Good vision is essential for proper physical development and educational progress in growing children. The development of the visual system is extremely age sensitive and hence early detection and treatment of visual problems in children is absolutely critical.

Recommendations for Eye examination in children

• A pediatrician should examine a new born’s eyes. An ophthalmologist should be asked to examine all premature infants.
• Vision screening should be done between 3 and 3½ years of age.
• Detailed eye examination must be done if there is appearance of symptoms of visual impairment.

Common eye problems in children

• • Refractive errors (spectacle number) account for 80% of visual impairment in children. This includes Myopia or near-sightedness, where distance vision is blurred, but a child can usually see well for reading or other near tasks. This occurs most often in school age children. The prescription for glasses will indicate a minus sign before the prescription (for example, -2.00 D). Another problem is Hyperopia (far-sightedness), where problems such as crossing of the eyes, blurred vision, or discomfort may develop. However, most children are far-sighted early in life and it becomes a concern only in excessive cases where the focusing muscles are not able to keep the vision clear. A prescription for hyperopia will be preceded by a plus sign (+3.00 D). Astigmatism is also common and is caused by a difference in the surface curve of the eye. Instead of being shaped like a perfect sphere (like a basketball), the eye is shaped with a greater curve in one axis (like a rugby ball) and this causes fine details to look blurred or distorted. Here, the prescribed glasses have greater strength in one direction of the lens than in the opposite direction. Anisometropia causes children to have a different prescription in each eye. This can create a condition called ‘lazy eye’, where the vision in one eye does not develop normally. Glasses (and sometimes patching) are needed to ensure that each eye can see clearly.

• Lazy eye or Amblyopia is seen in 1% of children. It is a failure of the eye to connect to the brain due to lack of use of one eye during infancy and childhood. Therefore, the vision in the amblyopic eye remains poorer than in the normal eye. To solve this, the poorer seeing eye is forced to be used by patching the preferred eye and combined with the use of glasses where necessary. Amblyopia must be corrected by 9 years of age by which time it becomes permanent.To detect and treat ambylopia, it is necessary to examine pre-school age children.