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Childhood Vision Problems

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.

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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 good news.

“Scientists 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.”

Another new 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.

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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.

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When 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 minutes.”

What 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 to aapos.org.

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