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Pediatric Ophthalmology

Babies’ Vision

Pediatric Ophthalmologist Pennsylvania

Babies have poor vision at birth but can see faces at close range, even in the newborn nursery. At about 6 weeks of age, a baby should be able to fixate on an object (such as a face) and maintain eye contact. Over a child’s first few years, vision develops rapidly; 20/20 vision can be recorded by 2 or 3 years of age.

Parents should be aware of signals of poor vision. If one eye “turns” or “crosses,” that eye may not see as well as the other eye. If the child is not interested in faces or age-appropriate toys, or if the eyes rove around or jiggle (called nystagmus), you should suspect poor vision. Other signs to watch for are tilting the head and squinting. Babies with profoundly poor vision may sometimes rub their eyes. Babies and toddlers compensate for poor vision rather than complain about it.

Should a baby need eyeglasses, the prescription can be determined fairly accurately by dilating the pupil and analyzing the light reflected through the pupil from the back of the eye.

A baby’s vision can also be tested in a research laboratory, where the brainwaves are recorded as the child looks at patterns of stripes or checks on a television screen. This is called a visually evoked potential (VEP) test. Another test, called preferential looking or Teller acuity cards, uses simple, striped cards to attract the child’s attention. In both tests, as the stripes grow smaller and closer together, they become more difficult to see, and the child’s level of visual acuity can be assessed.

Childhood Reading Problems

When children have difficulty reading, poor vision may or may not be the problem. If a visit to an ophthalmologist (Eye M.D.) or optometrist rules out any medical or vision problems, your child may have a learning disability.

A learning disability is a disparity between a person’s overall abilities and their performance in a certain area. It has nothing to do with intelligence or IQ. A learning disability can make it difficult to succeed in school and, if untreated, can get worse, causing a child to lose self-confidence and interest in school.

Identifying the learning disability is the first step in treating it. Dyslexia, a reading disability that may involve reversing letters and words, is one of the many learning disorders that can affect reading.

Exercises have been used to improve the coordination or focusing of the eyes. Since poor reading is not usually an eye problem, these exercises rarely prove helpful. Colored lenses, special diets or vitamins, jumping on trampolines, or walking on balance beams have also been prescribed without much success. Over time, these methods have tended to fall out of favor.

Children with learning disabilities benefit from various educational programs, in or out of school. Parents also play a vital role. They can support their children by reading with them at home. Children with learning disabilities need to be encouraged to develop strengths and interests so they can fully develop their unique talents and abilities.

Children and Vision

Many people are confused about the importance of eyeglasses for children. Some believe that if children wear glasses when they are young, they will not need them later. Others think that wearing glasses as a child makes him/her more dependent on them later. Neither is true. Some children need glasses because they are genetically nearsighted, farsighted, or astigmatic. These conditions generally neither go away nor get worse because they are not corrected. For people with refractive errors (which means that light rays do not focus precisely on the retina), eyeglasses or contacts are necessary throughout life for good vision. (Refractive surgery, such as LASIK, is almost always reserved for adults.)

Nearsightedness, or myopia (when distant but not near objects appear blurry) typically begins between the ages of eight and fifteen but can start earlier. Farsightedness, or hyperopia, is actually normal in young children and not a problem as long as it is mild. If a child is too farsighted though, vision is blurry or the eyes can cross or eye strain may cause reading problems. Crossed eyes from hyperopia usually is evident at about age 2; the crossing is often worse with near viewing. Almost everyone has some amount of astigmatism (oval instead of round cornea). Eyeglasses are required only if the astigmatism is strong.

Unlike adults, children who need glasses may develop a second problem, called amblyopia or lazy eye. Amblyopia means that the connections between the eye and the brain do not develop properly. Usually, this happens in the eye with the worst prescription. It can occur in both eyes if the prescription is really strong in each eye. Wearing eyeglasses can prevent amblyopia from developing or may treat amblyopia if already present.

Children (and adults) who do not see well with one eye because of amblyopia, or because of any other medical problem that cannot be corrected, should wear safety glasses to protect the normal eye.

Children’s Eye Safety

Accidents resulting in serious eye injury can happen to anyone, but are particularly common in children and young adults. More than 90% of all eye injuries can be prevented with appropriate supervision and protective eyewear.

Goggles and face protection can prevent injuries in sports like baseball, basketball, racket sports, and hockey. It is more difficult to protect against injuries in boxing, although thumbless gloves help.

Children (and adults, too) with vision loss in one eye should wear polycarbonate safety glasses all the time and should wear safety goggles for sports and other risky activities. Choose frames and lenses that meet the American National Standards Institute (ANSI) standard for safety (Z87.1). Criteria include shatter-proof lenses of polycarbonate or Trivex and a sturdy frame – no rimless or wire-mounts.

Appropriate adult supervision is an essential part of preventing eye injuries. Children should never be allowed to play with fireworks or BB guns. Sharp and fast-moving objects such as darts, arrows, scissors, knives, and even pencils or pens can be dangerous. Special care should be taken when working around lawn mowers, which can throw rocks and debris, and when banging two pieces of metal together (like hammering a nail), which can dislodge small shards of metal. Children should stay clear of such activities unless wearing eye protection (true with adults, too). Chemicals such as toilet cleaners and drain openers are especially hazardous.

A primary care physician or an emergency room physician can treat minor injuries, such as foreign body or an abrasion (scratch) on the cornea. Any foreign material will be removed from the eye, an antibiotic eye drop or ointment may be used, and an eye patch may be applied for comfort.

More serious injuries, such as blood inside the eye (hyphema), a laceration (cut) of the eye, or rupture of the eye, require examination by an ophthalmologist (Eye M.D.). Both surgery and hospitalization may be necessary.

Chemicals that burn should be rinsed from the eye immediately. Chemical burns can cause severe damage, so eyes should be flushed immediately. If sterile solutions or eyewashes are readily available, use them to flush the affected eye. If not, flush the eye with liberal amounts of water from the nearest sink, shower, or hose for ten minutes. Be sure water is getting under both the upper and lower eyelids. After the eyes have been flushed for ten minutes, bring the child to the emergency room immediately. The ultimate visual outcome after a chemical burn depends on the severity of the injury, which cannot always be identified in the initial examination.

If you are seeking a pediatric ophthalmologist in Pennsylvania please fee free to contact us directly. Leader Heights is committed to excellence in ophthalmology and child vision care.

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