The sense of sight is responsible for approximately 85% of the stimuli received by humans from the world around us. It is the cognitive and communication functions of sight that make it tantamount in children during their development. At birth, a visual system is not fully developed. Normal visual acuity is achieved by the age of 6-8 years [1]. It is during this period that we should pay particular attention to the correct development of children's eyesight. The first examination should take place at the age of 3 (unless there are worrying symptoms earlier, such as an eye misalignment), and subsequent examinations should be performed every 2 years until school age.

Do not forget - check!

A school-age child’s eyesight should be checked at least once a year, unless a specialist advises otherwise. Previous studies by many authors have shown a correlation between visual organ condition and educational progress achieved by children at school [2]. Undiagnosed and uncorrected impairments can result in dyslexia, dysgraphia and learning problems. At school, during routine health checks, the nurse or paediatrician checks the eyesight very carefully. It is quite often according to “can see/cannot see from a distance” principle. Hidden hyperopia very often does not cause any issues with distant vision. In addition to the impairment/acuity itself, we have a number of other components of vision, such as colour vision, accommodation, eye movements, and binocular vision.

Short-sightedness

Short-sightedness is the most common visual impairment in children. Nowadays, it is even referred to as an epidemic and is considered a disease of civilisation. School education is mentioned as one of the reasons for its occurrence. Short-sightedness occurs in 2% of children starting school and this percentage increases significantly during education. 80-90% of school-leaving children in South and East Asia (Singapore, China, Taiwan, Hong Kong, Japan and Korea) have myopia, of which 10-20% have high myopia [3]. In the USA and Europe already approx. 50% of school leavers are short-sighted [4].

Short-sightedness progresses with age. It is estimated that half of humanity will be short-sighted in 2050 [5]. Nowadays, people spend far more time in close proximity than even 100 years ago. The social environment in which we live also has an impact on the development of Short-sightedness. Children living in cities are 2.6 times more likely to develop Short-sightedness than those living in rural areas [6]. The increasingly rapid development of civilisation and society's pressure to be the best is not conducive to stopping the progression of myopia. Easy access to smartphones and tablets means that we spend increasingly more time in increasingly shorter distances. Much research is currently being conducted to find as many causes of short-sightedness progression as possible and methods to stop it.

Teach and watch

If you want to take care of your child's eyesight, you should remember that prevention is the best option. The earlier you go for an eye examination with your child, the better the chance of spotting any disorders at an early stage. In addition, a child who is used to regular visits from a young age will not be afraid of them. It is also worth paying attention to proper eye hygiene, i.e.:

  • spending about 2 hours outdoors every day
  • observing correct posture and distance while reading
  • taking regular breaks every 20 minutes to look out of the window while using the computer
  • when using digital devices, make sure you have appropriate filters in your glasses
  • reduce the time spent on the computer/tablet/cell phone to the minimum.

It is important to remember that a young child will not tell us on their own that they see poorly. This is usually because they don’t know that they should see differently. It is worth observing your child while during various activities throughout the day. If your child spends a lot of time at school/preschool, you could ask the teachers if they have noticed anything worrying. We should not ignore any of the signals. Situations that should concern us in a child are:

  • sitting close to the TV/monitor
  • placing objects close to the eyes
  • narrowing, rubbing eyes
  • tilting the head when looking at an object
  • eye-hand coordination problem
  • reduced concentration
  • lower grades at school
  • confusion of word endings, letters, numbers
  • sudden change of seat at a school desk

Visit to an ophthalmologist/optometrist

What can we do if we suspect a child has an eyesight problem? The best option is to go and see an ophthalmologist/optometrist. It is a good idea to prepare your child before the visit. Before the first visit with a young child, you can read them a story in which a character goes for an eye examination. With an older child, simply tell them what the examination will look like, e.g., that it may resemble reading from a school blackboard. The most important thing is not to frighten your child. It is worth saying that there might be a need they have some drops administered (which only prick slightly but do not cause pain). You can say that there are no wrong answers with an ophthalmologist/optometrist - it's okay to say, "I don't know/can't see".

If you go for an eye examination yourself, it's a good idea for your child to observe what it's like in case of a parent. It is best to remain silent during a child's eye examination. Some children are very sensitive to all verbal and non-verbal cues. They don't want to disappoint their parents, which can translate into stress and trying to respond according to our expectations rather than how the child actually sees things. It is also a good idea to ask the child if they want us to accompany them to the examination. There are children who open up more when their parents are not around.

The last school year challenged the children on plenty of fields. Long hours spent in front of a computer have, in many cases, affected the eyesight of the youngest children. Before the new school year starts it is a good idea to have your child's vision checked. Remember - we only have one sight. Regular checks, appropriate working distances, breaks or filters in glasses will help us to take care of the correct development of our eyesight.

Sources

[1] M. Molska. Rozwój widzenia u dzieci. Izoptyka 2008; 46:12-14

[2] Borish I. M.: Clinical refraction. Ed. 3, Professional Press, 1975

[3] Morgan I. G. et al., Myopia, The Lancet 379 (2012)

[4] Loughman J et al., The acceptability and visual impact of 0,01% atropine in Caucasian population, Br J Ophthalmol 100 (2016)

[5] Holden BA et al., Nearly 1 billion myopes at risk of myopia-related sight-threatening conditions by 2050 time to act now, Clin Exp Optom 98 (2015)

[6] Warner N. Update on myopia, Curr Opin Ophthalmol 27 (2016)

By Balbina Krzyżańska-Wojciechowska M.Sc., Medicover Optyk optometrist