Vision allows infants, toddlers and school-aged children to make sense of the world around them, learn and interact. That’s why it’s so important to address pediatric eye problems as soon as they crop up. Whether the fix is as simple as wearing glasses or it’s something that requires a more serious intervention, seeking help can give children the gift of clear, crisp eyesight or allow you to adapt their environment to meet their needs. To shed some light on the subject, I’ll be covering the most common kids’ eye diseases and vision issues as well as the signs and symptoms.
The Importance of Healthy Vision in Children
Babies don’t have excellent eyesight at birth but their visual system and eyes develop rapidly over the first few months. Healthy vision is important because babies use their eyes to take in information and stimulation essential for their development. Unfortunately, detecting eye problems in infants can be challenging because they can’t talk. That’s where your pediatrician comes in. They’ll screen your baby for eye health during their checkups and refer you to an eye doctor if necessary to help you avoid developmental delays.
Once your tiny tot reaches toddlerhood and the preschool years, they’ll fine tune and build on their visual skills. They start to form the perceptual abilities they’ll rely on when they begin to read and write as well as develop eye-hand and eye-body coordination and fine motor skills. You’ll still want to closely monitor their visual development because even though they can talk now, many kids don’t know the right words to verbalize that they’re having problems with their sight.
When kids start school, their vision takes on a whole new level of importance. From reading and writing to staring at a chalkboard or playing sports, they use their eyesight constantly. Visual acuity, eye tracking, eye focusing, using both eyes together, eye-hand coordination and perception are among the visual skills they need for both learning and playing. When overlooked, vision problems may have a significant impact on their school performance and can even be mistaken for ADHD.
There are ways parents can play a role in encouraging their child’s visual development, especially before the age of eight, whether they’re suffering from a vision problem or not. Here are some ideas to try:
For Toddlers and Preschoolers:
- In those first few months, switch up the position of the crib every so often and alternate the side you hold them on during feedings.
- Put objects with high contrast just out of their reach.
- By five months, hang toys from their crib or bouncer seat so they can grab and pull at them.
- Play peek-a-boo for visual memory development.
- Point out objects and name them.
- Encourage exploration, crawling and playing.
- Read books to them, which aside from helping with language development allows them to start to visualize.
- Roll a ball back and forth with your child so they have to track it with their eyes.
- Play matching card games.
- Give them toys that create a visual response when touched (think flashing lights or moving pieces).
- Show them photos and have them point out people or objects.
- Play with toys that involve left to right movements so they can learn the tracking needed for reading.
- Draw, color or paint for visual motor skills.
- Get outside and let them run, kick a ball and move things from place to place for eye-hand, eye-body and eye-foot coordination.
- Do puzzles or build things with blocks.
- Make art projects together that involve coloring, cutting and pasting.
- Continue to play with puzzles, blocks and visually stimulating toys.
- Build their eye-hand coordination and eye-body coordination through sports, jumping rope, riding a bike, kicking and all sorts of outdoor play.
- Have your child read to you.
- If your child has an eye condition, work closely with their teacher to ensure they’re sitting in a spot where they can see and they have any additional help they need.
Signs of Eye Problems in Children
While encouraging the development of your child’s visual skills is beneficial, the real key to maintaining healthy eyes is with regular screenings at the eye doctor or pediatrician’s office. Noticing the symptoms of eyesight problems in children is extremely helpful too. If you see any of the following signs, schedule an appointment with your eye care professional as soon as possible:
- Squinting when looking at objects in the distance
- Avoiding close activities like reading
- Poor tracking (following an object with their eyes)
- Sitting extremely close to the television
- Abnormalities in the movement or alignment of the eyes
- Holding books close to their face
- Closing one eye or covering it with their hand
- Complaints of blurry or double vision
- Excessive blinking
- Sensitivity to light
- Frequent eye rubbing
- White pupils
- Tilting the head to one side
- Red, irritated or watery eyes
- Problems with concentration
- Difficulty remembering something they’ve just read
Common Pediatric Eye Diseases and Vision Problems
Refractive Errors – A refractive error happens when the shape of the eye doesn’t allow light to focus directly on the retina, which causes blurry vision. Refractive errors can usually be treated with glasses or contact lenses, though they can also lead to a lazy eye (amblyopia), which we’ll get to shortly. Typical refractive errors in kids include: Myopia (nearsightedness) – This is the most common kids’ eye problem and it means they have poor distance vision. Hyperopia (farsightedness) – Hyperopia is when a person has trouble seeing up close. Astigmatism – When the curve of the eye is irregular, it’s known as astigmatism. While most people have some degree of astigmatism, it’s usually so mild they don’t notice it. If it results in blurred vision, glasses or contact lenses can improve eyesight.
