THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, October 24, 1995 TAG: 9510240482
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: By DIANE TENNANT, STAFF WRITER
LENGTH: Long : 176 lines
THE AVERAGE CHILD has two eyes. We're all pretty much agreed on that.
But those eyes come in an amazing variety of shapes and sizes, which affect the way images are focused inside. And that means some children will need eyeglasses or contact lenses.
So who should examine a child's eyes, an optometrist or an ophthalmologist? How can parents tell that a child might have a vision problem? Could corrective lenses actually make a child's vision worse?
When it comes to divisions of opinion and no easy answers, the eyes have it.
One out of five children ages 3 to 18 wears corrective lenses of some sort, says the American Optometric Association, which represents optometrists.
The most common reason for those lenses is nearsightedness, which means that the child can clearly see objects close to him but that objects at a distance are out of focus. The association says nearsightedness affects 3 percent of children ages 5 to 9 and 8 percent of children ages 10 to 12. Among teens, the rate rises to 16 percent.
This is, in part, because nearsightedness tends to worsen until around age 25. Both nearsightedness and farsightedness are treated with corrective lenses.
Recent evidence suggests that both conditions could be altered early in life through the use of such lenses. Research published in August in the journal Nature Medicine showed that the eyes of young monkeys actually grew into different shapes when spectacle lenses were placed in front of them. Could placing glasses on young children change the shape of their eyes? Could glasses actually make children's vision better - or worse - over the long run?
Maybe, maybe not. Dr. Earl Smith, professor of optometry at the University of Houston, wrote of his research: ``We simply do not know if the results that we obtained from our very young monkeys can be used to explain why school children often develop nearsightedness. In this respect, our results should not be taken as proof that spectacle lenses prescribed for nearsightedness in older children will cause the eye to become more nearsighted.''
The eyes of Smith's little monkeys changed shape to compensate for what the monkeys saw. If the lens they wore simulated farsightedness, their eyes grew longer than normal, correcting part of the problem. If the lens simulated nearsightedness, the eye growth slowed.
In an interview, Smith said his research, if transferable to humans, would apply to children before age 2. ``If little children are like little monkeys, that would suggest certain kinds of lenses could change the way eyes grow early in life,'' he said. ``Spectacles could actually help them grow normally.''
And the prescribing of glasses is becoming more common among preschoolers, he noted. ``We're beginning to recognize there are things you can prevent by prescribing spectacle lenses early in life for children,'' Smith said. ``It's just something not to be taken lightly. Putting glasses on a young child is a serious thing.''
Parents may wonder whether to take their child to an optometrist (a doctor of optometry who can examine eyes, prescribe corrective lenses and, in most states, use some drugs to treat eye problems) or an ophthalmologist (a physician who can treat eye problems, prescribe corrective lenses and treat patients with drugs or surgery). There is no easy answer.
Among themselves, optometrists and ophthalmologists agree that all children should have an eye exam by age 3. But they differ on who should do that exam.
``Obviously, we recommend that children be seen by an optometrist,'' said Charlotte A. Rancilio, news services manager for the American Optometric Association. ``The ophthalmologist is really an eye surgeon. Ophthalmologists are primarily interested in eye health problems and are not as likely to be concerned about how well a child sees as about the eye's health.''
``The American Academy of Ophthalmology has recommended that all children have an eye exam by an ophthalmologist by the age of 3,'' said Dr. Sharon Freedman, a pediatric ophthalmologist and assistant professor at Duke University Eye Center. Having all those children seen by ophthalmologists, particularly in areas where such doctors are in short supply, would be a daunting task, she added, and optometrists can work hand-in-hand with ophthalmologists in seeing well children, fitting glasses and ruling out abnormalities. Any medical problems, though, should be seen by an ophthalmologist, she said.
Pediatricians do basic eye screening during well-child checkups. By age 3, children should have an actual eye exam by an eye-care specialist. If no problems are noted, they probably don't need another exam until they are in school.
