Handbook of Language and Literacy Development - a Roadmap from 0 to 60 Months

children image

Where and How to Get Helpclick to print Print

Eye care practitioners for children

Eye care for infants and children typically centers on the following practitioners:

Parents and caregivers will be familiar with the first two practitioners of children's overall health care.

If a child has suspected vision problems, then optometrists and ophthalmologists are qualified to provide a full assessment of a child's visual system. See your family doctor or optometrist immediately. The public health nurse in your area may also help.

Detecting Eye Problems

Detecting vision problems in children is extremely difficult for a parent/caregiver.

Often parents can detect a turned eye (strabismus), but even this can be difficult. The loose tissues of the eyelids of young infants (epicanthal folds) can give the false impression of an inward turn of an eye. Any of the health care practitioners listed above can quickly confirm the presence of an eye turn.

Other anomalies are very difficult to detect. A parent or caregiver might think a child wanting to sit close to the TV signals reduced vision or a focusing error; it is often not the case as the child may only want the big screen effect.

It is difficult to detect if a child's vision is subnormal by their behaviour unless the child's vision loss is extreme. Infants and toddlers have a rather limited amount of fine detail that they need to see. Kicking a ball sitting on the floor can be done with only gross details of the visual image. Only when the necessary visual information becomes more demanding, such as with print, does reduced vision become manifest and noticeable.

Children's Eye Examination

It is highly recommended that all children's vision be tested around 3½ years to 5 years of age. The results from the examination should provide the practitioner with enough information to predict the likelihood of future problems concerning most eye turns and errors of focus.

In many provinces annual eye exams for children are a covered service. Eye examinations that test the vital sensory-motor and optical functions can start as young as 6 months of age. There is sufficient evidence now about the expected age-related norms for a number of visual functions so that effective evidence-based management of visual problems between 3½ and 5 years is possible.

Although the question of routine assessment at this age is under debate, infants having a family history of infant or childhood vision disorders should be examined by a professional. In addition, any concern of a turned eye or a change in visual behaviour, for example, suddenly not seeing what used to be seen, should trigger concern and an eye examination should be conducted immediately regardless of the child's age.

A hypothetical crossed eye case

A mother notices that her 5-month-old child's right eye turns in. She mentions this at a routine appointment for the child with the paediatrician. The paediatrician confirms the eye turn. A referral is made to a local optometrist who provides a full eye examination. An assessment of the nature of the eye turn and related visual functions is made. It is determined that the eye turn is reducing the vision in one eye (amblyopia) and no spectacles are required.

An appointment is then made with a paediatric ophthalmologist regarding corrective eye surgery. The ophthalmologist is hospital-based in a larger city located 100 km away. Because this surgery is elective, the waiting time is 5 months. In the meantime, the optometrist prescribes an eye-patching program. For a 2 month period, the "straight eye" is patched (4 hours a day) in order to force the normally turned eye to do the "seeing" and thus, build normal eye to brain neural connections.

It is noted that after 2 months the child does not favour one eye. While one eye always is turned in, the child can alternate fixation between the eyes. In this case amblyopia is not likely to occur and each eye could potentially see equally well. Following surgery, the eyes do not appear to turn in at all. The optometrist monitors the child and carefully monitors the child's visual development. Ideally some binocular vision will result although to date it is never perfect. With time, should the eye turn increase in its magnitude the child is referred back to the paediatric ophthalmologist.

A hypothetical vision screening case

Through agreement with the local school board, the Lions club conducts a vision screening program of kindergarten children. Because the testing is non-invasive and quick, the school encourages all children to attend. A mother has no cause to believe her child has a vision problem but feels it wise to sign her up. The screening finds that her child may be quite farsighted. A referral is made to a local optometrist who conducts a full investigation. The farsightedness is confirmed and a spectacle correction is given to the child for wearing only when she is doing sustained reading or other activities. The mother notes that her child's reluctance to read has reduced considerably.