Amblyopia (Lazy Eye) – Technically called amblyopia, a lazy eye is when one of the eyes has poor vision that eyeglasses can’t fully correct. This can occur when there are different refractive errors (nearsightedness, farsightedness, astigmatism) in each eye so that one is much stronger than the other, something is blocking light from getting through one eye or the eyes are misaligned. Sometimes there are no visible signs of the condition. Amblyopia usually develops when children are preschool aged. The earlier amblyopia is treated, the better the outcome and it gets harder to fix after age eight once eyesight has fully developed. If it’s not addressed, it can lead to an irreversible loss of vision in the eye. Treatment for a lazy eye will depend on its cause and the severity. However, it involves forcing the brain to use the weak (lazy) eye so that it builds strength. First, the doctor will treat the underlying issue such as prescribing glasses to fix a refractive error or, if a cataract is blocking the light, surgically removing it. The child may need to wear a patch over the strong eye for several weeks or months. When the lazy eye is milder or a kid is really anti-eye patch, atropine, an eye drop, can be used to blur the vision in the strong eye.
Strabismus – Strabismus is the misalignment of the eyes. There are a few different forms with the most well-known being esotropia, or crossed eyes, where the eyes turn in. However, an eye can also turn up (hypertropia), out (exotropia) or down (hypotropia). When one eye is consistently misaligned, it can result in a lazy eye. If untreated, it may cause permanent vision problems. Strabismus can occur during childhood and is usually diagnosed between ages one and four, though people can also be born with it. Sometimes an eye patch is used on the aligned or more aligned eye to force the misaligned one to work harder, which strengthens it. Treatment options includes eye exercises, glasses or eye drops to blur the straighter eye. If none of these approaches work, eye muscle surgery could be a possibility.
Eye Infections – Let’s face it, kids aren’t exactly known for their love of washing their hands and avoiding germs. When they touch their eyes it can lead to infection. The most common type of eye infection in kids is conjunctivitis, or “pink eye.” The conjunctiva, which is the tissue that sits over the white portion of the eye and lines the inside of the eyelid, gets inflamed. Symptoms include discharge and eyes that are red, itchy, watery and sensitive to light. A thick yellow crust will typically form in the corner of the eyes and over the eyelashes. Conjunctivitis can be caused by bacteria, viruses, irritants or allergies. If it’s a bacterial infection, antibiotics in eye drop, pill or ointment form will be prescribed. Viruses will run their course but are very contagious so taking proper precautions, like not sharing towels and encouraging frequent hand washing, is definitely recommended. Conjunctivitis is easily treated and doesn’t usually lead to long term vision problems. However, it’s always a good idea to see a doctor when your child’s eye appears to be infected or inflamed as other infections could cause more serious harm if they’re not dealt with.
Blocked Tear Ducts – Blocked tear ducts are pretty common in babies and affect about six out of 100 newborns, though they can occur at any age. The tear duct is either completely or partially blocked which prevents tears from draining properly. The duct might fill with fluid, swell or, occasionally, get infected. Usually, blocked tear ducts resolve on their own in the baby’s first year. Your doctor will probably instruct you to keep the eye clean, wipe away drainage and massage the blocked duct. It’s rare that additional measures like probing or surgery are necessary.
Nystagmus – This condition involves uncontrollable, repetitive, rhythmic movements of the eyes, which make focusing on an object and seeing clearly nearly impossible. The eyes often move side to side but they can also move up and down or in a circular pattern. Both eyes or one eye will oscillate in a jerk or pendulum motion. The most common type of nystagmus is congenital, sometimes called infantile nystagmus, and present when a baby is born, though not typically diagnosed at birth. Nystagmus can also be acquired and caused by a head injury, neurological issues or a disease, like multiple sclerosis. Sometimes, there is what’s known as a null zone, which is a position where the eye movement is lessened and vision is much clearer. If a child has a null zone, they’ll hold their head at an abnormal angle to maximize sight. When treating nystagmus, the first order of business is correcting refractive errors, usually with contacts, and, if necessary, amblyopia is also treated. Contacts tend to be more effective than glasses because the centers of the lenses move in tandem with the eyes. Depending on the type of nystagmus, surgery can reduce the head turn and there is also a procedure designed to fix head positioning and move the null zone into a better position for improved visual function. Other options include medication, Botox, though it’s only temporary, and biofeedback therapy.
