By Dr (Prof) Meenakshi Y Dhar
Children constitute one third of our population in India which is around 470 million below the age of 18 years. The vision problems and their presentation may be slightly different at different ages. Early childhood is the most important period for development of vision and eye – especially the first two years of life. If the child does not see clearly during that period, the visual pathways to the brain do not allow vision to develop adequately. Hence any vision problem should be addressed as early as possible in life to allow the full visual potential to develop.
The common problems in childhood are refractive errors. These refer to the inability to form a clear image on the retina which is corrected by glasses. It is like having a defocused photograph. In childhood the eye tries to compensate for this by using accommodation and hence, the child may have headache, watering or squint. Others may complain of frequent blinking or squeezing of eyes in an attempt to see clearly.They may not see the blackboard clearly and scholastic performance may decline. Hence, for early detection, every child should undergo an eye examination annually. India has had the School Health Program for over five decades or more wherein children should undergo an eye exam at least once annually, but a lot is still amiss and uncorrected refractive errors form a big burden to eye diseases in India.
In ‘Myopia’, the image is formed in front of the retina, more often in large eyes and it is corrected by concave lens spectacles. Children can’t see distant objects clearly and bring things close to read. Myopia has shown an exponential rise ever since the Covid-19 pandemic with no outdoor play and too much of near work on computers and mobile, so much so that the ophthalmologists have now come up with consensus guidelines on its prevention and management, which include insistence of at least two hours of outdoor playing for school-going children. In relevant cases and only under an ophthalmologist’s supervision low dose atropine eye drops are advised to halt myopia progression. With high myopia the retinal periphery should be screened by an ophthalmologist annually as myopes can have retinal complications also.
Hypermetropia occurs in small eyes, and here the image is formed behind the retina. These children may have problems in close work and also seeing far or may start squinting. These children need to have their accommodation relaxed with cycloplegic eye drops prior to testing glass power, otherwise a wrong power will be prescribed. It is corrected by convex lenses in spectacles. If not treated early these children can have a lazy eye or amblyopia which needs more close followup with an eye doctor. Fine near work is encouraged with corrective spectacles worn and better eye patched in order to improve the visual potential of the weak/ lazy eye. This is best started at the earliest and may not be effective after seven years of age.
Astigmatism occurs when all rays don’t get focussed simultaneously on the retina-some are focussed in front and others behind retina. It is corrected by cylindrical lenses in spectacles. It is also prone to amblyopia and should be treated stringently.
Glasses are for constant use and should fit the correct size – depending on the size of the face and worn straight and not tilted; scratched glasses should be changed. All children should wear plastic frames and plastic lenses, metallic frames are to be avoided. Contact lenses are to be worn when indicated. Refractive surgery to remove spectacle wear is a complete ‘NO’. It must not be done till the child becomes an adult.
Squint or strabismus is another problem that requires spectacle and retina assessment. In many cases wearing glasses may improve squint, others require surgery. Very rarely, eye tumours called retinoblastoma which though rare may present as sudden onset squint; as also cataracts which must be investigated and treated promptly.
Frequent rubbing of eyes can be due to allergic conjunctivitis and its severe form spring catarrh bothers children annually and should be treated promptly. Rubbing should be avoided. Indiscriminate use of steroids whether local/ systemic in children can cause glaucoma and irreversible visual loss and hence, should be avoided.
To summarise, eye problems in children should be evaluated promptly and thoroughly and parents should follow the corrective measures advised.
(The author is the HoD, Dept of Ophthalmology, Amrita Hospital, Faridabad)
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