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Children's Vision, a Guiding Mechanism in Growth and Development

By Dr. Linda Chous, Pediatric Optometrist

The child has homework left unfinished, difficulty remembering what was read, and omits, repeats or misspells small words. These may be symptoms of a vision problem. Eighty percent of a child's learning is accomplished through sight and at least one quarter of all kids have vision problems. While parents depend on school eye screenings, screenings are diagnostically limited, and eyesight is just one component of vision.

Vision is a kind of guiding mechanism in growth and development, in navigating daily life, and plays a role in eye-hand coordination. Vision is the ability to take in information through the eyes and then process the information for meaning. Good vision is more than seeing something clearly at 20 feet. There are conditions effecting eyesight that only a comprehensive eye exam can diagnose. Ideally, every child should have an eye exam in infancy, at age three and prior to kindergarten, and at least every two years thereafter. At the minimum, an eye exam before entering kindergarten is important.

In school vision screenings, farsightedness (hyperopia) often goes undetected, yet it's a significant cause of learning problems, and is more common among school-aged children than myopia (nearsightedness).

25 percent of children aged six months to 18 years have hyperopia, 23 percent have astigmatism and 18 percent are myopic, or nearsighted. Early onset myopia occurs between second and fifth grades, with onset most common between ages eight and twelve. Astigmatism results with blur in both near and far vision, and is found in combination with farsightedness and nearsightedness.

A child may have problems with eye focusing or trouble coordinating vision on a moving object. Eye focusing allows the eyes to focus and shift focus on near and distant points, and eye motility means that eyes can move together to read, to directly view an object or move to another viewing area.

Every week I hear children say, "Oh, I didn't know I could see like this." Kids can't tell you when they can't see something with clarity; they have no comparison.

How can you tell if your child is having trouble seeing? The child may:
• Rub eyes frequently
• Complain of headaches or eyestrain
• Avoid finishing school work
• Cover one eye to see something
• Avoid or dislike close work
• Uses a finger to maintain her place on the page
• Complain of burning and itching eyes, red watery eyes, or encrusted eyelids

Always consider vision problems when there are learning problems, or if the child has poor eye-hand coordination. Untreated vision problems also can lead to behavioral problems in school.

Some eye disorders, left untreated, can lead to blindness or sharply reduced vision. Non-strabismic binocular disorders affect 12 percent of kids aged six months to 18 years. Here the eyes don't aim at the same point, resulting in learning difficulties and fatigue if not treated. Strabismus affects 12 percent of kids, and entails an eye turn, in which the eyes are "crossed" or appear to wander. Early detection is key; if surgery is necessary, it should be performed before the child is two years old for the best chance for a functional cure, in order to equalize the individual eye's abilities.

Amblyopia, commonly known as "lazy eye," affects seven percent of children. It's the permanent reduction of the eye's best sharpness and the leading cause of vision loss in people under age 45. This happens because the brain is constantly ignoring the image from a crossed eye or one that's significantly different in visual acuity than the other eye. A proper prescription and a patch are viable treatments. Untreated astigmatism can actually lead to lazy eye.

Childhood diabetes also poses vision problems, primarily diabetic retinopathy, involving damage to blood vessels in the retina. The duration of the diabetes is the factor: After having the disease for five years, there are possible ocular manifestations; after ten years, 60 percent of all Type 1 diabetics have some degree of retinopathy and after 15 years virtually all have some degree of retinopathy. Retinopathy must be tracked and can be successfully treated with laser surgery methods. Every diabetic child needs a yearly eye exam.

Even infants in their first year of life are appropriate candidates for eye exams, when problems can be diagnosed and tracked early. In fact, visual development is most dramatic between six and twelve months of age. InfantSee, a national program sponsored by the American Optometric Association, offers a one-time exam at no charge with its participating eye doctors.

Computer vision syndrome (CVS) is common among students who spend hours daily on the computer. Headaches, blurred vision, and itchy, burning eyes are among the symptoms. Computer users tend to stare at the monitor for long periods of time without changing eye focus, and the distance between the eyes and the monitor may be wrong. Be sure to set a reasonable limit on computer time. The light in the room should be lower than the computer screen. The student should take a break every twenty minutes, perhaps getting up and resting the eyes by focusing on a far point in the room.

Glasses or contacts? Glasses can be cool. Kids like them, I've found, and there are so many fun frames to choose from. Whether contacts are appropriate really has more to do with maturity than age. Is your child responsible enough to care for the lenses properly, and not over-wear them? There are nine-year-olds who are very responsible with contacts, and forty-five year-olds who aren't.

Vision therapy has helped many children with functional vision deficits, and has been clinically shown as an effective treatment for accommodative disorders and inefficient eye teaming, eye movement disorders, turned eye (strabismus) and lazy eye (amblyopia). Neurotransmitter skills, such as eye focusing and eye teaming are learned and developmental in nature. These abilities can be retrained. Sometimes a combination of corrective lenses and vision therapy is effective. Length of treatment ranges from several weeks to several months and also depends heavily in the child's engagement in his treatment.

Many parents don't realize their insurance will usually cover their children's exams. School screenings, not available in all schools, indicate many vision problems, but a regular eye exam should be part of every child's health regime.

For tips, facts, InfantSee, and educational activities go to Minnesota Optometric Association's website.

Linda Chous, O.D., is a pediatric optometrist whose practice is Glasses Menagerie in the Uptown area of Minneapolis. Dr. Chous is a member of the Minnesota Optometric Association Board of Trustees and is a member of its Children's Vision and Healthy Eyes Healthy People Committees and Speakers Bureau.

Categories: Children's Health, Health & Wellness,

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