A child’s sense of sight develops over a period of time after birth. It is most vulnerable during the first seven to eight years of life. As a child grows, there may be changes in her vision and this can impact her learning. She may not be able to express her difficulties in seeing; hence most vision-related issues go undetected by parents and teachers. Therefore, a formal vision check-up is important at this stage.
At birth, a child’s vision, which is poor, grows very fast along with the brain. By 3 months of age, a baby is able to fix her gaze at close range and thus smiles at her mother. This is an important landmark in a child’s visual milestone. From here on, the child’s vision keeps developing till 5 years of age, when she is able to read 6/6 on the vision chart with each eye, provided her visual development is normal. She is also able to appreciate the depth perception (3 dimensional views). Any eye disease occurring during this time has a great impact on the achievement of normal vision. Presence of any problem, if detected early and treated promptly, can restore vision to normalcy.
This is a process of checking the visual functions. Different techniques of vision estimation are available and they vary on the basis of the age of the child. Even when quantification is difficult, a comparative qualitative examination is useful. In developed nations, this is done as a routine procedure as early as few weeks after birth, by the attending paediatricians during their clinical examination of the babies. In our set-up, a primary healthcare provider like a paediatrician, physician, nurse or even a teacher can detect visual problems. A child ‘screened’ should be referred to the eye doctor promptly. In the first year, one has to look for the steadiness of the eyes, signs of abnormality in the size, shape, movements and colour of the eye, position of the eyes, etc.
Vision Screening for premature babies
Special screening is done at the first month of life for premature babies born within 32 weeks of pregnancy, low birth-weight babies weighing less than 1800 gm and all sick babies, irrespective of the gestational age and birth weight.
In recent times, survival rate of premature babies in India has increased, thanks to improved neo-natal care. As a result, Retinopathy of Prematurity (ROP) is also on rise apart from associated squeal of prematurity. A study in India quotes an incidence of ROP at 38% amongst babies born with birth weight less than 1500 gm, and estimates that at least 20% of them are at a risk of developing permanent vision impairment.
When a child is born pre-term, the development of Retinal Vasculature (development of blood vessels that supply the inner portion of the retina) is not complete. This normally happens by 38-40 weeks. Though most of them develop into a normal mature retina, in some neonates with certain risk factors, the incompletely developed Retinal Vasculature gives rise to Neovascularisation (the formation of atypical, tiny and leaky fragile blood vessels within the eye). Its complications result in ROP, potentially leading to severe vision impairment. In its early stages, a simple intervention with retinal lasers is sufficient to prevent further complications.
It is recommended that premature and low birth weight babies undergo a thorough check-up of eyes 1 month after their birth. The condition, if not detected promptly, can lead to bleeding inside the eye, resulting in permanent loss of sight. Usually, this goes undetected silently when the infants are in NICU, since other systemic problems warrant more intensive care to save their lives.
From the second year onwards, in addition to the above, a child needs a detailed examination to detect refractive errors that may necessitate use of spectacles. This applies more to children of the parents and siblings with a history of eye ailments. They should have a periodic screening by an ophthalmologist.
In addition to the information given above, it is important you ensure your child eats a healthy diet. You should always include fruits and vegetables rich in Vitamin A in the diet of your child. It can be found in green leafy vegetables, carrot, papaya and cod liver oil. Ensure your child reads in adequate lighting and avoids doing excessive work that requires a closer, highly focussed look at a very early age, especially using mobile phones. Make sure your child protects his eyes from injuries by avoiding usage of sharp objects while playing, and maintaining basic personal hygiene.
After all, happiness is all about beautiful eyes!
ABCs of Vision Problem
- Eyes crossed, turned in or out.
- Eyes ‘wander’ all the time, part of the time or when child is tired.
- Red, watery or encrusted eyes.
- Drooping eyelid(s).
- Frequent styes or boils on the lids.
- Presence of white pupil.
- Eye injuries resulting in bruising, swelling or bloodshot eyes.
- Squinting, frowning, blinking or squeezing of the eyes.
- Thrusting head forward or backwards while looking at distant objects.
- Rubbing the eyes.
- Turning the head to use only one eye.
- Tilting the head to one side.
- Placing the head close to a book or desk when reading or writing.
- Closing or covering one eye, especially in the sunlight.
- Tripping, stumbling orday- dreaming excessively.
- Afraid of venturing in the dark or unable to see in ambient light.
- Eye pain.
- Nausea or dizziness.
- Burning, scratching or itchy eyes.
- Blurred or double vision.
- Words that move or jump while reading.
- Blurred vision when looking up after close work.
- Unusual sensitivity to light.
Eye Problems in Children
- Refractive Errors: Refractive errors are said to exist when light entering the eye does not get focussed in the back of the eye for us to see clearly. This could result in short or long sightedness or a condition called Astigmatism. Children affected by such a condition need to wear glasses regularly, if prescribed by their ophthalmologist. A regular eye checkup, once in 6 months is needed in children less than 5 years of age and once a year after that.
- Squint or Lazy Eye: Squint is a misalignment of the two eyes pointing in different directions. Such a misalignment maybe constant for a few, while it may be intermittent for others. The deviation of eyes maybe in any direction–inward, outward, upward or downward. If a child is not treated at the appropriate time, a condition called Amblyopia occurs, which eventually leads to permanent loss of vision. Treatment for Squint involves immediate consultation with an eye doctor and most of the time, warrants surgery.
- Cataract: Unlike popular belief, cataract is not a disease confined to adults and the elderly. Children are also vulnerable to this condition. Cataract is clouding or opacification of one’s natural crystalline lens used for focussing light in the back of the eye. It causes blurring of vision and if not treated on time, can lead to permanent loss of sight due to Amblyopia. Treatment involves surgical removal of cataract with or without artificial lens implantation. Parents who’ve had cataract in their childhood should have their children screened as early as few weeks of age, since it can be inherited.
- Allergic Conjunctivitis: This condition occurs when eyes come in contact with allergens like smoke, dust, pollens, animal hair, feathers, etc. It is characterised by redness, tearing, itching and ropy discharge from the eyes. Prevention involves avoiding exposure to dust, frequent washing of the eyes and face, cold compresses with ice pack to avoid itching and rubbing of eyes, and appropriate treatment by the eye doctor. Off the shelf usage of steroid drops should be avoided as they can have vision-threatening side effects.
- Problems with one eye: Whatever the reason may be, if a child does not see well with one eye, the brain starts to ignore that eye, which subsequently goes into disuse and becomes lazy, leading to ‘Amblyopia.’ If this condition goes undetected early in life, it can lead to an irreversible loss of sight. Most of the time, this happens in conditions like squint (deviation of one or both eyes from its normal, straight ahead direction), nystagmus (abnormal dancing movements of the eyes), child not wearing spectacles when needed, any obstacle in clear viewing like Cataract or Tumour, and Haemorrhage or Opacification (discoloration) of front part of the eyeball.