Babies have poor vision at birth but can see faces at close range, even in the newborn nursery. At about six weeks a baby’s eyes should follow objects and by four months should work together. Over the first year or two, vision develops rapidly. A two-year-old usually sees around 20/30, nearly the same as an adult.
Parents should be aware of signals of poor vision. If one eye turns or crosses, that eye may not see as well as the other eye. If the child is uninterested in faces or age-appropriate toys, or if the eyes rove around or jiggle (nystagmus), poor vision should be suspected. Other signs to watch for are tilting the head and squinting. Babies and toddlers compensate for poor vision rather than complain about it.
Should a baby need glasses, the prescription can be determined fairly accurately by dilating the pupil and analyzing the light reflected through the pupil from the back of the eye.
A baby’s vision can also be tested in a research laboratory where brain waves are recorded as the child looks at stripes or checks on a TV screen. The test is called Visual Evoked Potential (VEP). Another test called preferential looking or Teller Acuity Cards uses simple striped cards to attract the child’s attention. In both tests, as the stripes grow smaller, the child eventually does not respond (with brain waves or by looking at the stripes).
CHILDREN AND VISION
People are often confused about the importance of glasses for children. Some believe that if children wear glasses when they are young, they won’t need them later. Others think wearing glasses as a child makes one dependent on them later. Neither is true. Children need glasses because they are genetically nearsighted, farsighted, or astigmatic. These conditions do not go away nor do they get worse because they are not corrected. Glasses or contacts are necessary throughout life for good vision.
Nearsightedness (distant objects appear blurry) typically begins between the ages of eight and fifteen but can start earlier. Farsightedness is actually normal in young children and not a problem as long as it is mild. If a child is too farsighted, vision is blurry or the eyes cross when looking closely at things. This is usually apparent around the age of two. Almost everyone has some amount of astigmatism (oval instead of round cornea). Glasses are required only if the astigmatism is strong.
Unlike adults, children who need glasses may develop a second problem, called amblyopia or lazy eye. Amblyopia means even with the right prescription, one eye (or sometimes both eyes) does not see normally. Amblyopia is more likely to occur if the prescription needed to correct one eye is stronger than the other. Wearing glasses can prevent amblyopia from developing in the more out-of-focus eye.
Children (and adults) who do not see well with one eye because of amblyopia, or because of any other medical problem that cannot be corrected, should wear safety glasses to protect the normal eye.
EYEGLASSES FOR INFANTS AND CHILDREN
Prescriptions for glasses can be measured in even the youngest and most uncooperative children by using a special instrument called a retinoscope to analyze light reflected through the pupil from the back of the eye.
Most lenses today, especially for children, are made of plastic, which is stronger and lighter than glass. It is a good idea to get a scratch-resistant coating on plastic lenses. Children can be rough with glasses and plastic lenses scratch easily.
Color tints or tints that respond to changes in light can be incorporated into lenses. For children, the tint should not be so dark that the child has trouble seeing indoors.
Frames come in all shapes and sizes. Choose one that fits comfortably but securely. There are devices available to keep glasses in place, a good idea for active children and young children with flat nasal bridges. Cable temples, which wrap around the back of the ears, are good for toddlers. Infants may require a strap across the top and back of the head instead of earpieces. Flexible hinges hold glasses in position, allow the glasses to “grow” with the child, and prevent the side arms from being broken.
Children often do not like their glasses although the prescription is correct. Distraction, positive reinforcement, and bribery help children get in the habit of wearing glasses. If all else fails, your ophthalmologist can prescribe an eye drop that blurs vision when the glasses are not in place. This often overcomes the child’s initial resistance to wearing glasses.
CHILDHOOD READING PROBLEMS
When children have difficulty reading, parents often think poor vision is the problem. If a visit to an ophthalmologist rules out any medical or vision problems, it may be a learning disability.
A learning disability is a disparity between a person’s ability and performance in a certain area. It has nothing to do with intelligence or IQ. A learning disability can make it difficult to succeed in school and, if untreated, gets worse, causing a child to lose self-confidence and interest in school.
Identifying the learning disability is the first step in treating it. Dyslexia, a reading disability that may involve reversing letters and words, is one of the many learning disorders that can affect reading.
Exercises have been used to improve the coordination or focusing of the eyes. Since poor reading is not usually an eye problem, these exercises rarely prove helpful. Colored lenses, special diets or vitamins, jumping on trampolines, or walking on balance beams have also been prescribed without much success. Over time, these methods have tended to fall out of favor.
Children with learning disabilities benefit from various educational programs, in or out of school. Parents also play a vital role. They can support their children by reading with them at home. Children with learning disabilities need to be encouraged to develop strengths and interests so they can fully develop their unique talents and abilities.
CHILDREN’S EYE SAFETY
Accidents resulting in serious eye injuries can happen to anyone, but are particularly common in children and young adults. More than 90% of all eye injuries can be prevented with appropriate supervision and protective eyewear.
Goggles and face protection can prevent injuries in sports like baseball, basketball, racket sports, and hockey. It is more difficult to protect against injuries in boxing, though thumbless gloves help.
People who must rely on only one good eye should wear polycarbonate safety glasses all the time and should wear safety goggles for sports and other dangerous activities. Choose frames and lenses that meet the American National Standards Institute standard for safety (Z87.1).
Appropriate adult supervision is key in preventing all eye injuries. Children should never be allowed to play with fireworks or BB guns. Sharp and fast-moving objects, such as darts, arrows, scissors, knives, and even pencils or pens can be dangerous. Special care should be taken when working around lawn mowers, which can throw rocks and debris, and when banging two pieces of metal together, which can dislodge small shards of metal. Chemicals such as toilet cleaners and drain openers are especially hazardous.
A primary care physician or an emergency room can treat minor injuries, such as a foreign body or an abrasion (scratch) on the cornea. Any foreign material must be removed from the eye. An antibiotic drop or ointment may be applied, perhaps with an eye patch for comfort.
More serious injuries, like blood inside the eye (hyphema), a laceration (cut), or rupture of the eye, require examination by an ophthalmologist. Both surgery and hospitalization may be necessary.
Chemicals that burn should be rinsed from the eye immediately. The ultimate outcome depends on the severity of the injury, which cannot always be identified in the initial examination.