MB.BS, FRCS, FR­COph­th

Con­sul­tant Oph­thal­mol­o­gist,

Med­ical As­so­ciates Hos­pi­tal

Pre­vent Blind­ness has de­clared 2022 the “Year of Chil­dren’s Vi­sion” with “the goal of high­light­ing and ad­dress­ing the di­verse and crit­i­cal vi­sion and eye health needs of chil­dren and to im­prove out­comes through ad­vo­ca­cy, pub­lic health, ed­u­ca­tion, and aware­ness. Com­mon vi­sion dis­or­ders in chil­dren in­clude am­bly­opia (lazy eye), stra­bis­mus (crossed eyes), and re­frac­tive er­ror, in­clud­ing my­opia, hy­per­opia and astig­ma­tism.”

Let’s ex­plore Case Sce­nar­ios

The fol­low­ing sce­nar­ios demon­strate the po­ten­tial for sav­ing chil­dren from blind­ness and vi­son im­pair­ment. The win­dow of op­por­tu­ni­ty in chil­dren is of­ten lim­it­ed and must be seized with­out de­lays.

1) ↓1 week old ba­by, 32 weeks ges­ta­tion

The Oph­thal­mol­o­gist was called to the neona­tal unit to ex­am­ine a one week old ba­by who was born pre­ma­ture­ly at 32 weeks ges­ta­tion. The child weighed 1250gm at birth and, be­cause of breath­ing prob­lems, need­ed to have oxy­gen sup­port in an in­cu­ba­tor. Spe­cial ex­am­i­na­tion equip­ment was used by the doc­tor, af­ter plac­ing drops in the eyes. The right eye was nor­mal but the left eye showed a sus­pi­cious area in the reti­na at the back of the eye. A re-ex­am, one week lat­er, re­vealed ab­nor­mal blood ves­sels in the reti­na. LASER treat­ment was done to save the sight in the af­fect­ed eye. Week­ly ex­am­i­na­tions were done to i) en­sure no fur­ther prob­lems in the treat­ed eye and ii) de­tect prob­lems de­vel­op­ing in the right.

Pre­ma­ture ba­bies have un­der­de­vel­oped or­gans in­clud­ing the eyes. The more pre­ma­ture, less than 32 weeks, and the low­er the birth weight, less than 1500 grams, the greater the risk. There is a crit­i­cal pe­ri­od dur­ing which re­peat­ed ex­am­i­na­tions are nec­es­sary week­ly, fort­night­ly or month­ly to de­tect on­set of dis­ease. Ear­ly de­tec­tion and treat­ment can pre­vent blind­ness. If dis­ease is de­tect­ed af­ter the child demon­strates a white pupil, it is usu­al­ly too late to save sight.

2) 5 year old girl with glare sen­si­tiv­i­ty

This pa­tient was brought to the eye doc­tor be­cause of glare sen­si­tiv­i­ty and oc­ca­sion­al “squint­ing” of the eye­lids. Vi­sion in both eyes was sub-nor­mal at 20/50. Bi­lat­er­al cataracts were di­ag­nosed. She was born pre­ma­ture, had neona­tal oxy­gen ther­a­py and a heart mur­mur was de­tect­ed. This prob­a­bly di­vert­ed at­ten­tion and no eye con­di­tion was sus­pect­ed.

Con­gen­i­tal cataract is of­ten a sur­gi­cal con­di­tion which re­quires ear­ly in­ter­ven­tion to al­low for nor­mal de­vel­op­ment of the vi­su­al sys­tem in­volv­ing the eyes, op­tic nerves and vi­sion cen­tre in the brain. De­layed treat­ment can re­sult in per­ma­nent­ly im­paired vi­sion.

Chil­dren with vi­sion prob­lems eg. “squint­ing” to see, hold­ing read­ing ma­te­r­i­al and dig­i­tal de­vices close to the face, tilt­ing the head when look­ing at ob­jects, demon­strat­ing rov­ing eye move­ments or crossed eyes, an eye that is larg­er or small­er than oth­er kids, or the black of the eye look­ing grey or white must be ex­am­ined by an eye care pro­fes­sion­al.

