The most fundamental mistake families make in our country regarding the eye health of babies and children is to wait until the child is old enough to express complaints. In developed countries, as part of general health policy, eye examinations for babies and children are carried out as systematically and regularly as childhood vaccinations, and are repeated at specific intervals.
Through this system, which we have been striving to make widespread in our country in recent years, not only refractive errors that cause amblyopia but also rare conditions usually considered adult — yet also encountered in babies and children, and causing severe damage when diagnosed late — such as glaucoma (raised eye pressure), cataract, diabetes, hypertension and childhood ocular tumours can be diagnosed. Early treatment can produce far more satisfying — and even lifesaving — results. For example, we have patients who, despite having no obvious joint complaints, were referred to a rheumatologist after abnormal findings were detected on routine eye examination, and were diagnosed with a rheumatic disease and started on treatment.
An eye examination in children should be carried out within the first 6 months. If this period has been missed, the first examination must be completed by the age of 2 at the latest, and repeated at age 4 and when starting primary school. The examination should involve not eye screening but a full eye examination, with measurements taken using pupil-dilating drops to determine whether both the structures of the eye and the eye prescription are age-appropriate.
Refractive errors are of genetic origin; the absence of refractive errors in the parents does not mean that the child will be free of refractive errors. When we consider that the prevalence of refractive errors in preschool children is 25%, that amblyopia is seen in 3–4% of the population, that the first few years are very important in the development of amblyopia, that response to treatment is better in the early period but that after the age of 7 the response to treatment is poor, the importance of early and regular examinations becomes clearer.
Myopia is the inability to see distance well. Because myopic children see near well, they often do not notice their refractive error and assume that everyone sees distance in the same way. Hyperopia is not the exact opposite of myopia. The child has difficulty at distance, but by using the eye muscles can partially clear the distant image; however, since more accommodation is needed at near, after a while, the image at near (for example, during long reading sessions) begins to blur. In addition, the effort to focus sometimes leads to inward deviations at near.
Wearing glasses does not change the prescription — it neither increases nor decreases it; it simply allows us to see well. Glasses must be worn regularly and continuously. There is no such practice as taking glasses off occasionally to “rest” the eye — on the contrary, glasses are what rest the eye.
What Are the Other Signs That Should Alert Families to Refractive Errors?
If one of your child’s pupils appears white, if the pupils differ from each other in shape or size, if one of the eyelids droops so much that it covers the pupil significantly, if there is involuntary eye movement (nystagmus),
If your baby’s eyes are larger than normal, very uncomfortable in light and watery,
If, in babies, deviation persists beyond 6 months; in older children, if you suspect that the eyes deviate when they are tired and sleepy, or when examining things up close,
If they close one eye in the sun,
If they do not make eye contact appropriate to their age and show no interest in their toys, or if they want to look at the television from very close because they cannot make things out at a distance,
If they blink frequently, rub their eyes a great deal, or hold their head tilted to one side,
If they say that words get jumbled when reading, become quickly tired, do not want to read, skip lines, cannot follow lines without using a finger as a guide, or cannot perceive three-dimensional images at the cinema — bring them in for an eye examination.
The family preparing the child for the examination through conversation, and where possible drawing the letter E and playfully teaching the child to indicate the direction of the lines with their hand, can make the examination easier.
In summary, let us always have an eye examination performed for every child within the first year, and at the latest by the age of 2; let us repeat the examination at ages 4 and 6 even in the absence of any complaints, so that our most precious treasure — our children — can look towards the future clearly and brightly.
Prepared by the Editorial Board of the Eye Foundation Hospitals.
