Do You See What I See?

How to protect and preserve your child’s eyesight.

Vision problems affect almost 13.5 million children and adolescents. Seeing clearly affects kids’ physical and mental development, including how they learn and play. It’s important to note that some threats to healthy eyesight are not obvious, which is why routine vision screening is an essential part of health care. You can help protect your child’s sight by learning about vision milestones, screening timing and symptoms to watch for.

Infants are not born with the ability to see the same way as older children and adults. They need to learn how to see. The brain is not ready to process all the information, and eye muscles and other parts of the vision system need time to develop. Although newborns can see shapes, light and movement, sight is fuzzy and objects are best seen from 8 to 12 inches away. Their sight is about 20/400. Babies’ eyes may even cross for the first month or two until the muscles learn to focus.

examBy two to three months, the ability to see colors, patterns and designs becomes more differentiated. Infants enjoy primary colors and more complicated designs, and begin to track objects. By five months, depth perception is developing, and babies learn to grasp onto objects. Giving them a rattle to hold helps with this milestone. After six months, crawling and walking aid in furthering vision by helping with judging distance and eye-hand coordination.

A two-year-old’s vision can be nearly that of an adult’s: 20/20. Screening for general eye health, visual acuity and eye alignment is recommended throughout infancy and childhood. One in 20 preschool children and one in four school-age kids have vision problems that can lead to permanent vision loss or poor school performance. Therefore, identifying problems early on and beginning treatment as soon as possible are critical.

Signs that your child may have a vision problem include:

  • Chronic redness, tearing or crusting
  • A white instead of a black pupil
  • Abnormal alignment or T of the eyes after three months of age
  • Poor focusing, poor tracking of an object
  • Extreme light sensitivity
  • Constant rubbing of the eyes
  • Droopy eyelids

Once your child is in school, additional signs of possible sight issues include:

  • Being unable to see objects in the distance
  • Having trouble seeing the blackboard
  • Having difficulty reading
  • Sitting too close to the TV
  • Headaches
  • Squinting

Visual-acuity screening picks up the conditions that follow.

Amblyopia (lazy eye) is a lifelong, secondary condition in which the eye is misaligned or focus is uneven. There is reduced vision in the eye that did not develop properly in early childhood. Highly preventable and treatable, this condition develops when one eye sees worse than the other eye, and the brain only “sees” through the good eye.

Amblyopia affects 2 or 3 people out of 100, and often is identified at 3 to 5 years of age. Because it is difficult to notice, early vision screening is essential and should occur at birth, 6 months to 1 year, 3 years of age and routinely during school age.

Strabismus (crossed or wandering eye) occurs when one or both eyes turns in, out, up or down. It is not a problem with the eye, but with the brain’s inability to coordinate both eyes at the same time. This condition typically develops before age two, but can develop as late as age six. It may be extremely noticeable or very subtle, and parents may not notice, but it does require prompt treatment, as kids do not outgrow this condition. It often becomes worse, and complications may develop. Strabismus affects three to five percent of children.

chart (2)Myopia (nearsightedness) is characterized by being unable to see objects in the distance. The eyeball is too long or the cornea has too much curvature. Usually identified in school-age kids, myopia is corrected by wearing glasses.

Hyperopia (farsightedness) is being able to see objects in the distance, but having difficulty with nearby items. The eyeball is too short, or there is too little curvature of the cornea. Hyperopia is often corrected with glasses.

Astigmatism is blurred vision due to an irregular-shaped cornea or curvature of the lens on the inside of the eye. It is a common disorder. Slight amounts of astigmatism don’t impact vision and don’t require treatment. However, large amounts of astigmatism can distort vision and create discomfort or headaches. Astigmatism may be present at birth, can worsen or improve over time, or may develop as a child gets older. Treatment is typically with glasses.

Color blindness is a vision deficiency in which a child has difficulty differentiating among colors. More specifically, it is a problem with the cones of the eyes, which are little cells on the retina. Cones “see” red, blue and green in a healthy eye; in color blindness the cones are not working. The brain, therefore, cannot interpret which color is being seen. It is common to have difficulty with red and green. Often genetic, color blindness is seen more frequently in boys than girls and is not a serious problem. Children and adults typically adapt to the identification of objects such as a stoplight. Instead of identifying STOP as red, it is identified as the top circle.

Long-term vision problems in children are often preventable and treatable. The best outcomes for lifelong visual health occur with early screening and appropriate treatment.

The American Academy of Pediatrics and the American Academy of Pediatric Ophthalmology and Strabismus recommend vision screening from infancy through adolescence. Vision screening is a simple, cost-effective tool to identify most problems. Coupling screening with prompt referral to a specialist if necessary can spare your child’s vision any long-term complication.

Kari Gali, DNP, RN, CPNP, is a PNP with over a decade of experience. She helped launch a preschool vision screening initiative at the Cleveland Clinic where she works. Her interest is partnering with families and quality improvement.