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Did you know that one in four children has an undetected vision problem that can interfere with learning?

Two years ago, when our daughter was in kindergarten my wife suspected that she may be having some problem with her vision. She noticed that the little one kept her head too close to her books and tilted her head to one side while watching the TV. Both my wife and I are myopic, we always knew our kid had a high genetic predisposition for myopia. We took her for an eye exam and were surprised by the findings in the visual acuity test. She had normal vision in one eye and high myopia in the other eye. She had started developing anisometropic amblyopia.

Anisometropia is the condition in which the two eyes have unequal refractive power; that is, are in different states of myopia (nearsightedness) or hypermetropia (farsightedness). Anisometropia can adversely affect the development of binocular vision in infants and children if there is a large difference in clarity between the two eyes. The brain will often suppress the vision of the blurrier eye in a condition called amblyopia, or lazy eye.
More information on Amblyopia is available here & here for health professionals and here & here for non-professionals.

She has been on occlusion therapy (or patch treatment) for the past two years. This involved patching the normal eye and letting her use the myopic eye for about 8 to 10 hours a day for 5 days a week. The Ophthalmologist has recently changed the treatment to alternate patching - occlude the normal eye for 4 days, the abnormal eye for 2 days with a patch holiday on Sunday.

According to what I learnt from the Ophthalmologist and the internet, the results of treatment are better if amblyopia is recognized early. Patching for anisometric amblyopia gives best results if done before nine years of age. There is a difference of opinion among ophthalmologists about patching the abnormal eye only or going in for alternative patching.

I also learnt that there are different protocols for checking the vision in kids, including one which recommends a complete check at 6 months of age. None of these are practised in India as far as I know. I have not heard of a single pediatrician recommending a routine eye checkup in normal kids. Eye checks are only advised for kids who come with problems. I think it should be made mandatory to test all the vision of all kids at least at the time of admission to kindergarten.

Young children with vision problems often do not know the world is different from the way they see it. They may never have seen clearly, hence they have no way of knowing their vision is not normal.

Vision problems are treated more successfully during the growth and development of a child’s visual system. By the time children finish primary school their visual system has virtually completed its development, so a delayed eye exam can spell trouble.

So if you are a parent and you happen to live somewhere like India where there is no set protocol for checking childrens vision and if you don’t have a good pediatrician or primary care physician, you have to make sure that your child gets periodic eye checkups.

To start the school year, your child needs:

• New clothes & shoes.
• Books.
• Pencils & erasers.
• Lunchbox & Water bottle &
• A Professional eye exam. A timely, comprehensive exam by a qualified eye-care professional is key to discovering vision difficulties in children.

Parents and teachers should watch for certain tell-tale signs of possible vision problems:

• Placing the head close to a book when reading; losing place while reading.
• Squinting, closing or covering one eye.
• Turning or tilting the head to one side.
• Excessive blinking or rubbing of the eyes.
• Dislike and/or avoidance of close work.
• Short attention span; frequent daydreaming.
• Complaints of headache, nausea and dizziness.
• Excessive clumsiness.

If you notice any of these symptoms in your child, you need to get the child examined for any vision problems.

Children may not know what to expect during a routine professional eye exam. Calm your child’s fears by setting an example: Get your eyes examined first! Then you can sit with your child for his or her eye exam.

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