A child’s eyes are the windows to the future

A good vision is crucial for a child’s physical development, and well-being. Before we discuss the problems a child faces from eye conditions we need to understand that children’s eye problems often differ from those seen in adults and are often different from those of a fully grown individual.

Children have eyes that are still developing and the impact of uncorrected eye problems during childhood may lead to visual loss for the rest of a person’s life

Babies are able to see as soon as they are born. For the visual system to continue to develop properly, children need clear input from both eyes to the brain. If there is some problem which interferes with vision in either eye or both, the connections from the eye to the brain can become weak or not develop properly. Crossed or turned eyes or imbalance in the way each eye focuses can interfere with this normal development of the visual system.

Ophthalmologists suggest that even healthy children without any known risk factors for eye disease should undergo age-appropriate screening examinations with their paediatricians.

Children with parents or siblings with certain eye conditions, such as strabismus or amblyopia, may be at increased risk for these problems, even if they do not appear to have any difficulty with their eyes or vision. These children would benefit from an assessment with a paediatric ophthalmologist.

Children with certain medical conditions, such as diabetes, blood problems, metabolic problems, and genetic diseases like neurofibromatosis, need to be examined regularly for eye problems.

Some serious eye problems have warning signs early in life. Poor vision, eye pain, changes in the shape or size of an eye, crossed or wandering eyes, or an abnormal appearance to the pupil of one or both eyes can all be signs of serious eye conditions and should be evaluated by a physician.

Most parents are unsure when to take their child to the Ophthalmologist, but the child can be taken to the doctor at any age, if there is a suspected problem. Otherwise an appropriate time can be between three and four years of age, with the examination including measurement of visual acuity, eye alignment, motility, refraction, and fundoscopy (an examination of the back of the eye). One of the most important aspects of the examination is to identify conditions that are only treatable at an early age.

Children below three years of age or those who cannot speak properly can also be taken to the Ophthalmologist. With special eye drops and equipment, the doctor can see into the eye and measure to see if the child needs glasses, even if they can’t read. The doctor will also check for any eye misalignment or other ocular problem.

Children may need glasses for several reasons—some of which are different than for adults. Because a child’s visual system is growing and developing, especially during the first 5-6 years of life, glasses may play an important role in ensuring normal development of vision. The main reasons a child may need glasses are:

• To provide better vision, so that a child may function better in his/her environment
• To help straighten the eyes when they are crossed or misaligned (strabismus)
• To help strengthen the vision of a weak eye (amblyopia or ‘lazy eye’). This may occur when there is a difference in prescription between the two eyes (anisometropia). For example, one eye may be normal, while the other eye may have a significant need for glasses caused by near-sightedness, far-sightedness or astigmatism.
• To provide protection for one eye if the other eye has poor vision

Some common eye disorders among children are:

Amblyopia -  It is a common vision problem in children and is also known as ‘lazy eye’. It is so common that it is the reason for more vision loss in children than all other causes put together.

Amblyopia develops in childhood when the connections between the yes and the brain are developing. The brain must learn how to put together information sent from the two eyes and make one picture. If the image from one eye is clear and the other blurry, or if the eye is misaligned and send two different pictures, the brain will ignore the picture sent from one eye. Amblyopia results when the brain consistently ignores the information from one eye, while the appearance of the eye may be perfectly normal yet its vision will be abnormal.

With early detections and treatment, visual loss from Amblyopia can be minimised or even completely reversed

Strabismus - It is one of the most common conditions seen by paediatric ophthalmologists and is a generic term for any misalignment of the two eyes

Eye misalignment can cause strabismus in children. When the eyes are oriented in different directions, the brain receives two different visual images. The brain may ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, an eye that sees poorly tends to be misaligned.

The goal of strabismus treatment is to improve eye alignment which allows for better work together (binocular vision).Treatment may involve eye glasses, eye exercises, prism, and/ or eye muscle surgery.

Problems associated with strabismus (including amblyopia, ptosis, and cataract) are usually treated prior to eye muscle surgery.

Paediatric cataract -  Paediatric cataracts often occur because of abnormal lens development during pregnancy. Cataracts can be genetic or they can occur spontaneously. These cataracts may be present at birth or may develop during childhood.  Some cataracts are small and/or off-center in the lens. These cataracts do not need to be removed because vision develops normally, even if the cataract is left in place.

Cataracts that interfere with vision should be removed as soon as is safely possible, especially if the cataract is present at birth.  A delay in cataract removal can interfere with normal development of the vision centers in the brain.

A few examples of warning signs of vision problems in children are:

Constant rubbing of the yes
White reflex in a photograph

Extreme light sensitivity

Poor ability to focus

Poor visual tracking

Chronic redness of the eye

Persistent tearing

Squinting (cross eyes)

Difficulty in reading

Covering or closing one eye

Looking at an object of interest with the head tilted or with a face turn

Wiggly eyes

Droopy eyes