Childrens Vision: Common signs of EYE problems
Your child’s eyes and vision are so special ! Don’t forget their eyecare and eye checks as well as your own eye problems.
As vision impacts learning often vision screening programs are relied on but comprehensive exams are more likely to uncover all the relevant issues and health problems. Most vision impairment is known to be preventable and curable.
Early detection of any eye condition is vital even before school age. Often children tend only to be examined if they have a problem reading a book perhaps. Only 8% of Australian children aged 0–14 have had a comprehensive vision assessment, despite an estimated one in five suffering from an undetected vision problem.
At birth, your baby’s eyes are already more than half of their adult size but not as light sensitive By 3 months should be following moving objects at this stage and starting to reach. Infants are recommended for eye exam by 6 months of age where vision can be objectively determined and eye health established eg risk of cancers.
Babies don’t see much detail more shades of gray but within weeks colours.Within a few days after birth, infants prefer looking at a known face to that of a stranger.
However to perform at their best,their eyes need to as well. Reading fluency is just one measure of good vision and eye health.
We have full ranges of children’s glasses to cater for any optical correction in glasses or contacts for that matter in addition to your child’s eye test.
Their first eye test as very young children allows us to diagnose potential vision problems even if they are unable to read before they start to impact their quality of life but sometimes is mistakenly defered until the child starts school. Every parent wants to ensure their child sees every opportunity to grow and enjoy and reaching their full potential. Vision is actually a skill that can be developed and improved through appropriate treatment. It’s important to note however, that addressing vision problems may only be one aspect of managing more complex learning difficulties. Visual acuity improves from about 6/120 at birth to approximately 6/9 at 6 months of age. Colour vision should be similar to that of an adult.
Children often assume their vision is just like everyone else’s, which means that vision problems can easily go undetected even eye injuries.
Babies also have better eye-hand coordination at 4 to 6 months of age.Most babies are born with blue eyes because darker pigments in the iris aren’t completely developed at birth. Over time, more dark pigment is produced in the iris, which will often change your child’s eye colour.
If your baby’s eyes are misaligned an examination as soon as possible is advised to check for visual impairment as for any child vision case.
Retinopathy of prematurity (ROP). This is the abnormal replacement of normal tissue in the retina with fibrous tissue and blood vessels. All premature babies are at risk of ROP.
Nystagmus is an involuntary, back-and-forth movement of both eyes and can be present at birth, or it may develop weeks to months later. Risk factors include incomplete development of the optic nerve, albinism and congenital cataracts. Babies with autism have reduced eye interactions.
Commonly children can have trouble tracking when reading; they lose their place often or they move their head back and forth, rather than moving their eyes. Problems with recalling the information they have read or comprehension declines as reading continues (with fatigue).
Studies show that children who spend more than 2 hours a day on screens, and less than 1 ½ hours outdoors, are more likely to become shortsighted.
Evidence shows that:
• Children who spend more time outdoors are less likely to be, or to become myopic.
• Increased study time of more than 2.5 hours per day can increase the risk of myopia.
• Half of children and youths exceed the public health screen time recommendation of 2 h per day or less.
• More than 2 hours of smart phone use produces greater chances of vision problems, and greater chances of multiple problems
• Most studies on the effects of screen time in children indicate that the odds of visual symptoms increase after 2–4 hours of use.
Does your child have trouble SEEING CLEARLY AND COMFORTABLY ?
- Red or irritated eyes
- Frequently rubbing eyes
- Difficulty concentrating
- Tilting head noticeably
- Covering or closing one eye
- One eye turns in or out,frequent blinking.
- Holding a book very close when reading
- Omitting confusing words or moving lips when reading
- Difficulty with ball sports or hand eye-coordination.
- Write on a slant or have irregular letter and/or word spacing.
- Re-read or skip words or lines without realising.
- Headaches, blurred or double vision
- Reversing letters or words
- Questionable alignment of a lazy eye
- Squinting or sitting very close to tasks.
- Problems recognising people in the distance
Myopia is now recognized as a serious public health issue by the World Health Organization (WHO) and is projected to affect 50% of the world population by 2050,with nearly one billion in the high myopia category.Due to their impact on concentration, vision related learning difficulties can even be mistaken for other disorders such as ADHD.
