Children are not born with vision, but with visual potential. Visual development takes place during the first several years of life. Just like learning a language, children are also learning to see the world around them. Ophthalmic problems or even routine refractive errors (the need for glasses) can interfere with a child’s visual development.
It is estimated that about 80% of a child’s learning is visually based. Good vision is not only necessary for a child to learn to read and advance academically, but also for appropriate social development, behavior, self-esteem, and coordination.
Since younger children cannot express or verbalize their vision, and older children may not be aware enough to understand they have a visual problem; it is important to have any concerns evaluated. Pediatric eye evaluations and treatment differ greatly from the typical eye problems of adults. Children should be seen by someone with special skills and knowledge in pediatric eye care.
Types of Vision Problems Affecting Children
The list of problems which can affect children and their visual development is quite long. Many of these problems can affect a child before they can speak. The most common vision problem to affect children is a refractive error. An eye examination with refraction is required to determine how well a child’s eye focus.
Common eye focusing problems include:
- Myopia (nearsightedness): If your child is unable to see objects at a distance, or the object appears blurry, your child may be myopic.
- Hyperopia (farsightedness): If your child is unable to see things at close range, your child may be hyperopic. Hyperopia occurs when the eyeball is too short or when the cornea’s curvature is too flat. Hyperopia may be hereditary and may be present at birth. Many children outgrow hyperopia, as they grow and their eye changes shape.
- Astigmatism is caused by the irregular shape of the cornea. If a child has astigmatism, their vision can be blurry at any distance. The cause of astigmatism is unknown, but is usually present at birth and may be hereditary.
Some additional conditions which can affect your child’s vision are more obvious even without an eye exam.
These conditions include:
Strabismus (Crossed eyes)
Nearly 3-5% of children have strabismus; this may be manifested by out-crossing or in-crossing of the eyes. Sometimes children with strabismus may hold their heads tilted or turned to one side. This may occur at any age. Typically, strabismus is an isolated problem, but could potentially be a sign of more serious eye conditions or neurological disease. Treatment of strabismus depends on a number of factors and could include: patching, eyeglasses, exercises, and surgery. All children with suspected misalignment of the eyes should see a pediatric ophthalmologist for evaluation.
Amblyopia (Lazy eye)
Nearly 2-3% of children have amblyopia; when one poor vision in one or both eyes. If left untreated, it cannot be reversed later in life. There are three major forms of amblyopia.
- Amblyopia due to crossed eyes (strabismus).
- Amblyopia due to refractive error (need for glasses).
- Amblyopia due to blockage of vision (for example, cataract or droopy eyelids).
Amblyopia is only treatable during childhood. Therefore, it is important that any child with suspected amblyopia see a pediatric ophthalmologist for appropriate evaluation and treatment. Otherwise, the vision in the affected eye(s) may be lost for life.
Blocked Tear Ducts
Many infants experience tearing due to blocked tear ducts. This will manifest as tearing, crusting, and discharge from the involved eye(s). In most cases, massages and time will allow the passageways to open. In some cases, the ducts remain blocked, and a procedure to open the ducts can be performed. Other diseases can present as tearing in a child as well, and examination by a pediatric ophthalmologist can help with making the right diagnosis and treatment plan.
Through school and play, children are frequently exposed to ocular infections. These infections can be quite dramatic in children, sometimes requiring medications. If your child has red-eye or drainage, an ophthalmologist should be consulted. Topical or systemic antibiotics may be required.
The eyes are our windows to the world. Unfortunately, they also can be very sensitive to environmental allergens. Since children spend so much time outdoors, they can be affected by ocular allergies. Children with a history of asthma or rhinitis (runny nose) may be particularly bothered by ocular allergies. Avoiding the ocular allergens and cool compresses may help with symptoms. Prescription eye drops may be necessary to alleviate symptoms during exacerbations. Your pediatrician may recommend systemic medications as well.
If you have a family history of eye problems, or if you suspect a problem with your child’s eyes, we recommend evaluation by a physician trained in pediatric eye care.
How will I ever get my child to wear glasses?
This is a question commonly asked by parents of infants and toddlers. Most children will recognize that they see better with their glasses and will leave them on. Some children do not accept change easily or object to “things” on their face or head and will resist wearing the glasses. A positive attitude on the part of the parents is extremely important. Starting with a comfortable fitting by an experienced optician is very important. The glasses should fit so that the eye is in the center of the lens. The glasses should not be constantly sliding down the nose, as the child will look over the top of the lenses and defeat the purpose of the glasses. Many trips back to the opticians for adjustments may be necessary. Praising the child for keeping the glasses on, engaging in one on one activities that keep the hands busy and the mind distracted will help at the beginning. If the child is extremely strong-willed and refuses glasses despite all efforts, it is best to discuss other options with your physician. (Sometimes short term drops can be used at home to encourage the child to use the glasses.)