All babies come into the world with well-formed senses of
hearing and touch, but much of our visual development occurs during the weeks
(and even months and years) after birth. Newborns can see, but the ability to
differentiate colors, to focus at different distances, to move the eyes in
tandem, and to make sense of images, all get fine-tuned as babies grow. But in
some cases, problems can interfere with a child’s visual development—and if
left untreated, they can lead to permanent consequences. Here are some of the
most common pediatric eye problems that you need to know about.
Amblyopia, or Lazy Eye
What it is: Amblyopia occurs when the vision in one
eye is much stronger than in the other. As a result, the brain starts to favor
the strong eye and ignore the weak eye. “That’s a problem because the nerve
pathway between the brain and the eyes develops only until about age 9, and
this development is fueled by visual stimulation—the more you see, the more
connections are made,” says Dr. Ilana Friedman, pediatric ophthalmologist at
Montefiore Medical Center in New York City. “If amblyopia isn’t treated, the
child can suffer permanent loss of vision in the weak eye.” In fact, amblyopia
causes more blindness in children than all other causes put together.
What to look for: “Sometimes amblyopia can cause one
eye to cross or wander (see more below); in other cases it may be due to a
physical blockage of the weak eye, like a cataract or a droopy lid,” says
Friedman. But often there are no outward signs, which is why it’s so important
to get your child’s vision checked regularly.
How it’s treated today: The first step is to get your
child fitted with appropriate glasses—“in some cases, this may mean having a
different prescription for each eye,” says Friedman. “After two to three
months, we’ll recheck their vision, and if there is still a significant
difference between the eyes, that’s when we recommend using a patch over the
stronger eye.” But if you cringe at the memory of a neighbor or classmate being
teased for an eyepatch, or sporting the pirate look day-and-night, there is
have compared the effects of patching full-time versus patching for six hours a
day, and they found no significant difference in the long-term outcome,” says
Friedman. Dr. Ken Nischal, chief of
the division of pediatric ophthalmology at Children's Hospital of Pittsburgh goes
even further, suggesting that patching for two hours a day may be enough. “That
means your child could wear a patch before and after school, but skip it during
class,” he says. More good news for kids: “We typically recommend that kids
wear the patch while doing activities that require visual attention, like
homework, reading or coloring,” says Friedman. “In the past, we said they
couldn’t watch TV, but now we encourage kids to play video games while wearing
the patch, since that requires so much visual coordination.”
option: If your child’s amblyopia is not severe, ask the doctor whether he or
she could use blurring drops in the strong eye rather than wearing a patch.
NEXT: Crossed/Wandering Eyes
Strabismus, or Crossed/Wandering Eyes
What it is: Normally, your eye muscles work as a
team, synchronizing movement so both orbs focus on the same object. Strabismus
occurs when those muscles fail to cooperate; one eye focuses on an object while
the other eye moves in a different direction. Sometimes strabismus develops as a result of amblyopia, if the strain of focusing causes the weak eye to turn in
or out—and sometimes strabismus itself can cause amblyopia. “In an adult, crossed eyes would cause double
vision; in a child, the brain can quickly learn to ignore the unwanted image
from the second eye, which will cause that eye to weaken,” says Friedman.
What to look for: “Most parents will notice if one
eye is obviously crossed in or wandering out,” says Friedman. But she says you should
also take notice if your child complains of headaches or double vision.
How it’s treated today: Strabismus is corrected
surgically, typically during an
outpatient procedure done in a hospital operating room under general
anesthesia. “One of my colleagues jokes that there’s been nothing new in pediatric muscle surgery in the past 100 years,” Friedman says. “It’s not a
laser surgery—it requires an incision, and moving or cutting the eye muscles,
so there are some stitches. But it’s extraordinarily effective, which is why
the nuts and bolts haven’t changed.”
However, for mild strabismus,
scientists have hit on an alternative to surgery: Botox. “Botox works by
weakening muscles,” says Friedman. “By injecting it into the muscles of say, an
eye that turns in, you can allow it to relax out to a more natural position.”
Myopia or Hyperopia
What it is: In layman’s terms, myopia
(nearsightedness) and hyperopia (farsightedness) are just plain old poor vision.
“Most children are born slightly farsighted, but they typically outgrow it,”
says Friedman. “But persistent farsightedness or nearsightedness needs
correcting, even if your child isn’t in school yet. Otherwise, it could
interfere with the eyes’ developing connection to the brain.”
What to look for: An older child might squint or
complain that he or she can’t see the blackboard, but the signs can also be
more subtle, especially in small children. Watch for clumsiness (it’s easy to
trip over something if you can’t see it), clinginess (sometimes children are
scared to venture out on their own if the world is blurry) or strange head
positions (turning the head to the right or left when focusing on an object).
How it’s treated today: Despite recent developments
in contacts and laser surgery, for most kids glasses are still the best option.
“Today, soft contacts are so comfortable that it’s easy to pop them in and
forget about them,” says Nischal. “But doing that can open the door for serious
eye infections. A good litmus test that parents can use when deciding if their
child is ready for contacts: How tidy is his or her bedroom? If their room is a
mess, they’re probably not disciplined enough to practice good contact
hygiene.” However, Nischal notes that if your child’s vision is very bad, or if
he or she has a strong astigmatism, then contacts may be the best course of
treatment. “Laser surgery is typically only recommended for children who are developmentally
delayed, and can’t wear glasses or contacts for that reason,” he says. Why?
Most people’s visions don't stabilize until they’re in their early 20s.
choosing glasses for a very young child, “look for a soft frame that’s made of
plastic (not metal) and that comes with a strap to keep it in place,” says
Friedman. “It might be a struggle at first to get your child to wear his or her
glasses, but usually after a week or two it becomes second nature. Just keep
putting them back on, even if your child is taking them off every five
about the future? Scientists are hoping to develop hard contacts designed to
curb or reverse myopia in children by reshaping the cornea—however, Friedman
notes that this potential therapy is a ways away. “Right now, we’re still
working on figuring out why kids are developing such progressive
nearsightedness today,” she says.
“Plus, we know that children and contacts lenses don’t often mesh, so we need
to make sure that they will be safe for kids to use.”
To learn more about
children’s eye health, and to find a pediatric ophthalmologist near you, go toaapos.org.