Retinopathy of Prematurity – This pediatric eye disease occurs in premature babies. The blood vessels in the retina develop abnormally. In severe cases, it can lead to retinal detachment, which causes blindness since the retina is responsible for receiving light and turning it into messages that are sent to the brain. There are no signs or symptoms of retinopathy of prematurity, or ROP, and it can only be detected during an eye examination. A lot of times, ROP corrects itself and the baby’s vision is fine. If it reaches a certain level of severity and it’s caught early, surgery can effectively stop the growth of the abnormal blood vessels and has had good outcomes but some degree of peripheral vision will often be lost. Laser surgery is the most common approach, however, more recently, injections of medication into the eye have been used as well. When ROP is advanced and the retina has detached, scleral buckling or vitrectomy, which are more complex surgeries, can be performed. With both scleral buckling and vitrectomy, there will likely still be vision loss.
Retinoblastoma – This eye cancer generally occurs before a child reaches three-years-old and starts in the retina. Signs include loss of vision and the appearance of a white pupil. This is the most common kind of childhood eye cancer. Retinoblastoma is highly treatable when detected early and vision can usually be preserved, which highlights the importance of regular eye exams.
Pediatric Cataracts – Cataracts are when the eye’s lens is clouded, which causes blurred or distorted vision. In children, cataracts can be congenital or acquired. When they’re congenital, meaning the cause is genetic, lens opacity is usually present at birth and they’re referred to as infantile cataracts. When the onset occurs after infancy, they’re known as juvenile cataracts. The most common cause of acquired juvenile cataracts is injury, though metabolic disorders and other conditions can cause them as well. Signs include uncontrollable, rapid eye movements, a white or grey pupil and poor vision. Cataracts can lead to permanent vision loss if they’re not treated. They’re removed through surgery. Once the cataract is gone, contact lenses, intraocular lenses (implanted artificial lenses) or glasses are used to restore focusing power. If the cataract is in one eye, a lazy eye will often occur and this will be treated as well.
When Should Children Have an Eye Exam?
Exams are the best way to ensure early detection. Most children won’t need to go to an eye doctor regularly unless there’s a problem since a lot of pediatricians will do screenings at well visits and some schools also give them. Kids’ eyes should be checked three times in the first year of life and more often if they were premature or there’s a family history of childhood eye conditions. At around age three, the pediatrician should also give a visual acuity test. At five-years-old, or before going into first grade, the doctor will test their vision and eye alignment. If they fail the tests, they’ll be referred to an eye care professional. Between five- and 18-years-old, routine eye screenings are recommended every two years. If your child wears glasses or contacts, yearly visits to an optometrist or ophthalmologist will be needed. When it is time for an eye exam, here’s a great guide for preparing for and breezing through the appointment.
As I mentioned previously, some children’s vision problems will require the help of a specialist but many are effectively corrected with prescription glasses. I know that comes with its own set of issues since getting your child to wear their glasses on a daily basis can be a challenge. Fortunately, these days, there are so many fun styles, colors and patterns that kiddos will probably warm up to the idea easier than you think and, if not, there are tactics you can use to get them to love their specs (in fact, I wrote a whole post on it). At the Spectacle Shoppe, we carry a full selection of kids’ eyewear in Kerrisdale and we’ll help you find frames your child will be thrilled with so they can enjoy the benefits of clear vision.
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Morgan is The Spectacle Shoppe’s Lead Technician and Customer Relations Specialist as well as a Principle of Spectacle Shoppe. She is a licensed contact lens fitter and dispensing optician and has been working for The Spectacle Shoppe since 2006. She graduated from Douglas College’s two year Dispensing Optician and Contact Lens Fitting Program in 2008. From contact lens fitting to eyeglass repairs and adjustments Morgan is eager to help you with any optical needs. Connect with Morgan Nahanee on Google+