Health & Wellness: Vision of Youths
Coby Pighetti noticed that something just wasn’t right with one of the eyes of her 18-month-old daughter Gabrielle. To the first-time mother, it looked as though Gabrielle’s eye was turning in toward her nose.
After having amblyopia, or a lazy eye, during childhood herself, Pighetti felt it was necessary to ask her daughter’s pediatrician if she also noticed the baby’s eye turning. The pediatrician, after examining the eye, made a referral for Pighetti and her daughter to visit Marla Moon, OD, FAAO, an optometrist specializing in pediatric eye care and a founding partner of Nittany Eye Associates.
Upon visiting Dr. Moon, Gabrielle was immediately given glasses to begin correcting her lazy-eye condition. “The purpose of that was it would help strengthen the muscle and start pulling the eye back out,” Pighetti says. “They said if that didn’t work, we would try patching.”
In an attempt to correct Gabrielle’s lazy-eye condition before surgery was needed, Moon had decided to combine the little girl’s glasses routine with patching, where the stronger eye is covered to make the weaker eye work harder in an attempt to strengthen the eye muscles.
“One of the things with regard to kid’s vision is it changes pretty quickly, especially when children are very young,” Moon says. “A lot of growth, a lot of development with regard to the visual system comes during the first 18 to 36 months of life, so a lot of things can change.”
But because tracking skills, eye-teaming skills, and the focusing muscle do not fully develop until after birth, Moon says growth patterns and muscle-coordination control can still change until a child is about 7 years old.
A problem with eye-teaming and muscle-coordination control is what caused Karlee Bierly, 10, to have double vision.
“You could see it when she tried to bring her eyes together to look at something close up. Both eyes would start to go toward her nose, and then all of a sudden one eye would just relax and go back to its normal position. She could not make her eyes go in to focus properly,” Fawne Bierly, Karlee’s mother, says.
Though Karlee received her first pair of glasses at age 8, changes in eye growth and development caused her to need additional eye therapy to correct her double vision a year later.
This continued eye growth and development during early childhood is why the American Public Health Association, the largest body that represents all health-care providers, recommends that the first eye examination be done during a child’s first year of life. Additional visits should then occur when a child is 3 and 5, as vision problems affect 1 in 20 preschoolers and 1 in 4 school-age children.
Moon says examination techniques at these crucial early eye exams depend on the age or the developmental age of the child. “When kids are younger, or developmentally lower, we will use something called preferential looking,” she says. “It is based upon some research that psychologists did back in the early ’80s where babies tend to want to prefer something that has some detail.”
According to Moon, this conclusion is why development toys are often black, white, red, yellow and orange. “So, utilizing that, visual acuity [the clarity or sharpness of vision] tests were developed and standardized on that,” she says.
These visual acuity tests for young children include striped patterns of various widths. Eye doctors are able to see where the patterns are located through an observational hole. Moon says if a baby can resolve the striped patterns, eye doctors will keep varying the location and size of the pattern. Once babies no longer show a preference, their threshold has been reached, providing eye doctors with an equivalent visual acuity.
If young children are not tolerant of the preferential-looking test, eye doctors also may use the STYCAR test, which includes the use of Styrofoam balls in various sizes to evaluate the child’s visual acuity.
During these time periods, eye doctors also begin to check for certain types of lazy-eye conditions that can’t be seen by an eye crossing or an eye turning outward. Moon says if doctors can catch those conditions in the developmental formative years, the symptoms and causes can many times be turned around before they begin to affect school performance.
Because Gabrielle’s lazy-eye condition was caught at an early age, her schoolwork never suffered. She is now an active 12-year-old soccer goalie, swimmer, and book-lover who simply needs the aid of glasses or contacts.
“She excels athletically and academically. I think if we hadn’t caught it early, I wonder if we wouldn’t be where we are today,” Pighetti says.
In addition to testing for visual acuity and lazy-eye conditions, eye doctors also assess a child’s eye health during an examination. Moon says doctors check for cataracts, glaucoma, scar tissue, and hemorrhaging of the retina. Eye growth, or how much the eye is growing and elongating, is another aspect doctors look at. “That will tell us if a person is nearsighted, farsighted, or has astigmatism, and determines whether they need glasses or not,” she says.
According to Moon, about 85 percent of children are born farsighted. As they grow, so does the eyeball. In the majority of cases, this growth causes the farsightedness to be naturally corrected by the time a child is 5 to 6 years old. But if the eye continues to grow past this point, children may develop other refractive problems such as nearsightedness or astigmatism, or inability of the eye to focus on an object to give a sharply focused image. These refractive problems are the most common visual issue in childhood, affecting about 15 to 20 percent of children from birth to 18 years old.
Because the Centers for Disease Control and Prevention lists vision disorders as the fourth most common disability and the leading cause of handicapping conditions during childhood, Moon urges parents to have their children see an eye specialist as early as possible. A national program known as InfantSEE offers a no-cost eye and visual assessment to children between 6 and 12 months old.
Moon also believes parents need to be more aware of how to keep their children’s eyes healthy, as 80 percent of what children learn is acquired through visual processing. She believes having the right diet, using protective sports eyewear, having proper lighting for reading and watching television, and having routine eye care are the best ways to keep a child’s eyes healthy.
“Look at the visual system as tools,” she says. “Say you want to build a house and there’s this carpenter that needs to build the house. The lumber company dropped off the two-by-fours and dropped off the nails and dropped off the drywall — all that stuff. But if that carpenter doesn’t have the right hammer, the right saw, it’s going to be difficult for him to build that house. That’s how the visual system is. We need to make sure tools are working the way they need to be for the child to properly use those tools in learning.”