At school age, the number of children wearing glasses soars, and annual eye exams are needed.
Why do the numbers rise so much? Perhaps some people are prone, through heredity, to eye problems, Rancilio said, and those problems simply take a while to materialize. Or perhaps some kids' eyes are stressed by schoolwork.
Eye problems in schoolchildren are often discovered by teachers whose students cannot see writing on the chalkboard, or by school nurses during screenings.
Learning problems are not an automatic indicator of poor eyesight, but Norfolk ophthalmologist Dr. Annette Reda said corrective lenses are sometimes prescribed - wrongly - for academic difficulties.
``Glasses are very frequently prescribed for headaches or for learning difficulties at school,'' she said. ``Almost no headaches are caused by spectacle correction being wrong. A child that can't see the board is one thing. But a child who can see the board but is just having problems at school, very rarely is that a vision problem.''
Reda said she has seen ``glasses abuse,'' where children have been given glasses with extremely weak prescriptions, although they probably didn't need glasses at all, because their eye exam was conducted by someone who also sold glasses.
Generally, she added, a preschooler does not need glasses unless the child has a medical problem.
And some medical problems do require professional eye care.
Lazy eye, or ``amblyopia,'' is a common cause of treatable blindness in American children, Freedman said. It is essential to get early treatment for children with lazy eye, because it is almost impossible to retrieve vision lost from that condition by age 6 or 7.
Lazy eye shows up early, in infants and toddlers. It involves the loss of vision in one eye, usually caused because the eyes do not work together. One eye takes over the task of seeing, leaving the other eye to become ``lazy.''
Children will not outgrow either lazy eye or crossed eyes (also called ``strabismus''). Nor will they outgrow such problems as cataracts, glaucoma, excessively droopy eyelids or some other conditions.
Literature produced by the American Academy of Pediatrics, in conjunction with the American Association for Pediatric Ophthalmology and Strabismus, says that surgery may be required for some conditions. Literature from the American Optometric Association suggests that vision therapy, which involves retraining the eyes to work together, may work better than surgery on crossed eyes.
Young children often do not complain of vision problems, because they have nothing with which to compare their vision. Parents should watch for possible symptoms of vision problems. Contrary to popular opinion, sitting too close to the TV does not always indicate poor eyesight. Although it may be an indicator, children tend to move closer to objects they are interested in, and TV often acts like a flame to a moth.
Older children, however, may say they cannot see an object the parent points out. School-aged children may say they can't see what a teacher is writing on the blackboard, or school nurses may suggest a visit to the eye doctor.
However a potential problem comes to light, it is important that children be seen by an eye specialist, and the parent will have to decide between an optometrist and an ophthalmologist.
Those two eyes that the average child is born with are the only ones he will have for life. And if he's missing out on good eyesight, he's more likely to do poorly in school and, maybe, life. ILLUSTRATION: [Color Photo]
MARTIN SMITH-RODDEN
Staff photo illustration
Warning signs of eye problems in children
In preschoolers
- A baby who can't make steady eye contact by 2 or 3 months of
age.
- A constant crossing of the eyes or one eye that turns out. Some
crossing of the eyes is to be expected in infants, but not constant
crossing.
- A baby older than 3 months who cannot follow an object, such as
a toy, with his eyes as a parent moves it across his field of
vision.
In preschoolers:
- Misaligned eyes (eyes that are crossed or look in different
directions).
- A white pupil.
- Sudden pain and redness in one or both eyes.
In children of any age:
- The child's eyes flutter quickly from side to side or up and
down.
- The eyes are always watery.
- The eyes are always sensitive to light.
- Continued pus or crust in the eye.
- Redness that doesn't go away after a few days.
- Constant rubbing of the eyes.
- A constant squint, or closing one eye.
- A constant tilt or turn of the head to look at things.
- Droopy eyelids.
- Bulging eyes.
- Eyes that turn out, look crossed or don't focus together.
- Difficulty seeing writing on the blackboard at school.
Source: American Academy of Pediatrics
by CNB