Children’s vision

The following is an article written by Dr Michael Jones, published in Sydney Child magazine in 2013.

 

Often in the field of Medicine we are reminded of the truth that ‘you don’t know what you have until you lose it’. The impact of that statement is arguably never greater than when it comes to vision. Think then of children’s eyes and the impact of a lifetime of visual impairment that could have been avoided with a routine eye check, and it makes you feel sick to your stomach.

As parents, we are living in an age when we are more aware than ever of health and lifestyle issues and thanks to modern technology and ‘Dr Google’ we have access to a dizzying array of information. The trouble is that it is all too easy to take vision for granted because it is such a fundamental part of our lives. Young children routinely make several trips to the dentist for check-ups as they grow up but seldom to check their eyes.

There are many common eye conditions in children which although often sound familiar can be inherently confusing. What is a lazy eye? What does being longsighted or shortsighted mean? Confusion often turns to fear when it then comes to thinking about treatment. Will glasses make my child’s eyes worse? Would eye exercises or eye patching help? Is surgery safe in children?

We can help break down the complexities of these terms if we think of the visual system through the analogy of a camera (the eyes) focusing an image connected to the computer (the brain).

Starting with the eyes, it all begins with focus.

• Short-sightedness or myopia means that the image is focused in front of the back of eye because the eye is too long.
• Far-sightedness or hypermetropia means that the image is focused behind the back of eye because it is too short.
• Astigmatism means that the image has a stretched focus on the back of the eye.

Children with poor vision from poor focus can often go undetected as they simply don’t know any different and have a remarkable ability to compensate. As well as that, they may be too young to even describe what they are seeing. The trouble is that a child’s development can suffer accordingly for the want of a simple eye test. It’s amazing how often I’ve seen a child’s potential in the classroom unlocked by a pair of glasses.

To make things more complicated, we have not one but two cameras (eyes).

• Strabismus or squint means that the eyes are not both pointing at the same target.

 

Parents often first notice a turned eye in a photo or when a child is tired or day-dreaming. Regardless of whether the eyes are turned in or out, or if the turn is intermittent or constant, it is always worth checking out.  A young brain quickly learns to ignore a turned eye and this can lead to permanent visual loss if not corrected quickly.

Finally, we get to the brain or computer.

• Amblyopia is often called a ‘lazy eye’ but actually refers to loss of vision in the brain.

 

Fortunately, young brains have incredible plasticity and they can be made to recover the use of the weaker eye, which is why early diagnosis is so important. Typically, the younger you are the more recoverable the visual loss is, but amblyopia treatment can continue to be effective in teenage years too.

So, what to do?

Luckily in New South Wales the first step is often made for you through the Statewide Eyesight Preschooler Screening Programme (StEPS) (www.health.nsw.gov.au/initiatives/steps), which tests the vision of all kids before they start kindergarten.

My recommendation beyond this is that a routine eye check should be done around Year 3 and then again on entering high school.

However if there is a family history of eye conditions or either parent needs glasses, have your child’s eyes checked by a professional sooner rather than later. After all it’s hard to imagine anything more fundamental or important to unlocking the full potential of a child’s development than their vision.

Dr Michael Jones, paediatric ophthalmologist – Sydney Ophthalmic Specialists.