Eye Testing in Children
Ms Tabita Naomi Veeravalli
PREVALENCE OF CHILDHOOD EYE DISEASES
According to the recent survey (2011), World Health Organization (WHO) reported that about 19 million children were estimated to be visually impaired and 1.4 million children, blind worldwide¹. In India it is estimated that the percentage of blindness in children is 0.08%¹. Early detection or vision assessment in children is not only important to reduce the number of childhood avoidable blindness, but also to address & counsel the parents
WHY IS PEDIATRIC VISION ASSESSMENT IMPORTANT?
Uncorrected vision problems can compromise child development and interfere with learning, attitude and sociability. Visual function prognosticates the academic performance in school going children. Childhood eye diseases, if left unattended, may affect health and well-being even into adulthood.
In many cases, children may not complain or show any signs, but might still be having an eye problem. The child may not complain if the problem is in one eye.
My typical day in the clinic, testing a child to rule out squint or deviation in eye.
APPROPRIATE AGE FOR PEDIATRIC VISION TESTING
The ability of a child to develop focus, colour vision and depth perception is developed by the age of 6 months.
So the first sight test is to be done at the age of 6 months, then at the age of 2-3 years. It is recommended to have vision testing once every 2 years if the child does not require any Spectacles or Contact lenses. But if the child is recommended Spectacles or Contact lenses, appropriate follow ups are required with the Optometrist or the Ophthalmologist. It is not mandatory that the child needs to be verbally active for vision assessment. Non-verbal methods of vision assessment are also available.
ADVANTAGES OF EARLY DISCOVERY
Some corrective strategies like aspheric lenses, customised contact lenses and atropine therapy help in controlling the progression of myopia or short-sightedness. In such cases early detection helps. If a child is diagnosed with lazy eye, he or she can be treated with therapy which is more effective before the age of 12 years.
Child wearing a patch as a part of Amblyopic Occlusion therapy
If Squint (misalignment of eyes) is diagnosed and treated in and early stage, then 3D or stereoscopic vision can be stabilised.
In critical disease conditions like Retinitis pigmentosa, Congenital Glaucoma, Retinoblastoma, and Vitamin A deficiency, early detection can save the child from loss of vision or atleast slower down the vision loss along the way.
EDUCATION ABOUT OCULAR HEALTH IN CHILDREN
Some children do not report of blurred vision because they are unaware that it is abnormal. Children should be educated about their ocular health and hygiene. If the child is advised to wear Spectacles or advised any ocular therapy, it is important that he or she complies with the treatment as advised by the Optometrist.
It is also important to inform the child’s teachers about the child’s eye condition.
Lid hygiene is often neglected which gives rise to painful bumps along the lid margin. Rubbing of the eyes should be restricted. If it is persistent, immediate medical attention is required. Protective eye wear should be made a habit during sports.
COMMON SIGNS AND SYMPTOMS TO LOOK FOR
If the child experiences the following signs and symptoms, immediate medical attention is advised:
Redness , Watering &/or Discharge
Dry, swollen eye lids
Closing one eye
Tilting or turning head to one side
Blinks more than usual
Reading at a very close distance
Squeezing of the eyes
Poking of the eyes.
White reflex seen in photographs
In addition to the conditions mentioned above, it is important to be aware that the following factors may make a child more likely to develop a vision problem if the child:
Was born premature,
Has a family history of eye problems,
Has had an eye injury,
Has any systemic illness,
Has parental consanguinity.
The most common treatments given in children are usually the following:
SPECTACLES – Helps in focusing blur images in near and far sightedness.
PATCH THERAPY- Most common treatment for Amblyopia or lazy eye.
EYE EXERCISES – To improve coordination between the two eyes.
MEDICATION – To treat infections, allergies etc.
SURGERY is needed in cases like childhood Cataract to replace the lens, Glaucoma where the pressure is reduced and Strabismus where the misalignment is corrected to improve 3D vision.
Health education and immediate health care is essential for a good quality of living. Parents should understand the importance to separate fact from myths, especially when it comes to eye health. Genetic counselling for parents who are direct relatives or in consanguineous marriage can help in identifying and analysing a genetic disease. Crude medical practice or over-the-counter medications should be avoided till expert opinion is taken. Every school should be screened periodically to identify and treat avoidable causes of blindness and visual impairment in children.
Ms. Tabita Naomi Veeravalli received her Bachelor in Optometry from Bausch and Lomb school of Optometry, L V Prasad Eye Institute- BITS Pilani, Hyderabad. She worked in Pediatrics, Neuro and Strabismus department in L V Prasad eye institute for 3 years. She specialises in Orthoptics and Vision therapy. Her areas of interests are in Neuro- Optometric Rehabilitation and Vision Therapy. She practises Orthoptics and Vision therapy in Solis eye care Hospital.