Newswise — Often times, children will not tell you " or their doctors or teachers " that they cannot see out of one eye or that their vision is blurry. However, certain behaviors or problems in school may indicate a vision problem. Does your child tilt or turn his/her head to look at something? Does your child squint or close one eye? Does your child avoid close work or hold things very close to see? Is your child having new difficulties or becoming distracted with schoolwork? Does your child seem clumsier than other children in the same age group or have difficulty with hand-eye coordination? If so, it may be time for your child to have an eye exam.
Amblyopia, decreased vision in one or both eyes, also known as lazy eye, is the leading cause of visual impairment in children and affects up to 4% of the population. "Lazy eye" may occur in children with misaligned eyes (strabismus) as well as in children with different focus between their eyes (anisometropia), for example when one eye is nearsighted and the other farsighted. Amblyopia can also develop when both eyes are severely out of focus or when the pupil is blocked, such as with a cataract or droopy eyelid (ptosis). When the eyes are not straight or properly focused, vision does not develop normally. While parents often bring their children to see an eye doctor because they see a crossing or wandering eye, it is not always possible to detect focusing differences, a cataract, or very small eye misalignment simply by looking at a child.
When amblyopia is detected and treated early, most cases are reversible and severe vision loss can be prevented. The key to amblyopia treatment is "the earlier the better." Untreated amblyopia not only leads to poor vision and loss of depth perception but also increases the risk for vision loss in the good eye and may have a negative impact on school, work, and self-image.
Parents are often surprised when their child is diagnosed with an eye problem since many children appear to function quite well and may have no obvious difficulties with their vision. Because the conditions that cause amblyopia may be difficult to detect in children, vision screening is a vital part of a child's health maintenance.
The American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology have issued joint guidelines for eye examinations. Vision screening should begin at birth and continue as part of all well child visits with formal visual acuity testing and stereopsis evaluation beginning at 3 years of age. All children who are found to have an ocular abnormality, fail a vision screening, or are unable to be tested after 2 attempts should be referred to an eye care specialist. Infants and children who are at high risk for vision problems " such as premature infants, children with a family history of blindness or eye disease, and children with developmental delay or systemic diseases associated with eye problems " should be referred for a comprehensive eye examination. In Massachusetts, a pre-school vision screening legislative mandate has been passed. Upon entering kindergarten or within 30 days of the start of the school year, all children are required to present certification that they have passed a vision screening within the previous 12 months.
While amblyopia is the most common cause of decreased vision in children, it is treatable especially when detected early. Increased awareness of amblyopia and better screening protocols can detect children at risk at a younger age and reduce the incidence of severe amblyopia. Keep you children's eyes in sight by keeping their vision in mind.
Carolyn Wu, M.D. is a pediatric ophthalmologist at Children's Hospital Boston. Dr. Wu received her B.A. from the University of Pennsylvania and her M.D. from Albert Einstein College of Medicine. After her ophthalmology residency at New York University School of Medicine and Manhattan Eye, Ear & Throat Hospital, she completed a fellowship in pediatric ophthalmology at Children's Hospital Boston. Dr. Wu cares for patients at Children's Hospital Boston's Boston, Waltham, Weymouth, and Sandwich, Mass. locations.
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