Keep an Eye on Kid's Vision

From the day they are born, children spend a lot of time examining their environment. Their eyesight plays a major role in this process and in their development. Being able to see well helps children learn and grow.

Some children may develop vision problems that become apparent in the childcare setting. As a provider, it is important to know what is normal, what is not, and what to stay on the lookout for when it comes to children's vision.

Visual Milestones

Although newborn babies can see light and the forms of objects and people, their eyesight is not developed enough to see colors or distant objects. Generally, newborns can only focus for limited periods of time on objects within 12 inches of their faces. Once babies are one-to-three months old, they begin focusing for longer periods of time and start trying to follow objects with their eyes. Reaching for objects, developing hand/eye coordination, and distinguishing color, takes place around the fourth or fifth month.

As babies begin to sit up, roll over, crawl, and walk, their hand-eye coordination develops further. By eight-to-15 months, children learn to look for hidden objects, to imitate the faces of others, and to judge distances. Throughout the toddler and preschool years, kids become more interested in distant objects, improve their visual memory, and develop their hand-eye coordination.

Vision Screening

Vision screening is a general check of the eyes and vision and may be performed by a health professional, a childcare consultant, or even a child caregiver trained in the technology. Vision screening and eye examinations have come a long way from the standard vision chart in the past few years and there are many different techniques for vision screening. For children not yet talking, hand puppets may be used. An "E" chart, rather than alphabetical letters, may be used for young children or non readers. Specialized equipment is available, such as a special "camera" and the resulting photograph may indicate certain vision problems. Vision screening can aid in early identification of eye problems, which means children can be treated for visual problems before those problems interfere with development.

At or shortly after birth, most newborns receive a general eye check by the pediatrician or family doctor. In addition to this first screening, the American Academy of Ophthalmology recommends the following:

• From six-12 months, a child should receive an eye screening by his or her family doctor or pediatrician, usually during a well-child examination.
• During the third year, a child should be screened for visual acuity (the ability of each eye to fixate and follow objects), eye alignment, depth perception, color vision, and the physical structure of the eye.
• At age five, a child should be checked again for vision and eye alignment.
• If a child is premature, has a family history of eye disorders, or if any problems are detected or suspected at any of these screenings, the child should be referred to an eye specialist for an eye examination.

An ophthalmologist is a medical doctor who specializes in all aspects of eye care, including diagnosis, management, and surgery of ocular diseases, disorders, and injury. Ophthalmologists can also check vision and prescribe corrective lenses. They may even specialize further in their profession, such as pediatric ophthalmology. An optometrist, often referred to as an "eye doctor," is licensed to practice optometry, not medicine. The optometrist traditionally examines the eye to check vision and prescribe corrective lenses, and screen vision to detect certain eye abnormalities such as glaucoma, color perception, and the ability to focus and coordinate the eyes. An optician is a professional who can fill prescriptions for glasses and contact lenses.

As with vision screening, eye exams also have changed greatly in past years. For example, some examinations still require the eye drops that dilate the pupils and allow the doctor to see inside the eye; however, there also are special lenses that the doctor can look through and closely examine the eye structure, often eliminating the need to dilate the pupils. If a child receives treatment for an eye disorder or needs vision correction, regular (at least yearly) examinations often are recommended.

Common Vision Problems

Common vision problems in children include the following:

• Strabismus refers to crossed or misaligned eyes. Eye crossing is common in newborns. However, if it occurs in children older than three months, it may indicate a problem; treatments for strabismus include glasses or surgery.
• Amblyopia-lazy or drifting eye-can result in permanent vision loss if not treated. Depending on the severity of the condition, treatment may include wearing a patch, wearing glasses, or undergoing surgery.
• Nearsightedness, or inability to see distant objects, is also called myopia. It is usually treated with prescription glasses.
• Farsightedness, or inability to see close objects, also called hyperopia, also is often treated with prescription glasses.
• Astigmatism is an improper curve on the front of the eye. This condition is often treated with prescription glasses.

If a child is having an eye problem, you may notice one or more of the following symptoms:

• Squinting, frowning, excessive blinking or excessive eye rubbing.
• Shutting or covering one eye with a hand.
• Holding objects too close to the eye.
• Tilting or thrusting the head forward.
• Extreme sensitivity to light.
• Crossed or misaligned eyes, or abnormal movement of the eyes.
• Inflamed, watery, crusted, or red-rimmed eyes.
• A white pupil (center part of the eye) instead of black.

In addition to these behavioral and physical symptoms, a child also may indicate difficulty seeing, complain of sore, burning, or itching eyes, blurred or double vision, or suffer from dizziness, nausea, and headaches. If you notice any of these symptoms or other eye or vision abnormalities, you should discuss them with the child's parent and suggest a professional eye examination.

Treatment of Eye Problems

Children with refractive errors such as nearsightedness, farsightedness, or astigmatism probably will need to wear glasses to correct their vision problems. Kids often feel self-conscious about wearing glasses and may refuse to wear them. If a child hates the glasses, talk to the parent. Getting children to wear glasses can be as simple as allowing them to choose their own frames. Another way to overcome reluctance to wearing glasses is to show them how their favorite activities, like artwork, sports, or looking at books, are even more fun when they can see better.

Other types of vision correction--including contact lenses and refractive surgery--usually are reserved for older children or adults. However, depending on the type of eye problem, a young child may need eye surgery to correct her vision.

By Amy Sutton
Former Senior Editor, Alfred I. duPont Hospital for Children, Wilmington, DE

RESOURCES

American Academy of Ophthalmology, San Francisco, CA 94120-7424; 415-561-8500; www.aao.org

National Institutes of Health National Eye Institute, 2020 Vision Pl., Bethesda, MD 20892-3655; 301-496-5248; www.nei.nih.gov

Prevent Blindness America, 500 East Remington Rd., Schaumburg, IL 60176; 800-331-2020; www.preventblindness.org

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