A major part of children's learning involves their eyesight.

The correction to adopt for children's eyesight

A major part of children's learning involves their eyesight - beginning with the fundamental necessity of learning to read, on which their entire scholastic progress depends. This section examines the problems that can affect the eyes of small children, how to detect them and how to correct them efficiently.

When to seek consultation

The visually impaired child , (1% of births), is generally detected relatively early. Parents become worried as soon as their baby does not look at its toys or react to their smiles. It will be behind in its mobility and early learning. Sometimes parents notice objective anomalies: white pupils (cataract, tumour), jerky eye movements (nystagmus), small eyes (microphthalmus), opalescent cornea (leukoma, corneal sclerosis), or cloudy cornea associated with watering eyes (glaucoma). An ophthalmological consultation should be sought very quickly.

A child who squints (4% of children suffer from strabismus) must be treated as soon as the strabismus appears, since this is a serious anomaly. Whether marked or slight, a "dominant" eye quickly becomes established in which vision will develop normally and a "lazy" eye which remains deviated. If left untreated, maturity of this eye's visual function will not be achieved. Despite this, in general, parents are not worried by "squinting", only seeing the aesthetic aspects of strabismus and wanting to have an operation as quickly as possible.

The strabismus may appear in the first few days of the baby's life (congenital strabismus), some months later, or even between the ages of 1 and 3 years. An intermittent lack of coordination between the two eyes is frequent during the first weeks, but any strabismus which persists after 2 months must be treated.

Strabismus never disappears unaided, and parents should not wait until amblyopia has become established before seeking consultation. For 65% of strabismic children lose the sight in one eye if they are not treated at an early stage. Furthermore, a strabismic child, even after having undergone surgery, will never have good relief (binocular) vision and will experience problems of spatial localisation. These will include clumsiness, a poor appreciation of distances and depth, difficulty in following lines when reading or writing, difficulties in ball games and, at a later stage, disqualification from certain professions.

Is myopia the most commonly observed defect among children?

Myopia (an excessively long eye) is rare in very young children. It most frequently appears after the age of 9 years, due to the growth of the eyeball, with higher frequency among myopic families. On the other hand, pronounced unilateral myopia is congenital, without any hereditary factor, and affects 4 to 6% of children. It results in unilateral amblyopia if not corrected at a very early stage, making a systematic examination of refraction in all children before their first birthday essential. Optical correction by spectacles must be made around the age of 3 years to avoid eyestrain and allow visual acuity to improve before entering Junior School.

On the other hand, light hypermetropia (eye too short) is normal in babies and will disappear as the eyeball grows. If more pronounced, it requires a greater effort of accommodation to focus images on the retina and can then lead to strabismus caused by excessive convergence. In fact, accommodation and convergence take place simultaneously. A hypermetropic person has good distant vision, but only by accommodation, resulting in eyestrain and frequent headaches. In families with a risk of strabismus (strabismic parents, strabismic brother or sister) it is therefore important to check the child's refraction before the age of 1 year.

At what age can a visual defect be detected?

The quality of a child's vision can be assessed at birth and its normal development checked as it grows. There is no need to wait for reading age before quantifying visual acuity. In conclusion, if we want to make sure all children have "two eyes for a life", great attention should be paid to telltale signs of any possible visible defect and, even in the absence of any pathology, children's' eyesight should be systematically examined from the age of 2 to 3 years.

Efficiently correcting children's' eyesight

Guiding parents in the choice of frames ?

A child's eyewear is specific. Parents are advised to encourage them, especially infants, to wear their spectacles at all times so that they can get used to them more easily.

The ideal frame for very young children should be sturdy, not too thin, wide, very high and in plastic. It should also be fitted with a silicone bridge. The lens should reach from the wing of the nose to the eyebrow, so that the child does not look above it, since infants tend to look upwards.

Babies should be given lightweight frames to wear, fitted with a retainer or an elastic band.

Metal frames are only given to older children. For those with astigmatism, round spectacles should be avoided in favour of oval frames. When mounting, the lenses can have a tendency to turn in a round frame, which modifies the cylinder axis. Finally, attractive, coloured frames should be given preference to encourage children to wear them regularly. Manufacturers have been making efforts in this direction over the last few years.

The choice of frame ?

It is strongly recommended to dispense only organic lenses for children. For infants, lens diameter will be smaller than that generally offered. You should not hesitate to use calibrated lenses, which are considerably more attractive and make the eyewear lighter. The same solution can be offered for a hypermetropic child. For a CR39 +5.00 dioptres lens, for example, reducing the diameter by 10 mm allows the thickness at the centre to be reduced by 15/10 of a millimetre. 

Recommending coated lenses

You should not hesitate to offer tinted eyewear from the very earliest age. They are recommended to be worn in sunlight from spring onwards. Children's' eyelids are thinner than those of adults, making their eyes more fragile. Anti-scratch and anti-smudged coatings are also very useful for children, who do not take as much care of their eyewear as adults. An anti-reflective coating is also strongly recommended. 

Finally, children's' vision should be carefully monitored, with regularly programmed ophthalmological examinations. But most important of all, the eyewear must be regularly adjusted by the optician to improve clarity of vision and avoid the wearing of spectacles from becoming irritating for the child.

© BBGR UK 2015