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Children’s Vision

Children’s Vision

Children with uncorrected vision conditions or eye health problems face many barriers in life … academically … socially … and athletically. High-quality eye care can break down these barriers and help enable your children to reach their highest potential.

Vision doesn’t just happen. A child’s brain learns how to use eyes to see, just like it learns how to use legs to walk or a mouth to form words. The longer a vision problem goes undiagnosed and untreated, the more a child’s brain learns to accommodate the vision problem.

That’s why a comprehensive eye examination is so important for children. Early detection and treatment provide the very best opportunity to correct vision problems, so your child can learn to see clearly. Make sure your child has the best possible tools to learn successfully.

Everyone has a vision of what children’s eye problems look like: Squinting, sitting too close to the television, rubbing their eyes. Though those can be symptoms of vision issues, sometimes there are no signs your child isn’t seeing well. Here’s what to watch out for and what to do about it. In the first few months of life, infants can only see clearly objects that are 8 to 10 inches from their face. It isn’t until 12 to 16 weeks that their eyesight begins improving, and they start seeing things more clearly and further away. Over the next year, kids then develop depth perception, eye-body coordination, eye-hand coordination, and the ability to judge distances. It’s rare for children to have vision problems at this age. Vision problems in kids tend to emerge between 18 months and 4 years old. The two most common vision issues are:

A crossed or wandering eye, which troubles 3% to 5% of children. Symptoms include an eye that drifts or appears crossed in respect to the other eye, though “it isn’t really the eye that’s the problem,” says David Epley, MD, a pediatric ophthalmologist in Washington. “It’s the brain’s wiring that’s at fault.”

Uneven focus, where one eye is more farsighted than the other, affects 2% to 3% of kids. This vision problem is the hardest to detect, because young children don’t know their vision is compromised. “Seeing that way, it’s all they’ve ever known,” says Mary Collins, MD, a pediatric ophthalmologist practicing in Maryland, “so they won’t say anything about it.” Uneven focus or a slightly wandering eye may not seem that alarming, but if either condition goes untreated, a child’s stronger eye — the one that sees further, or focuses better — slowly becomes their dominant eye. The brain starts ignoring the images coming from the weaker eye, and stops developing the nerve connections leading to it. By the age of 9 or 10, the vision loss in that weaker eye is usually permanent.

The compromised vision in that weaker eye, called amblyopia or lazy eye, doesn’t have to happen. It can be stopped and reversed, but it needs to be caught early with a vision screening. Your child’s first vision screening may be done by your family doctor, pediatrician, the school nurse, or an eye specialist.

Experts have different opinions as to who should do vision screenings and exams for children. Many ophthalmologists and pediatricians feel that vision screening can be part of your child’s routine pediatric check-ups — with referral to an eye care provider if problems are noted. Optometrists, on the other hand, recommend more frequent comprehensive eye exams by an eye care professional. Your health care provider can help you determine what’s appropriate for your child.

It’s difficult to know if or when your child needs to see an eye care provider. But most experts agree that eye exams — performed during regular well-child visits — help protect your child’s vision and provide useful information about his or her eye health.

Children’s eye health begins in the newborn nursery and should continue throughout childhood, says Michael Repka, MD, professor of ophthalmology and pediatrics at Johns Hopkins University School of Medicine. “For many children, an evaluation by a pediatrician may be enough. But if a child has a family history of vision or eye problems or has symptoms, he or she may need to have an official eye exam,” he says. Even if there are no risk factors or family history of eye problems, children need their vision checked at 6 months, 3 years, and before first grade. Most states require children to have an eye exam prior to beginning public school. Even if your pediatrician doesn’t see a problem, there may be other signs that your child needs a more thorough eye exam.

A new survey of nearly 1,500 participants—co-sponsored by VSP Vision Care and Prevent Blindness America—indicates that more than one in five 12- to 17-year-olds have difficulty seeing the classroom blackboard, with more than 25 percent complaining of headaches. One possible reason? According to the survey, almost two-thirds (66 percent) of children under the age of six have never had an eye exam by an eye doctor.

These complaints about vision problems and headaches were noted even though 45 percent of the children in this age group wear some type of prescription eyewear, the survey indicates.

Additional survey findings show that one in four six- to 11-year-olds wears prescription glasses, and that the prevalence of common eye conditions, as reported by parents, increases with the child’s age.

“The survey provides a clear example of why regular eye exams are so important as children progress in school.” said Gary Brooks, VSP Vision Care’s president. “Most parents probably assume once a prescription is given, there isn’t a need for further follow-up. However, the survey results reinforce the need for regular eye exams as kids’ eyes continue to change and adapt.”

PBA recommends that all children have their vision checked at infancy and regularly throughout childhood, and that if a child fails a vision screening, or if there is any concern of an eye or vision problem, he or she should be referred for a complete eye exam by an eye doctor (ophthalmologist or optometrist).

The American Academy of Pediatrics, the American Academy of Ophthalmology and the American Association for the Pediatric Ophthalmology and Strabismus all recommend a combination of primary care doctor eye evaluations and vision screenings with a referral for a complete eye exam by an eye doctor, according to VSP. The American Optometric Association recommends that all children have a complete eye exam by an eye doctor at ages six months, three years and five years, and that between six and 18, children should visit an eye doctor at least every two years, or more if recommended by an eyecare practitioner.

“The good news is that most common eye problems in older children, including myopia, can be effectively treated if diagnosed early,” said Hugh R. Parry, PBA’s president and chief executive officer. “We urge all parents and caregivers to have their child’s vision checked regularly to promote a lifetime of healthy vision.”

It is widely agreed that screening of vision at schools is desirable since the prevalence of visual disorders among children is high and in a good proportion of instances adequate care would not be sought unless the disorder is uncovered by a screening programme. There is less agreement on what methods are most appropriate for school vision screening bearing in mind the need for the screening method to be efficient, easy to administer and inexpensive. The Orinda Study showed that the modified clinical technique (MCT) was efficient and not unduly expensive and that screening instruments had very high under- and over-referral rates. The present study evaluated the Mavis vision screener, an instrument which has a number of features that are appropriate to the screening of children’s vision. Despite careful training of the teacher operators who were highly motivated and very conscientious, the instrument had a high over-referral rate most likely due to proximal accommodation. Although the MCT to which the instrument was compared was not infallible, it seems that this is the preferable method of school screening especially for younger children. Since myopia is the principal visual disorder to emerge during the school years, screening with the Snellen chart by lay persons in the later years at school may be an acceptable procedure provided optometrists or ophthalmologists are used for a thorough vision screening of kindergarten and year one children.

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