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Why early detection of eye problems is so important for kids

NOTED logo NOTED 10/10/2018 Nicky Pellegrino
Photo/Getty Images © Bauer Media Photo/Getty Images

Early detection can pick up eye problems that, left untreated, will hinder a child’s development.

More than half of Kiwi kids aged 15 or younger have never had a full eye exam, according to nearly 1000 respondents to a survey done for optometrist Specsavers. That might not seem such a big deal. After all, most children get their vision screened at age four and then again at school in Year 7, so if they’re not squinting or complaining that the iPad screen looks blurry, then why would you bother?

Specsavers St Lukes, Auckland, optometrist Karthi Param says eyesight issues in kids aren’t always obvious, and although the screening programme is great, it doesn’t cover all the bases. Children themselves can be unaware they have an eye problem. “Kids are resilient and don’t tend to complain,” he says.

“Some will adapt and work past the problems they are having, meeting all their developmental milestones. Others can’t explain what is going on.”

It isn’t simply a matter of whether or not a child needs glasses. A full eye exam will pick up other issues such as binocular vision disorders, which it is important to correct early.

Binocular vision is the two eyes working together to perceive a single 3D image of the surroundings. Sometimes the eyes don’t align properly, causing the sufferer to overcompensate.  This can lead to eye strain, blurry vision, headaches and problems with co-ordinated activities as the brain starts to favour one eye over the other. There are various forms of this, including the common lazy eye (amblyopia), and the treatment involves exercises rather than corrective lenses.

Although some kids may not show that they are struggling, there are signs to look out for, such as a tendency to tilt the head to avoid using one eye. Others include closing one eye, squinting, forced blinking, frequent eye-rubbing or chronic headaches.

“And, of course, learning difficulties are an important indicator of vision problems,” Param says. “A child who has eye strain won’t read for as long or enjoy reading as much.”

a man smiling for the camera: Karthi Param. © Bauer Media Karthi Param.

If a parent suspects their child might need it, Param recommends a first full eye exam at age three. At that stage, it can be challenging for optometrists. Shape identification is used rather than letters. “But their attention span is short and if you don’t have bright colours in the room you have no chance.”

As eyes are still developing, young children often grow out of minor problems, so it’s more a matter of monitoring to make sure nothing gets worse.

Before starting school, between ages four and five, is a good point for all children to get checked. Some families may be deterred by the potential cost. However, Specsavers has a Kids Go Free programme that offers two-yearly eye tests for children under 15.

Today’s kids are often pleased to be told they need glasses – in fact, some even fake eye problems because they view frames as a hot fashion accessory and want to wear them. “In optometry terms, it’s called malingering,” Param says.

For kids who are sporty, and do genuinely need their vision corrected, it may be preferable to use contact lenses, as long as it’s possible to get them into good hygiene habits. “It’s more dangerous if a ball hits them in the face, and the glass shatters, than wearing contact lenses and the risks that come with that.”

Since being extremely short-sighted can lead to trouble later in life – such as an increased risk of retinal tear and detachment – there is a trend to try to slow the progression of myopia in children. In Singapore, where there is an epidemic of short-sightedness, they have pioneered the use of atropine eye drops and corneal reshaping Ortho-K lenses. In New Zealand, we have been more cautious but these therapies are starting to be used here.

What isn’t yet known is the long-term effect of spending long periods staring at screens. In the past, it was only very studious children who did a lot of close work, such as reading, who were at increased risk of myopia.

“But now we’re seeing a lot of kids coming in who are doing ridiculous amounts of close work,” Param says. “Screens are generally worse to look at than books because of the illumination. And there’s evidence that children who spend more time outdoors in natural light don’t have as many problems.”

This article was first published in the September 29, 2018 issue of the New Zealand Listener.

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