Childhood sight problems you shouldn’t ignore

Words: Tammy Jacks. Article from Living and Loving Magazine October 2015.

Paediatric optometrist Leoni Joubert chats to Tammy Jacks about the importance of spotting any vision problems in your child early on.

Normal vision is an essential part of your child’s development, but it takes several months for your little one’s sight to develop fully. Don’t be surprised if he doesn’t seem to be focusing on objects or your face in the early days. In fact, most babies are born with healthy eyes and start to develop the visual abilities they need throughout life without difficulty. However, in some cases, vision problems can start early.

Researchers at the South African Optometric Association point out that more than 10 million children suffer from undetected vision problems simply because they are not evaluated properly. Although this sounds alarming, it’s never too early, or too late, to assess your child for the following eye problems:

Short sightedness (myopia)

This happens when the eye focuses light in front of the retina instead of on it, explains Leoni. Objects in the distance will be blurry for your little one, while close objects will be clearer.

How to spot it: From birth to around three months of age, babies don’t focus on objects more than 20 to 25cm from their faces. It’s rare for babies to be born short-sighted, says Leoni. However, it can become a problem for young children. If your child struggles to see distant objects or scrunches up his eyes to see, for instance while looking at a blackboard or when watching TV, there’s a good chance he’s short-sighted.

How to treat it: Shortsightedness is becoming more common as children spend more time on smartphones, computers and tablets. It’s important to limit ‘tech time’, warns Leoni. If you suspect your child might be short-sighted, take him to an optometrist early so that it won’t affect his learning abilities. Spectacles or contact lenses will help to compensate for this problem.

Long sightedness (hyperopia)

Children are sometimes born long-sighted. This happens when light is focused behind the retina and the child has to accommodate for this by using the lens of the eye to make objects clear.

In this case, objects in the distance will be clearer than those close by, says Leoni. The eyes will try to compensate for this, which can cause eye strain.

How to spot it: Most babies are born slightly long-sighted, but this usually disappears naturally by the age of six, explains Leoni. If your child is long-sighted, he’ll battle to focus when reading and might even miss words or read them again. When it comes to focusing on work later on, your child may complain of headaches as well as sore, tired eyes due to visual strain.

How to treat it: Severe long-sightedness can also lead to one eye turning inwards, which can be corrected with glasses or contact lenses, but needs to be picked up early.

Astigmatism

This is a defect of the eye where the cornea (the first refracting surface of the eye responsible for controlling the amount of light that enters the eye) is oblong rather than round. For example, think of the shape of a soccer ball versus a rugby ball, says Leoni. This causes two focal points to form for the same object, which can lead to blurry vision, both near and far.

How to spot it: Your child might not be able to see things clearly and he may complain of headaches or eye strain.

How to treat it: This problem is fairly common and can be corrected with spectacles or contact lenses.

Squinting (Strabismus)

According to recent studies published in the Journal of the Royal Society of Medicine, about one in 50 children have a squint and it can run in families. A squint is defined as any deviation of the eye from the normal straight-ahead position. However, it can also occur when a child is looking in different directions. “If you suspect your child has a squint, it’s important to have it checked urgently – especially if it happens suddenly, as it often leads to amblyopia (lazy eye),” says Leoni. Problems start when the brain switches off input from one eye in order to avoid seeing double and to maintain single vision.

How to spot it: It’s normal for a baby’s eyes to cross now and then when their vision is still developing, particularly in the first three months. However, if your baby’s eyes squint more often or seem to be moving in different directions, speak to your doctor. In older children, a squint will be easier to notice as the eyes tend to look in different directions. Some squints can also be due to trauma, neurological problems, brain tumours or eye muscle dysfunction.

How to treat it: When it comes to treating this visual problem, “Time is of the essence as a child’s visual system and binocular system develop during a critical period and treatment must be sought before the child is six years old,” says Leoni. Surgery is sometimes recommended to straighten the eyes. Eye exercises might also be necessary to help your child realign his eyes.

Lazy eyes (Amblyopia)

This often starts in early childhood and is the result of one eye not developing as it should. When one eye has a squint, or vision isn’t equal in both eyes, the brain chooses to switch sight off in the one eye to avoid seeing double, says Leoni. This causes delays in the visual pathways from the eyes to the brain and can lead to permanent vision problems in that eye. This is why it’s critical to ensure that both your child’s eyes are working optimally.

How to spot it: Your child’s eyes might appear normal and healthy. However, in the case of a lazy eye, one eye will be performing the bulk of the work while the other does less. This means that a lazy eye isn’t always easy to detect, because children won’t usually complain as they have no idea that it isn’t normal to see this way. Doctors at the Vision Therapy Centre in the US point out that extreme clumsiness could indicate that a child has a problem with depth perception, which may be linked to a lazy eye. If you suspect your child has a vision problem, have their eyes checked as soon as possible.

How to treat it: Correction of the refractive error with spectacles or contact lenses is required. Surgery might be necessary for any squint associated with amblyopia.

Colour deficiency

Normally, a baby’s colour vision matures along with their other visual abilities. Around the four- week mark, they start to become sensitive to the brightness or intensity of colour and will look longer at bold colours and contrasting patterns than at lighter tones. By about four months, babies can differentiate and respond to the full range and shades of colours. However, if a child has a colour defect, also known as colour blindness, they won’t be able to see specific colours such as red-green or blue-yellow tones, says Leoni. It is very rare for children not to see any colours at all.

How to spot it: Researchers at the Colour Blind Awareness Organisation in the UK have found that colour deficient children will often make mistakes when it comes to distinguishing colours. They may have a low attention span with tasks such as drawing or colouring in, and could experience difficulty reading from coloured paper or worksheets. On the other hand, children who are colour deficient tend to have an excellent sense of smell and good night vision. If you suspect your child is finding it difficult to distinguish colours, take note of how he responds to colouring in pictures, playing games with coloured blocks, shapes or letters and naming or learning colours.

How to treat it: There aren’t many options in South Africa, but a good optometrist will help you to develop strategies that will help your child cope with colour vision. The good news is that the vision of most colour deficient children is usually normal in all other respects and certain adaptation methods are all that’s required to boost their self-esteem.

Warning signs

Take your child for an eye test if you notice any of the following:

• A white-looking pupil in either eye

• An eye turn (squint)

• Any discharge or sign of infection

• A sudden change in your child’s visual behaviour

• Your baby is battling to see or follow objects such as your face or a toy

• One pupil is a different size to the other (this can be a sign of a brain tumour or neurological damage.

• Your child complains of sore eyes or headaches.

Eye tests for babies and toddlers

How to test: Not all eye-care professionals do vision testing on babies and toddlers who aren’t speaking yet. See an eye-care practitioner who specialises in paediatric vision. They will have the special instruments and skills to evaluate your child’s vision from as young as six months, says Leoni.

When to test: The earlier your child can be tested, the better. Test your child at six months, then at three years, then again just before entering formal education at around five or six years (this can be Grade 0 or R), then annually after that.

Good to know: Vision tests aren’t painful for babies and toddlers. Children usually enjoy the activity, especially if the practitioner has good skills and new instruments, such as iPads, to use in the examination.

Go to Living and Loving click on ‘Child’, then ‘Health’, for a checklist you can use to track your baby’s visual development

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