Myopia ( short sightedness) is increasing often requiring glasses for distance often for genetic reasons and too much time indoors.
The brighter visible light causes dopamine release, and this slows down the myopic growth of the eye.
The International Myopia Institute has developed clinical management guidelines including tracking software and calculators (eg Brien Holden Vision Institute, UNSW ) to illustrate and predict evidence-based outcomes and strategies. There are many factors in myopic progressions
Of the fast and slow progressors in conventional lenses, the aim is to get those that are progressing quickly (particularly if young) into a myopia control option.
The SV control group in the prism lens myopia control study were those who were all progressing really quickly.
If an individual isn’t progressing corrected by single vision options special myopia control treatments can be avoided. Even after cataract extraction myopic progression or tendency can sometimes continue. The Brien Holden myopia calculator tries to estimate the progression in SV lenses that might occur, but it is an estimate only and not individual.
Progressive lenses sometimes can be used-
- as an entry point for parents and patients who don’t want either soft multifocal contact lenses or ortho K types
- an adjunct for when the patient is not wearing their contacts
- as alternatives such as prism controlled executive bifocals
- as alternatives such as Eyezen (extended near lenses) – now that higher concentrations of atropine are used where accommodation may be impaired.
Screen time recommendations
0 – 2 Years None
2 -5 Years 1 hour per day or less
5 – 18 Years 2 hours per day or less
Excessive computer and screen use has been shown to be associated with a greater risk of developing shortsightedness as well as increased symptoms of eyestrain, headaches, blurred vision, dry eyes, and neck and shoulder pain.
Ensure Good Posture – device should be no closer than the distance to the elbow.
Looking away after every 20 minutes of continuous near focusing, and a physical break every hour for children under the age of 9 years of age is recommnded.
Stop screen use for an hour before bed time
Management of amblyopia and strabismus (turned eyes)
Assessesment of vision procesing skills as well as refractive error.
Vision therapy services
Assessment of vision issues of children and adults with learning difficulties, dyslexia, ADD, ADHD, Autism Spectrum Disorders, Parkinsons and those with special needs or who are developmentally delayed and those who have had a stroke or head injury
Amblyopia, commonly known as a lazy eye occurs when the brain does not fully acknowledge the images seen by the affected eye found in about 3 % of children.
It is also the most common cause of monocular (one eye) visual impairment among young and middle-aged adults.
Treating amblyopia lazy eye involves forcing more use of the eye with weaker vision. Pairs of glasses may be required to aid focus,concentration and to avoid suppression.
- Patching treatment or medication to blur non amblyopic eye to allow more input from the amblyopic eye.
- An adhesive patch is worn over the stronger eye for weeks to months or daily patching.
- <3 hrs per day effective if < 4yrs age
- >3hrs per day required if > 4 years of age
Vision is responsible for around 80% of all learning during a child’s first 12 years ^
So protect their eyes and help them to learn by seeing as well as possible even before school age.
School vision screenings are not as comprehensive as an optometrist examination
We have a duty to ensure eye care for distance vision and near vision is balanced,healthy and comfortable as possible. Kids glasses can be prescribed and vision training instigated as required
^Vision council of america, making the grade, 2009.
A detected and treated lazy eye found from a children’s eye examination means vision problems will not limit a child’s learning potential. It may be as simple as a contact lens for balanced distance or near vision.
Amblyopia can result from any condition that prevents the eye from focusing clearly. Amblyopia can be caused by the misalignment of the two eyes (known as strabismus) where the eyes can cross in (esotropia) or turn out (exotropia). Occasionally, amblyopia is caused by cataract.
Children and even adults whose amblyopia persists despite the recommended two hours of daily patching may improve if daily patching is extended to 6 hours. The brain’s plasticity makes the condition most treatable.
Vision development is a vital concern of any eye doctor.Eye exams will detect eye problems including vision or lazy eye that require kids glasses or contacts.Such eye health checks need to be ongoing from young children as well as measuring refractive error, distance vision,teaming and near performance
Erasmus Darwin introduced occlusion therapy for amblyopia. The Pediatric Eye Disease Investigator Group (PEDIG) Amblyopia Treatment Studies (ATS) including Monitored Occlusion Treatment of Amblyopia Study (MOTAS) have refined the techniques for treatment.
