Newsletters

Healthy Child Spring/Summer 2001

Caring For Young Eyes

CARING FOR YOUNG EYES
by STEVEN ROSENBERG, M.D. and AMY LAMBERT, M.D.
PEDIATRIC OPHTHALMOLOGY AND STRABISMUS, PEDIATRIC EYE ASSOCIATES, LLC, LIVINGSTON

Parents frequently wonder whenthey should start thinking about vision care for their children. Routinely, each newborn infant's eyes are examined by a pediatrician or family physician for general eye health shortly after birth. Ophthalmologists are commonly asked to examine infants who are considered at high risk for eye problems because they were born prematurely, have a family history of eye diseases at a young age or have possible eye abnormalities identified by the pediatrician or family physician. No child is too young to be examined by an ophthalmologist and any parent
who suspects that his or her child might have a vision problem should consider having the child seen by an ophthalmologist.

Children who do not appear to be having problems with their eyes or vision still need to have routine vision screenings to look for problems that may not be readily apparent to their parents. When your child is about 3 1/2 years old, he or she should have a vision screening which includes assessment of visual acuity (reading the eye chart), ocular alignment (are the eyes straight?) and a look inside the eyes. At that time, the physician will check for amblyopia, or lazy eye, which is one of the most common vision problems for small children.

Eye Problems

An eye does not have to look lazy to be lazy. Amblyopia can be caused by any of the following: strabismus (misalignment of the eyes such as crossed eyes or wall eyes); a need for prescription glasses where one or both eyes has a vision problem; or anything that stops an eye from seeing a clear image. Poor vision in one eye can go completely unnoticed by the parent and if the lazy eye goes untreated it can cause permanent visual loss. Fortunately, amblyopia can be treated - with prescription glasses and/or patching the better-seeing eye - if it is found early enough. The earlier amblyopia is detected the better; successful treatment is rare after 8 or 9 years of age.

Strabismus, or a misalignment of the eyes, is also a common ocular problem in small children. Eyes may be crossed from birth or can begin to cross or wander at any time. Any child with a constant crossing or wandering of the eye should be seen by an ophthalmologist without delay as this can lead to a lazy eye or be a sign that there are other eye problems. Some occasional misalignment of the eyes can be seen in many children before the age of 3-4 months, but if occasional or frequent misalignment of the eyes remains or begins after the age of 4-6 months, the child should be examined by an ophthalmologist. This condition can also be treated - usually with glasses or surgery.

Refractive errors such as nearsightedness, farsightedness or astigmatism are also commonly seen in children. Nearsightedness (or myopia) means that your child has difficulty seeing far away objects and children with nearsightedness often complain of difficulties seeing the blackboard at school. Farsightedness (or hyperopia) means that your child finds it more difficult to see things that are near. It is normal for young children to be a little farsighted and they are able to overcome this by their naturally high ability to change the focus of their eyes. However, if an imbalance exists between the two eyes or the farsightedness is very high, the child can develop a lazy eye. Astigmatism refers to a condition in which the front of the eye is not completely round. This causes the eye to view both near and far away images as distorted. Most of the time, refractive errors can be treated with glasses and it is normal for a child's glasses prescription to change as the child grows. Vision screenings by a physician and/or at school should be continued at about two-year intervals if your child has no eye problems and at one-year intervals if your child has a refractive error.

Adjusting to Glasses

Parents sometimes find that it is difficult to keep glasses on their child, especially if the child is very young. The child will sometimes think of the glasses as another toy, often playing the annoying game of "glasses on, glasses off." Here are some tips to make the transition to life with glasses a little easier for your preschooler.

• Your own attitude is key. Do not let your child sense that you are disappointed that he or she has to wear glasses. Try to make your child feel that the glasses are a positive thing that is going to make life better for him or her. If you have glasses yourself, wear them, even if you frequently wear contact lenses.
• Try to incorporate the glasses into the daily routine. Put the glasses on your child when he or she wakes up or is getting dressed. Take them off at bedtime.
• Let your child do a pleasurable activity, such as playing a favorite game, listening to a beloved story or watching a chosen television show, when he or she is wearing the glasses. Sometimes it is helpful to stop these activities if the child pulls the glasses off, but keep in mind that positive reinforcement for wearing the glasses usually works better than negative reinforcement for taking the glasses off. Try to remain calm even if you find the process frustrating.
• Make sure the glasses have been fit properly. Glasses of the wrong size can pinch a child's nose or rub behind the ears. Discomfort canmake a child more resistant, so examine your child's nose and ears frequently to be sure that the glasses are not leaving red marks.
• A child is more likely to throw glasses when he or she is bored. In places without many toys, like the car, make sure your child has something to keep him or her busy, like a favorite tape, hand-held toy or cup of cereal.
  
• Again, remember to try to keep calm when the glasses end up on the floor. You will probably feel more relaxed if you order polycarbonatelenses for your child.These lenses are shatterproof and are made of the same material as safety and sport goggles. If the frames become bent, many opticians will unbend them free of charge.
  Unbending them yourself is more likely to cause them to break.

For a referral to a Saint Barnabas Medical Center ophthalmologist, please call the Physician Referral Service at 1-888-SBMC-DOC.

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