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

New Zealand Listener - - CONTENTS - By Nicky Pel­le­grino

Early de­tec­tion can pick up vi­sion 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.”

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 longterm 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.”

In the past it was only the very stu­dious chil­dren who were at risk of my­opia.

Karthi Param: kids are do­ing “ridicu­lous amounts of closework”.

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