Vision therapy/training integrated for brain,eyes and body can be employed that specifically targets and enhances the quality of visual and oculomotor control for young children through to adults. Children with peripheral visual deficits performed significantly worse on tasks that required visual attention than the normal vision peers and children with poor central vision (Tadin et al., 2012).
Eye muscle surgery for strabismus can involve:
Recession is when an eye muscle is detached and then reattached further away from the front of the eye to weaken the muscle.
Resection is when a portion of an eye muscle is removed to make the muscle stronger.
AMBLYOPIA FEATURES AND TREATMENT
- Dullness of vision
- Poor unilateral or bilateral visual acuity
- Abnormal macular OCT
- Abnormal submacular choroidal thickness on OCT
- Optic disc dysversion
- Optic nerve hypoplasia
- Gaze instability
- Fine motor skill deficits
- Abnormal saccades
- Reduced maximum reading speed
- Corrective prescription glasses – symmetrise sensory input
- Opaque Occlusion
- Translucent Bangerter occlusion
- Alignment surgery alone, Surgery + patch/ atropine
- Magnetic brain stimulation CNS Drugs
- Liquid crystal glasses (allows alternate between transparent and opaque occlusion)
- Binocular sensory treatments
Protecting Childrens Vision
Chidrens Vision is often assumed is just like everyone else’s, which means that vision problems can easily go undetected such as ambylopia lazy eye.
Poor vision can interfere with their ability to learn and develop. A developmental or paediatric optometrist that concentrates on the way vision is interpreted is known as a behavourial optometrist.
Many parents find that it can be difficult to ensure that their child is wearing protective eyewear, especially in situations when they may not be present, like walking to or from school and during recess.
So for our kids be they in Narooma or Eden, Tathra to Bombala, Bega, Merimbula or elsewhere its one test too important to miss. A childrens eye test is often forgotten in eye care as young children will not self report their eye condition.Establishing good vision means identifying childrens eye and vision problems by thorough eye checks in an eye examination.
Kid’s eyes need protection, too. In fact, children are more at risk of the eye-damaging effects of UV exposure than adults. The eye of a child under the age of ten allows more than six times the amount of UV light to penetrate than an adult’s eye, so it’s never too early to start protecting a child’s eyes.
Children’s eyes are more transparent and the UVA, UVB and UVC can all penetrate deeper into the eye structure than an adults eye. Most literature is based on an adults eye that has had changes to the transmission properties caused by sunlight. Transitions lenses can help. They block 100% of UV radiation and reduce glare. And they’re available in the sturdy, lightweight, shatter and impact-resistant materials that are best for children.A child’s retina can be damaged by UVB because the lens has only a small ability to absorb UVB, even though less than 2% of UVB is thought to penetrate through the lens of an adult eye.
Even if UVC does not penetrate beyond the lens, it can still cause damage to other structures of the eye. The conjunctiva is more sensitive to UV than the cornea and the skin around the eye can also be affected by the ultraviolet radiation
Hundreds of thousands of Australians are immersed for too long in virtual reality headsets eg Google, Samsung, Sony.
Eye strain and dizziness can easily result as the focus and convergence are more dissassociated and may require longer and more frequent breaks than actually occur as the experience can be addictive for some especially children.
Nowadays the majority of children (even preschoolers) report digital eye strain when using digital devices and are found to have dry eye issues from inefficient blinking and blue light from screens.
Computer vision syndrome is now called digital eye strain because it related to all digital device use not just computers.
The Telsyte Australian Virtual Reality and Augmented Reality report predicts a quarter of Australian homes will have a VR headset by 2021.
At a minimum use the 20-20-20 rule. Every 20 minutes, take a 20-second break and focus your eyes on something at least 20 feet (6metres) away performing some clockwise and anticlockwise movements,stand up and blink completely !
Have your children’s eyes examined every couple of years as a general guideline. Kids glasses for permanent or part time use after regular eye checks to correct focusing and certain eye conditions can often help in a future child’s eye test and a child’s vision long term as vision to the children’s eye is so important for learning.
Genetics,environmental and social factors are major influences on myopia. Evidence shows that time spent outdoors in childhood partially protects against the development of myopia and in countries such as China where the condition is rampant such policies are being enforced in schools.
In areas such as dyslexia bad advice or simplistic advice can abound for treating conditions such as amblyopia or visual dyslexia.