Medical Associates Hospital
Prevent Blindness has declared 2022 the “Year of Children’s Vision” with “the goal of highlighting and addressing the diverse and critical vision and eye health needs of children and to improve outcomes through advocacy, public health, education, and awareness. Common vision disorders in children include amblyopia (lazy eye), strabismus (crossed eyes), and refractive error, including myopia, hyperopia and astigmatism.”
Let’s explore Case Scenarios
The following scenarios demonstrate the potential for saving children from blindness and vison impairment. The window of opportunity in children is often limited and must be seized without delays.
1) ↓1 week old baby, 32 weeks gestation
The Ophthalmologist was called to the neonatal unit to examine a one week old baby who was born prematurely at 32 weeks gestation. The child weighed 1250gm at birth and, because of breathing problems, needed to have oxygen support in an incubator. Special examination equipment was used by the doctor, after placing drops in the eyes. The right eye was normal but the left eye showed a suspicious area in the retina at the back of the eye. A re-exam, one week later, revealed abnormal blood vessels in the retina. LASER treatment was done to save the sight in the affected eye. Weekly examinations were done to i) ensure no further problems in the treated eye and ii) detect problems developing in the right.
Premature babies have underdeveloped organs including the eyes. The more premature, less than 32 weeks, and the lower the birth weight, less than 1500 grams, the greater the risk. There is a critical period during which repeated examinations are necessary weekly, fortnightly or monthly to detect onset of disease. Early detection and treatment can prevent blindness. If disease is detected after the child demonstrates a white pupil, it is usually too late to save sight.
2) 5 year old girl with glare sensitivity
This patient was brought to the eye doctor because of glare sensitivity and occasional “squinting” of the eyelids. Vision in both eyes was sub-normal at 20/50. Bilateral cataracts were diagnosed. She was born premature, had neonatal oxygen therapy and a heart murmur was detected. This probably diverted attention and no eye condition was suspected.
Congenital cataract is often a surgical condition which requires early intervention to allow for normal development of the visual system involving the eyes, optic nerves and vision centre in the brain. Delayed treatment can result in permanently impaired vision.
Children with vision problems eg. “squinting” to see, holding reading material and digital devices close to the face, tilting the head when looking at objects, demonstrating roving eye movements or crossed eyes, an eye that is larger or smaller than other kids, or the black of the eye looking grey or white must be examined by an eye care professional.
3) 12 year old boy with Keratoconus
This patient presented with itching and eye rubbing due to allergies associated, presents for his first eye exam with blurring and glare problems. He never had glasses. Right vision was down to Counting Fingers, the left 20/30. Best vision, in the right, with spectacle lenses was limited to 20/100. The gradual deterioration of his right vision went undetected because left vision was good. His was diagnosed with keratoconus by corneal topography scans.
Keratoconus is a common condition that causes abnormal bulging, thinning and irregularity of the cornea. It is commonly associated with itching and eye rubbing. The condition can progress to corneal scarring that requires corneal transplant surgery. Most cases can be treated, to prevent this, if caught early. Any child who is short sighted, has signs of allergies, rubs the eyes often and requires frequent changes of spectacles should be considered at risk of having keratoconus and be referred to an Ophthalmologist. Simply updating their glasses annually is not the correct management as a more sinister problem can be missed. Children with eye allergies should also be treated by an Ophthalmologist because they are at risk of developing vision problems due to corneal scarring.
What should parents look out for?
Children with vision problems will often show signs of poor reading and comprehension, fall behind in class, lack confidence and may have poor social skills.
They may be poorly equipped for a fully productive life and can be a burden to their families and the state.
It is a common experience that gradual vision change go unobserved when the fellow eye has good vision. This occurs with other conditions like cataract and glaucoma. If, on the other hand, vision should change suddenly, it will be noticed.
We must therefore be committed to preventing visual impairment and blindness among our children to secure their future and that of society.
WHEN SHOULD YOUR CHILD HAVE THEIR FIRST EYE EXAMINATIONS?
The American Association of Optometrists (AAO) recommends that the first eye examination should be between 6-9 months of age.
HOW OFTEN SHOULD CHILDREN HAVE A COMPLETE EYE EXAMINATION?
Annually. As children grow, their eyes also grow and develop. Depth perception, eye-hand coordination and other visual skills develop. It is important to regularly track the health and development of the eyes much like regular physical examinations.
WHAT ARE SOME SYMPTOMS THAT INDICATE MY CHILD MAY HAVE A VISION PROBLEM?
• Red, itchy or watering eyes
• Sensitivity to lights
• ↓An eye that turns in or away from the nose
• ↓Tilting the head to one side or having an unusual posture
• ↓Squinting, rubbing the eyes, or excessive blinking
• ↓A lack of concentration in school or on homework
• Covering or closing one eye
• Holding objects very close to the face
• Avoiding books and TV
• ↓Tired eyes or pressure/strain around the eyes on homework.