Early Detection Is Key for Childrens' Eyesight
by Susan Blair
1/1/2006
Susan Blair, an ophthalmologist at Pleasant Valley Ophthalmology, says screening helps identify visual abnormalities or risk factors for developing eye problems.
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A frequently asked question by parents is at what age their child should have an eye exam. Detection of eye abnormalities in the young pediatric group is very important because infants and young children are uniquely susceptible to permanent visual loss known as amblyopia. After a child is born, the visual connections between the eye and the brain continue to develop until approximately 10 years of age. During early childhood, the brain must receive equally clear, focused images from both eyes simultaneously for visual pathways to develop properly. If the image from one or both eyes is not clear, such as occurs with congenital cataracts, misalignment of the eyes, or significant uncorrected refractive errors (nearsightedness, farsightedness, astigmatism), the child will not develop full visual potential (i.e., 20/20 vision) if left untreated. Vision screening helps to identify children who may have eye or visual abnormalities or risk factors for developing eye problems. Age-appropriate eye/vision evaluations by the primary care physician (PCP) are performed in the newborn period and at all subsequent wellness exams. At a newborn's first examination, the PCP should be made aware of any family history of eye problems. At that visit, the PCP will check to see that there is a red reflection present when a light is shone into the eye and check for structural abnormalities of the eye. At age 3 to 6 months, an infant should be able to fixate and follow objects with each eye. Measurement of vision at screening exams is recommended for all children by age 3. Vision screening is also done within the school system at regular intervals starting at the pre-K level.  |  |  After a child is born, the visual connections between the eye and the brain continue to develop until approximately 10 years of age.  |  |  |
According to the Preferred Practice Guidelines developed by the American Academy of Ophthalmology, infants with a family history of congenital cataract, congenital glaucoma or retinoblastoma should have a comprehensive eye exam by an eye specialist as early as possible. Those with a family history of amblyopia, ocular misalignment or other childhood eye disorders should be examined by 18 months.The PCP will refer a child to an eye specialist if there is a red reflex abnormality or a structural/alignment abnormality. A child should also be referred if vision measurement cannot be done by age 3; if a 3-year-old has vision of 20/50 or worse; if a 5-year-old has vision 20/40 or worse; and if a 6-year-old has vision 20/30 or worse. In addition, a two-line difference in vision (for example, 20/30 in one eye and 20/50 in the other eye) in a child of any age should be referred to an eye specialist. Vision screening and/or exams should be performed periodically even after a child is outside the age range for developing amblyopia, as significant refractive errors occur in 20 percent of children during the teen years. Signs & Symptoms • Defective fixation or visual interactions
• Abnormal light reflex (including both the corneal light reflections and the "red" reflex)
• Ocular misalignment or ocular movement abnormality
• Shaking of eyes
• Persistent tearing
• Persistent ocular discharge
• Persistent redness
• Persistent light sensitivity
• Squinting
• Eye closure
• Head tilt
• Learning disabilities (Susan Blair, an ophthalmologist at Pleasant Valley Ophthalmology, sees many children in her practice.)
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