3) 12 year old boy with Ker­a­to­conus

This pa­tient pre­sent­ed with itch­ing and eye rub­bing due to al­ler­gies as­so­ci­at­ed, presents for his first eye ex­am with blur­ring and glare prob­lems. He nev­er had glass­es. Right vi­sion was down to Count­ing Fin­gers, the left 20/30. Best vi­sion, in the right, with spec­ta­cle lens­es was lim­it­ed to 20/100. The grad­ual de­te­ri­o­ra­tion of his right vi­sion went un­de­tect­ed be­cause left vi­sion was good. His was di­ag­nosed with ker­a­to­conus by corneal topog­ra­phy scans.

Ker­a­to­conus is a com­mon con­di­tion that caus­es ab­nor­mal bulging, thin­ning and ir­reg­u­lar­i­ty of the cornea. It is com­mon­ly as­so­ci­at­ed with itch­ing and eye rub­bing. The con­di­tion can progress to corneal scar­ring that re­quires corneal trans­plant surgery. Most cas­es can be treat­ed, to pre­vent this, if caught ear­ly. Any child who is short sight­ed, has signs of al­ler­gies, rubs the eyes of­ten and re­quires fre­quent changes of spec­ta­cles should be con­sid­ered at risk of hav­ing ker­a­to­conus and be re­ferred to an Oph­thal­mol­o­gist. Sim­ply up­dat­ing their glass­es an­nu­al­ly is not the cor­rect man­age­ment as a more sin­is­ter prob­lem can be missed. Chil­dren with eye al­ler­gies should al­so be treat­ed by an Oph­thal­mol­o­gist be­cause they are at risk of de­vel­op­ing vi­sion prob­lems due to corneal scar­ring.

What should par­ents look out for?

Chil­dren with vi­sion prob­lems will of­ten show signs of poor read­ing and com­pre­hen­sion, fall be­hind in class, lack con­fi­dence and may have poor so­cial skills.

They may be poor­ly equipped for a ful­ly pro­duc­tive life and can be a bur­den to their fam­i­lies and the state.

It is a com­mon ex­pe­ri­ence that grad­ual vi­sion change go un­ob­served when the fel­low eye has good vi­sion. This oc­curs with oth­er con­di­tions like cataract and glau­co­ma. If, on the oth­er hand, vi­sion should change sud­den­ly, it will be no­ticed.

We must there­fore be com­mit­ted to pre­vent­ing vi­su­al im­pair­ment and blind­ness among our chil­dren to se­cure their fu­ture and that of so­ci­ety.

WHEN SHOULD YOUR CHILD HAVE THEIR FIRST EYE EX­AM­I­NA­TIONS?

The Amer­i­can As­so­ci­a­tion of Op­tometrists (AAO) rec­om­mends that the first eye ex­am­i­na­tion should be be­tween 6-9 months of age.

HOW OF­TEN SHOULD CHIL­DREN HAVE A COM­PLETE EYE EX­AM­I­NA­TION?

An­nu­al­ly. As chil­dren grow, their eyes al­so grow and de­vel­op. Depth per­cep­tion, eye-hand co­or­di­na­tion and oth­er vi­su­al skills de­vel­op. It is im­por­tant to reg­u­lar­ly track the health and de­vel­op­ment of the eyes much like reg­u­lar phys­i­cal ex­am­i­na­tions.

WHAT ARE SOME SYMP­TOMS THAT IN­DI­CATE MY CHILD MAY HAVE A VI­SION PROB­LEM?

• Red, itchy or wa­ter­ing eyes

• Sen­si­tiv­i­ty to lights

• ↓An eye that turns in or away from the nose

• ↓Tilt­ing the head to one side or hav­ing an un­usu­al pos­ture

• ↓Squint­ing, rub­bing the eyes, or ex­ces­sive blink­ing

• ↓A lack of con­cen­tra­tion in school or on home­work

• Cov­er­ing or clos­ing one eye

• Hold­ing ob­jects very close to the face

• Avoid­ing books and TV

• ↓Tired eyes or pres­sure/strain around the eyes on home­work.

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