Two words: myopia and amblyopia.
Amblyopia
My daughter recently had her 18-month check-up at the pediatrician’s office and at the end of the exam, the doctor mentioned her dental health and the importance of a dental exam but made no mention her ocular health or the need for an eye exam. Being an eye doctor as I am, I inquired why they did not recommend eye exams? With a puzzled looked, my pediatrician, whom we love dearly, mentioned they will not regularly refer a child for an eye exam unless a problem is noted on their (rather limited) ocular evaluation. On that note, I took the opportunity to review with our doctor the need for early intervention as there are subtle defects that cause visual loss and if left untreated cause permanent vision loss. He probably didn’t enjoy the lecture in the middle of his morning schedule but he seemed to understand and took it in stride.
Eye exams are crucial for detecting small discrepancies in vision that could leave a lifetime blur if not corrected early. While pediatricians do an excellent job in the primary care of a child, their ability to diagnosis subtle eye turns and refractive error is limited. This is not due to any fault of their own—they are not trained to find visual deficits as small as those that can cause permanent visual loss.
The sneakiest of the bunch is amblyopia—the leading cause of vision loss in children. Amblyopia also is known by the terrible term “lazy eye,” is decreased vision in one or both eyes not due to ocular pathology but by a poor connection of the eye to the brain. During development, both eyes need to see clearly and focus together. If there is an eye turn (strabismus) or blurred vision due to uncorrected nearsightedness or farsightedness, the eye will not make a strong connection with the brain and will have permanently reduced vision if left untreated.
Ever notice those cute little babies in eyeglasses? Not all of them presented with eye turns. Although an eye turn is obvious to parents and will raise suspicion to have it checked, it is a difference in refractive error (i.e. glasses prescription) between each eye that can fly under the radar and cause amblyopia.
Fortunately, we can treat amblyopia but it has to be caught early. After the age of 5, the rate of successful intervention starts to decline due to the hardwiring of the brain.
To prevent amblyopia and other risks to your child’s vision and health, the standard of care for your child’s first eye exams is at age 1. Yes! Even at 12 months, we can pick up, not only refractive errors but congenital variants and cancers such as retinoblastoma.
Myopia
Myopia, also known as nearsightedness, has increased substantially in the US and has effectively doubled in the last 3 decades. This is a pandemic, meaning not just in the US, but worldwide. Recent research attributes a number of factors to this including the usual suspects like genetics, but also the increased near activity of children (think tablet and iPad use) and reduced outdoor activity. Researchers believe the problem lies in not extending focus beyond near objects and the absence of natural light. You can read more on this on our ”Nearsightedness– Can We Defeat It?” (create hyperlink) blog post.
Through ongoing research, a number of treatments that slow the progression of myopia have been developed and we do have those available at Carolina Eye Doctors.
We can intervene and treat in a number of ways. Two of the most effective treatments are through pharmaceutical and optical pathways. The Atropine for the Treatment Of Myopia (ATOM) study and the Low-Concentration Atropine for Myopia Progression (LAMP) Study have shown that using low concentration atropine eye drops can significantly reduce myopia progression.
Another tool we have to substantially reduce progression is corneal refractive therapy (CRT). This treatment falls under the term “orthokeratology” which entails application of a gas permeable contact lens. This lens is worn overnight to induce temporary changes in corneal curvature, allowing for clear daytime vision without glasses or contact lenses. Although these lenses were designed for the correction of refractive error, studies have shown a secondary advantage of slowing myopic progression. So it’s a great two-for-one benefit.
Take-Home Message
While two of the most common causes of children being unable to see (myopia and amblyopia) can be treated, they first must be diagnosed. And the earlier the better. We recommend eye exams at 6-12 months of age, age 3, just before they enter the first grade — at about age 5 or 6—and every year thereafter. Visual conditions are the leading cause of poor learning and classroom performance. Caught early, they can be diagnosed and treated, optimizing your child for learning and preventing common educational delays.
