Safeguarding Children's Vision and Ensuring Eye Health

Early detection and treatment of eye problems are essential to a child’s health and the key to a lifetime of good vision.

Taking care of a child’s eyes begins at birth and requires an adult’s continued attention toward the warning signs of any serious vision problems that can occur during childhood.

Such attentiveness helped Erin Maglietta, now 12, safeguard her eyesight. When she was just 2, her family noticed her left eye was turning inward. Erin’s grandmother, Lois Maglietta of Roselle Park, N.J., says at first they thought Erin was just having a difficult time seeing beyond her long bangs. “I thought she needed a haircut,” says Ms. Maglietta.

But after closer observation and an examination by an ophthalmologist, the Magliettas learned that Erin was showing signs of serious eye problems. Those problems included a condition called amblyopia, which could have blinded Erin in one eye. Fortunately, her family saw that she got the treatment she needed, and her vision was preserved.

A child’s first eye examination should be in the hospital nursery, where a pediatrician screens the newborn’s eyes, looking for signs of problems.

Although the American Academy of Pediatrics recommends that regular eye screenings should continue as part of well-baby doctor visits and then during a child’s regular doctor visits, a child’s vision problems often become apparent at home, when a child displays a warning sign. A child should see a pediatric eye doctor (ophthalmologist or optometrist) for any specific problems. (An ophthalmologist is a medical doctor who specializes in treating eyes and eye diseases; an optometrist is trained to diagnose and treat many of the same diseases but has not attended medical school and does not perform surgery.)

Here are some of the childhood vision conditions that parents or significant adults should watch for, as well as some precautions to be taken:

CROSSED EYES

This can be an early sign of amblyopia, which is often called “lazy eye.”

With amblyopia, the child’s brain doesn’t “learn to see” out of one eye. This happens generally when the eye is out of focus due to a need for glasses, a cataract, or some other factor blocking clear vision.

According to the National Eye Institute, amblyopia affects two to three of every 100 children in the country, and if untreated, can lead to permanent vision loss.

Treatment, particularly when amblyopia is detected early, consists of a patch or eye drops used to blur vision in the strong eye and force the brain to strengthen vision connections to the weak eye.

MISALIGNED EYES

Also referred to as “strabismus,” this condition occurs when the two eyes aren’t focusing on the same image, and the brain may ignore the signals coming from one eye. Without treatment (which is usually glasses, eye drops, and/or surgery), amblyopia may develop.

DIFFICULTY SEEING THINGS

A child’s inability to see objects up close (books) or at a distance (the blackboard) are also troubling signals.

These symptoms indicate a possible refractive error in the eye such as nearsightedness, farsightedness, or astigmatism—conditions that are usually treated with glasses or contact lenses.

A FAMILY HISTORY OF CHILDHOOD EYE DISEASE

This important warning sign can indicate an increased chance of vision problems for a child and is a reason to bring that child to an eye doctor within the first few months of life.

“Things to be aware of include a sibling, cousin, or aunt with ‘lazy eye’ (amblyopia), or such disorders as cataracts or glaucoma,” says Dr. Norman B. Medow, director of Pediatric Ophthalmology and Strabismus at Manhattan Eye, Ear & Throat Hospital in New York City. Even though cataracts and glaucoma are usually associated with older adults, Dr. Meadow warns that a baby can be born with them or acquire them at an early age.

THE “RED EYE” WARNING SIGN

This signal for a possible vision problem involves the red eye displayed by children in their photographs. If a child is looking directly at the camera, ophthalmologists say the red should be equal—or appearing the same—in each eye. (Adults must keep in mind, however, that a child must be looking directly at the camera for these “red eye” warnings to have any validity.)

“If they get an unusual white reflection off the back of the eye or complete absence of the reflex in one eye consistently, that is a potential cause for concern,” says Dr. James Ruben, a pediatric ophthalmologist at Kaiser Permanente in Sacramento, Calif., and clinical professor at University of California Davis. It’s a rare situation, but Dr. Ruben says, “We have picked up some eye tumors or cataracts early because parents noticed it.”

NOT ADEQUATELY PROTECTING THE EYES

Another major cause of blindness among children isn’t any of the conditions mentioned so far. It’s trauma, and as Dr. Medow explains: “That means getting hit in the eye with a hammer, for example, or chopping wood and not wearing protective glasses, or two boys horsing around with a stick making believe they’re sword playing, or getting punched in the eye.” The best precaution against such trauma, Dr. Medow says, is the protection of glasses, with either prescription or protective lenses. Be sure to use them in any activity in which protective glasses are required.

This important precaution is something the Boy Scouts of America recognizes in its Guide to Safe Scouting (BSA No. 34416F). Official BSA policy requires that safety glasses be worn in a number of situations—for instance, when working with tools and on all shooting ranges.

NOT WEARING PRESCRIBED GLASSES

Ophthalmologists say that once a child is diagnosed with a condition that can be helped by wearing glasses, the child should actually wear them! That often requires encouragement and planning on the part of the adult. If youngsters are overly self-conscious or afraid of teasing by peers, they may conveniently leave their glasses at home.

Toddlers also may resist wearing glasses initially, but pediatric ophthalmologists say that often, once the little ones realize they can see better with their glasses, they’ll happily wear them.

Take Jacob Williams, for example. He’s a preschooler in Sacramento, Calif., being treated with glasses and a patch for amblyopia, astigmatism, and farsightedness. Because he is 4 years old, his mother, Michelle, says it is difficult to get him to wear a patch for two hours daily as prescribed, but his glasses are no problem for him. This mom says her little boy gets up every morning saying, “I want my eyes.”

Interestingly, in a recent development, ophthalmologists are also challenged by children who are eager to wear glasses because of peer pressure to be stylish—but who don’t actually need them. These kids go with an adult to the eye doctor complaining that they need help seeing. All the while, they actually have 20/20 vision!

Because a child’s vision is such an important aspect of his or her overall health, parents or significant adults must make the early detection and treatment of eye problems in children priorities. Then, looking into their child’s eyes will be a pleasure, knowing that those young eyes are truly at their optimum health.

Editor’s note: This column is designed as an educational tool only. For specific advice on eye health, consult your physician.

Cynthia Wallace, who writes from New York State, also wrote the Family Talk column “Helping Children Manage Anger and Conflict” in the March-April 2006 issue.