Early Testing Provides Insight Into Kids' Vision Problems
Common, Correctable Vision Problems
- Strabismus is a deviation in the alignment of the eyes, such as the eyes looking at or away from each other (crossed and wall eyes). Most cases can be detected soon after birth.
- A myopic or nearsighted person can’t see distant objects clearly. A person with severe myopia is at risk of suffering a detached retina, which requires emergency surgery.
- A hyperopic or farsighted person can’t see close objects clearly. Many babies and very young children are slightly hyperopic but their vision often improves as they age.
- Astigmatism is a refractive error where an exaggerated curve of the cornea results in distortion or blurring of objects near and far.
- Some children have cataracts at or shortly after birth. The condition can develop at any age, however, and may result from an eye injury, diabetes, or as a reaction to certain medications.
March 2006 — Many parents never consider having their children’s vision tested. Others don’t know that screenings are available for very young children.
“Parents usually think you have to wait until a child can recognize all of the letters of the alphabet to be tested,” says Mark Dorfman, MD, Chief of Pediatric Surgery at Joe DiMaggio Children's Hospital and pediatric ophthalmologist on the medical staff at Memorial Regional Hospital, Memorial Hospital West and Memorial Hospital Miramar. “This is not the case. Just by dilating the eyes, I can detect the optical power of an eye in a 6-month-old child.”
Very young children can be tested with pictures, or the doctor can move a toy around to determine how the child’s eyes are tracking. The “tumbling E” test, which asks the patient to indicate which direction the “E” is pointing, is effective for children who aren’t speaking or reading yet.
Potential Problems
Amblyopia is a medical condition in which vision in one of the eyes is reduced because the eye and the brain are not working together normally. Affecting 2 to 3 children out of 100, amblyopia can result from any issue that affects normal vision development or use of the eyes, including cataracts or droopy eyes, which block light from entering the eye. Strabismus — a condition that causes the eyes to cross in or turn out — also can produce amblyopia. These conditions are fairly easy to recognize, so concerned parents often bring their children to a pediatric ophthalmologist at an early age.
But a parent might not notice another problem: refractive errors, such as nearsightedness. “No one tells a child that the right eye’s vision should be the same as the left eye’s,” Dr. Dorfman says. “The child doesn’t know any better because blurred vision is all he’s ever had.”
All of these conditions are likely to develop into amblyopia, causing the brain to favor the stronger eye and the weak eye to stop developing. To minimize the risk, every child should be tested by age 4. A child with a family history of vision problems should be tested at 1 year. Up to age 10, when the child’s eyes finish developing, parents should watch closely for problems.
“If parents think their children don’t see well or have other visual difficulties, they should see their physician or ophthalmologist,” Dr. Dorfman says. “Parents are usually right. And in a case like this, it is better to be proven wrong.”
For some cases of weakness in one eye, treatment can be as simple and inexpensive as an eye patch, eye drops or glasses.
Dr. Dorfman adds: “Through the eyes, you can detect diabetes, high blood pressure, the elevation of intracranial pressure and other conditions. The eyes truly are the windows of the body.”
If you would like a referral to a pediatric ophthalmologist, please call Joe DiMaggio Children’s Hospital Physician Referral Service toll-free at (866) JDCH-DOC. We’re available 24 hours a day, 7 days a week.