A Child’s Eye And Common Refractive Errors

 Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions and are patient and cooperative durin

Published: 17th May 2018 10:29 PM  |   Last Updated: 18th May 2018 03:10 AM   |  A+A-

Express News Service

TIRUVANANTHAPURAM :  Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions and are patient and cooperative during a medical examination. So, a comprehensive eye check-up is always mandatory at the earliest as routine. While in my practice, I often, came up with certain queries from parents and their near ones. 

To start with, we recommend, Comprehensive assessment of eye every year starting at age 1 in order to check the vision, the muscles, the external and internal health of the eye to all kids. One of the greatest tasks of a school-aged child is learning to read and in older children, the amount of reading required. Hence, Annual eye exams help to monitor the child for progression or improvement if there is a slight nearsightedness or farsighted. If a child is skipping lines, uses his or her finger to help with reading or is constantly mistaking letters, an assessment is recommended. 

Today it seems that many children are very quickly diagnosed as learning disabled or dyslexic. Here the question comes - does vision play into the problems? The answer is, yes, Vision does contribute to learning disability and it is recommended that lazy eye or need for glasses is ruled out before any other medical interventions. 

The term ‘Lazy Eye’ has become a buzz now. Different people mean different things when they say “lazy eye”. Some mean a drooping eyelid, some mean eye misalignment, and others mean that one eye just doesn’t see as well as the other, even though they may be straight. A drooping eyelid is called ptosis. In a young child, a drooping eyelid may cause astigmatism, which can lead to amblyopia. A drooping eyelid may be a sign of a more serious medical condition. Eye misalignment is called strabismus.

Like strabismus, amblyopia needs evaluation and treatment by an eye doctor to restore and maintain good vision in the weak eye. Amblyopia should be detected and treated as early as possible. It gets harder and harder to treat with each passing year, and is very difficult totreat after age 9. Many parents ask us that their child is struggling with reading and want to know whether the eyes are the main reasons for it. We explained that- The eyes are almost never the sole cause of reading or learning problems. Because of this, eye-related treatments such as reading glasses, tinted plastic sheets to lay over the page, eye exercises, or so-called “vision therapy” are almost never the correct treatment for your child’s reading or learning problem. 

Nevertheless, it is wise to have your child’s eyes examined by an ophthalmologist if there is a struggle with reading or learning, for two reasons: first, to make sure that he is not one of those very few kids who does have an eye problem that is contributing to the reading or learning difficulty, and second, so that you and the school will both know that you can strike eyes off the list and move on to educational evaluation and educational remediation to see what really is the cause of the reading or learning difficulty.

There are certain confusions among parents and apprehensions loom large among them about their newborn squinting eyes. Many newborns do in fact have transient eye misalignment, either crossing or an outward drift. This generally goes away in the first several months of life and should be gone by six months. More commonly, what appears to be crossing is, in fact, the illusion of crossing due to the broad nasal bridge, so that when the child looks even a little bit to one side, less white shows on the nose side of that eye, making it look crossed. 

One of the best ways for you to try to determine whether your child has true crossing or this “pseudoesotropia”(the illusion of crossing due to a broad nasal bridge) is to look at a flash photograph. 
In two instances parents use to ask certain queries. The first one is that their child is not able to read the last line in vision chart ( vision 6/9) yet we are not recommending any therapy or glasses. The answer to this is that the child might have a relatively mild refractive error: either mild nearsightedness or mild to moderate astigmatism. These conditions do not harm the eye in any way, and as long as the child is able to see adequately in school, I’ll often recommend having him or her sit in the front half of the class, reserving glasses for when he can no longer see clearly or adequately in school. 

The second instance is that though the child can read all the lines (6/6), still we are prescribing glasses. If the child sees 6/6 with each eye and still needs glasses, then he or she most likely has accommodative esotropia (crossing of the eyes related to farsightedness). Their glasses are needed to keep the eyes straight, not to let them see. In our hospital, we have many instruments especially for children to correct vision, amblyopia etc through glasses, stimulation therapy like CAM, HB Stimulation, and vision therapy. We fit contacts as early as age 7 for sports. 

I always recommend, doing an early eye examination at the age of 6 months of the child. And advice parents to be vigilant of any signs of squinting, head tilt or diminution of vision till the age of 3 years. 
If any alarming signs are anticipated, please report to your Pediatric ophthalmologist and get check up. Routine, yearly examination is always good to preserve a good eye health. Always remember ‘a little vigilance on eye health can prevent many untoward consequences’. A little care can save the vision of a child.

Dr Anup Das
Dr Anup’s Insight Eye Hospital
Thiruvananthapuram
(The views expressed by the author are his  ow
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