhood. Children are completely and wholly reliant on their parents / carers to look out for them and ensure their well-being and development. Unfortunately, having no prior experience or reference points makes it impossible for a child to tell you that there is something wrong with their senses. Think about it, if a childs’ vision has always been blur, that’s what they think the world is – a blur. They will never know to ask you to get them glasses. If they’ve always had difficulty seeing colours like in some retinal conditions, they will have never seen the full spectrum of colours you and I know, and so will sometimes mix up colours when painting for example.
Some children have such poor vision that they are unable to keep up in class as they can’t see well enough to read books or the blackboard. This makes them crave stimulation from other senses and so they become fidgety and physically active. They are then labelled as attention-deficit or just plain naughty and are punished at school and at home. And all they ever needed were glasses! Some children have a problem in only 1 eye but because their vision is good in the other eye they carry on unaware of their problem. Of course many times, parents are, likewise, understandably unaware until it is too late for anything corrective to be done for the ‘bad’ eye. These are some but a few painful examples of the importance of vision screening in childhood. None of us want any harm to come to our children so for these reasons, checking their vision is a matter of global importance as blindness or severe visual impairment has a significant socioeconomic impact for every nation.
Yes. In a middle to high income country such as Malaysia, problems with the retina or optic nerve and retinopathy of prematurity (ROP) are prevalent causes of blindness. Another emerging but easily remedied cause of visual impairment is uncorrected refractive errors. As in any condition, early & timely detection is the key to successful management and good outcomes. Screening services in other developed countries advocate paediatric eye screening at a few determined ages in a child’s life. In the UK this is:
At birth by a healthcare professional (any doctor) but should be by an ophthalmologist if your baby is born prematurely (too early)
Preschool (Between ages 4 & 5) to assess visual acuity, squint and refractive error
Before Secondary School – Education about eye care & colour vision check if they have specified career ambitions
At any age if a child is diagnosed with any other significant medical problem (like hearing loss)
Do babies/ Children Need Regular Eye Check
how often should testing be done
Once a child has been screened and is found to have normal vision, you just need to ensure you follow the above protocol. If however your child fails their screening then they should be seen by an ophthalmologist as soon as possible. In the interim if you notice your child having any difficulty with their vision like when reading or at school, then see an optometrist or ophthalmologist for a check-up. For a child who requires glasses then they should be seen at least once or twice a year to ensure their glasses doesn’t need to be changed.
What are some of the signs parents should look out for that may indicate vision problems?
The best history is usually obtained directly from the patient though in the case of children, we have to rely primarily on the carers’ observations. Children generally do not complain of blurring or double vision but if they do it usually means the problem has occurred recently or suddenly at a severity they are unable to tolerate.
In cases of a suspected squint the doctor will usually ask if the parents have noticed their children having any abnormal head position or eye alignment. The frequency, duration and stability of the deviation is also important as is the activity which brings it on. It may occur when they are concentrating on something near or looking at something in the distance. The onset of the condition (ie. from birth or acquired) is also an important factor and sometimes it can be subtle or difficult to distinguish from a simple habitual posture. A useful tip in ascertaining this is to analyse old photographs. If your child always appears to adopt a certain head position in all the photos then this provides a useful clue.
Photographs can also sometimes help diagnose another condition called leukocoria (literally meaning white pupil). When a light (like a camera flash) is shone directly into the eye, the reflection is normally red in appearance but in leukocoria this reflex is white. Modern cameras usually suppress this reflex with its ‘red-eye reduction’ technology so if you do notice a white reflex it is usually warranted to get an eye examination to ensure there is nothing wrong with your child’s eye. Of course not all white reflexes are abnormal and it can sometimes simply be caused by a normal reflection form the optic nerve which is a pale yellow colour.
In cases of reduced vision, it would be helpful to specify the size of objects the child is having difficulty with. In the case of very young babies, do they use their eyes to fixate and follow lights, faces or toys? Do toddlers have difficulty finding 100s & 1000s on the floor? Or even seeing that aeroplane in the distance? For difficulties in school, it is important determine if the problem is only visual or is related to a particular subject area. Does the difficulty lie in discerning letters and numbers or is the difficulty with reading, spelling, writing or math?
A less frequently enquired factor is that of stress. Children get stressed too and this can be with events that take place at home or at school. The children themselves may not know their symptoms are due to this but a tell-tale sign is that the symptoms coincide closely with an event. For an example, a child may suddenly complain of blurred vision when their grandparents moved out. Or they may suddenly have difficulty seeing the blackboard when the teacher was replaced.