What parents should know about their children's eye health. When should you take your children to the ophthalmologist?

The IMO has produced this guide to enable parents to find out about the most common childhood disorders, how to treat them and when it is important to take your children to see the ophthalmologist

Video in Spanish

Amblyopia

Known as "lazy eye", it is characterised by loss of vision in one or both eyes due to lack of use during the period of visual development.

How can it be detected? 

It is asymptomatic, so to detect it, vision in both eyes needs to be regularly compared (this can be done at home, for instance, by playing "pirates").

What causes it? 

The brain suppresses and stops using images produced by the eye with poor vision, resulting in it becoming lazy.

Causes Strabismus, refractive errors, others (e.g. drooping eyelids).

How can it be treated? 

By correcting the cause and making the lazy eye work.

Strabismus

This is a disorder of the visual system, in which the eyes are not properly aligned with each other, resulting in each eye deviating in different directions.

What causes it? 

Mal control por parte del cerebro del alineamiento y movimiento ocular, secundario a defectos de refracción, otros: tumores, enfermedades del sistema nervioso.

How can it be treated? 

The eyes need to be checked to ensure the condition is not associated with a refractive error, and, then, the child has to wear glasses. If it has caused lazy eye, this disorder has to be treated and surgery considered (the surgeon must make the appropriate recommendations to the parents).

Refractive errors

Uncorrected optical defects cause bad vision due to objects not being focused correctly on the retina. In children, this requires special consideration, because visual development occurs in the first years of life, and, therefore, any cause of poor vision in one or both eyes can lead to a lazy eye problem. If the refractive problem is asymmetrical (higher optical power in one of the eyes), amblyopia is more likely to develop. Symptomatic refractive problems in childhood should be corrected to prevent amblyopia and not interfere with the child’s schooling.

Check-ups should take place every year for life if a refractive error or other eye problem exists

Birth

To rule out congenital abnormalities:   congenital glaucoma, cataracts, strabismus and ptosis, malformations, tumours.

At 3 – 4 years

First complete eye examination, visual acuity (lazy eye), ocular motility (strabismus), optical power with drops, fundus.   Then, annually until the age of 10 (to monitor the development of the visual system) and every two years until the age of 16.

Every two years from the age of 10

Visual acuity, motility examination, optical power, assessment of the anterior pole and intraocular pressure, assessment of the fundus. Detection of acquired refractive errors (myopia and astigmatism), strabismus or binocular problems, ophthalmic disorders.

How do we develop our visual behaviour?

  •  31 weeks of gestation: appearance of pupillary light reflex
  • Days after birth: eyelid closure in response to light
  • 6 weeks of life: reaction to facial expressions
  • 2 – 3 months of life: perception of movement (following a bright object)

In premature babies, the whole process is delayed.

Do parents take their children to the ophthalmologist?

IMO used its appearance at the Barcelona Children’s Festival to find out, as objectively as possible, the level of concern we have about the eye health of our children.   It conducted a survey of the thousands of parents of children between the ages of 2 and 10 who came to its stand.   The main conclusion was that "children learn to see during childhood, and, therefore, monitoring their proper visual development through check-ups ensures good vision during adult life."   Regarding paediatric check-ups, 38% of the parents surveyed said that their children’s vision was not examined in general health check-ups, while 62% said it was.   In this regard, 40% of parents believed that much less importance was attached to examining vision than the rest of the child’s health.

Key concepts

EKnowledge of the key concepts of visual development in childhood was similarly deficient among parents of children between the ages of 2 and 10, according to the survey. 78% did not know the meaning of binocular vision (the combining of images from both eyes and the ability to see in three dimensions) and an even higher percentage, 80%, did not know what amblyopia, or "lazy eye", was. Common in children, this condition occurs when the brain suppresses the vision of one of the eyes, because its vision is worse than the other, as a result of strabismus, a refractive error or another eye problem. "When a visual defect only or acutely affects one of the two eyes, the brain selects the best image and suppresses the other, which prevents the vision in that eye from developing.   To recover it, the problem must be treated in childhood, the age at which we learn to see," explains Dr Ana Wert. According to the specialist, "to detect visual asymmetry (when one eye sees better than the other), parents, as well as taking their children for eye check-ups, should also give them simple tests at home, such as getting them to look at a picture with one eye covered and then the other." 51% of parents, however, said that they had never checked their children’s vision at home.   With respect to the level of knowledge about an eye disorder that is directly associated with childhood, strabismus, the results improve substantially, with only 13% not knowing about the problem, in which one or both eyes deviate from the central axis.   

"Parents are generally better informed, because strabismus is symptomatic, hence they are the ones who first detect it and take the child to see a specialist," Dr Wert explains. When asked about eye disorders, 18% of respondents who had taken their children to the ophthalmologist said that their child had a diagnosed eye problem.   Although visual disorders in children are highly varied, the ones that were most common among respondents’ children were strabismus (20%), refractive problems (17%) and lazy eye (11%).   According to Dr Wert, "it is of some concern that 41% of children remain undiagnosed and have never been to the ophthalmologist."

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