Does your child need an Eye Examination ??  
by: Dr. Shobha Tandon
Screening and detection of eye diseases in children (birth to 18 years) is very important. Infants and young children are very susceptible to permanent loss of central vision ( amblyopia/ lazy eye) from some preventable eye disorders, which I am going to discuss in the following paragraphs. In contrast, these disorders may not cause permanent loss of vision in an . This visual loss in the children may not have any symptoms. A regular screening and comprehensive eye examination is required to prevent blindness in a child.

Some of the common disorders which can lead to blindness/ loss of vision are:

  • Uncorrected refractive error
  • Strabismus (Squint)
  • Cataract (congenital)
  • Droopy eyelid
  • Glaucoma (congenital)
Uncorrected refractive error: The incidence of eye disorders in pediatric population increases with age due to increase in refractive error. However, if a child has different refractive errors in the two eyes, uncorrected error leads to permanent loss of vision in the eye which needs more correction. This condition, called amblyopia or lazy eye is treatable and preventable during early childhood when the visual system is developing. After the maturation of visual system (usually by 9 years of age), the lazy eye can not be treated. Giving proper spectacle correction and regular follow-up can easily prevent this vision loss.

Strabismus: In simple terms, strabismus is a condition when the two eyes are not aligned properly. The eyes can turn in or out and this condition may be present intermittently or all the times. If the eye remains misaligned, it results in poor vision and loss of depth perception. This condition can be treated with glasses, patching, and/or exercises in a timely manner. The visual system continues to develop until 9 years of age. During this time, detection and treatment of strabismus can prevent permanent loss of vision.

Cataract: As most of us know, an eye works like a camera. The light from outside has to enter the eye for creating an image on the photographic film of your eye (retina). If the shutter of the camera is not open or the lens is scratched, you will not get a good quality of picture. Similarly, if the lens of the eye is cloudy, a blurry image will be formed on the retina. In s, removal of this cloudy lens (cataract) can restore the lost vision. In contrast, if a child is born with cataract and it is not removed early, permanent loss of vision occurs. Sometimes, only one eye has cataract, which is of more concern than the bilateral cataract. A child can develop constant movement (nystagmus) in the eye with cataract. Development of nystagmus is a poor sign for vision improvement.

Droopy Eyelids (Ptosis): The eyelid of your eye works similarly to the shutter of the camera. If the light is not entering the eye of your child due to droopy eyelid, visual system will not develop in your child. During the critical period of this development, a permanent loss of the vision may result due to this condition, which is preventable by surgery. Any condition which blocks the entrance of the light to your child´s eye may have profound effect on the development of normal vision within the first 6-8 weeks of life. In s, droopy eyelid is corrected for cosmetic reasons or to improve the peripheral vision. s are not at risk of developing lazy eye due to this condition.

Glaucoma: This is a condition when the pressure inside the eye increases and damages the nerve of the eye. A newborn child may have this condition. The signs could be excessive tearing from the eye and ´big´ eyes. In fact, the pressure inside the eye results in expansion of the eyeball of a child. Even though glaucoma is a blinding disorder, early diagnosis and treatment can prevent the severe loss of vision. The eye with glaucoma often becomes nearsighted due to enlargement of the eyeball. At this time, not only the pressure control, but also corrective eyeglasses can give useful vision to a child. Congenital glaucoma is a hereditary condition.

Recommendations for Screening and Eye Examinations

Children should be screened at the following ages:

  • Newborn to 3 months
  • 6 months to one year
  • 3 years
  • 5 years
All children should undergo a screening evaluation to detect eye and visual abnormalities. This process begins just after the birth of a child. Up to one year of age, parents can notice if a child is seeing the objects such as toys with both eyes and if he is following the toys. Misalignment of eyes (strabismus) should be notified to your eye physician. At 3 years of age, child should be able to see the letters. A 5 year old child should have good visual acuity (~20/40). If there is any indication that there is difference between eyes, he should be seen by an eye physician. Children older than 5 years of age have visual acuity of ~20/30 or better. Most of the children start going to preschool at this age. Proper attention by caregiver is very important to assess if a child can see or read the storybooks and if there is difference in two eyes. A family history of lazy eye, strabismus, cataract, glaucoma, or eye tumors is a strong indication for the eye examination of your child.

Dr. Shobha Tandon, M.D. Ph.D., is an Opthalmologist practicing in Mountain View, California.

Disclaimer -

The articles in this section are for general information only, and should not be considered as medical advice. Readers should consult their physician and medical care provider for professional medical advice.