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Question & Answer with Dr. Rich

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As children grow, their eyes change quickly. Careful attention to a child’s eye health can help catch problems early, while their eyes are still developing.

Q. How do I know if my child is farsighted?

A child, aged 5 years old, may be able to see 20/20, but that child may be having to work way harder than the next child to achieve that due to uncorrected farsightedness.   Unfortunately, this extra effort generally ends up with the child being labeled as attention-deficit or even as a troublemaker just because they can’t sit still, (takes too much work!)  Nearly all children start out farsighted which means they have to focus the lens in their eye, (or accommodate), to see clearly.  Over time, they can’t keep up working so hard so the easier eye to use is picked and the other ends up “lazy”.  Lazy eye disrupts learning due to inefficiencies and can be the cause of many additional problems. Learning disabilities are caused by problems with how the brain processes what it sees or hears, not by faulty eyes.

Children who are farsighted (hyperopic) can see distant objects better than near ones. Many kids who are farsighted may need glasses at a younger age but typically either grow out of the need completely or can use a reduced prescription as they get older.

Q. Can children get cataracts?

Children get cataracts too—they can be born with cataracts or develop them after birth. Without proper treatment, pediatric cataracts can cause abnormal connections between the brain and the eye that may become irreversible. The good news is cataracts are often discovered during the eye screening at birth, or at subsequent pediatric vision screenings.  Family Focus Eyecare recommends first exams between 6-12 months, 3 years old, and yearly after that.

Q. How do I know if my child is colorblind?

Colorblindness is much more common in boys and the symptoms can be hard to detect. Parents may only notice a problem when a child is learning colors. One symptom is the inability to tell the difference between shades of the same or similar colors. This happens most with red and green, and blue and yellow.

Q. At what age should my child have their first eye exam? 

A child’s first eye exam should be 6 months – 12 months, then 3 years old, then yearly after that.

By 3 months, a baby’s eyes should focus and follow objects. In the first two months of life, an infant’s eyes may appear to cross or wander out to the sides. This is normal. As visual coordination improves, the baby’s eyes will work together to focus and follow a moving object. If you do not notice this happening consistently by age 3 months, talk with your pediatrician.

By 5 months, babies can see in three dimensions. At this age, babies get better at reaching for objects because they can see how far an object is from them. They are developing depth perception. They may even remember what an object is if they only see part of it.

Around 9 months, babies’ eyes have nearly turned their final color. Eye color depends on the amount and distribution of a brown pigment called melanin in the iris. Light-colored eyes at birth may darken if melanin develops in the iris. It is not uncommon, however, to see slight changes in eye color during the first three years of life.

Q. What to Do If Your Child Fails a Vision Screening? 

School-based screenings typically use a standard vision chart, where your child will be asked to read lines of progressively smaller letters. Fortunately, regular screenings can catch problems before they affect your child’s learning and development. Almost all early-stage vision problems are easy to correct.

When a failed vision screen shows that your child has trouble focusing, a lazy eye or eyes that don’t align, your next step is to schedule a comprehensive exam with an eye doctor or other specialist in eye assessment.

A comprehensive exam is more thorough than a screening. Your child will receive eye drops to dilate the pupils. The doctor will carefully examine both eyes to determine the problem. Nearsightedness, the most common vision issue in kids, is easily corrected with glasses. Astigmatism is another common problem corrected with eyeglasses.

Q. Can I prevent my child from developing a lazy eye (amblyopia)?

Amblyopia develops from birth up to age 7 years. It is the leading cause of decreased vision among children. Rarely, lazy eye affects both eyes. Early diagnosis and treatment can help prevent long-term problems with your child’s vision. The eye with poorer vision can usually be corrected with glasses or contact lenses, or by patching therapy.

If you notice your child squinting, rubbing their eyes, having trouble concentrating, or complaining of headaches after doing schoolwork, make an appointment with an eye doctor. 

Hang a colorful mobile over your child’s crib. This gives them something interesting to look at while lying down and trains their eyes to focus better on distant objects.

Q. What is eye turning?

Up to 5% of the population has strabismus, or an eye turn. Strabismus (crossed-eyes) occurs when the two eyes are unable to maintain proper alignment and focus together on an object – one eye looks directly at the object, while the other eye points in a different direction. This usually occurs in children who are moderately to highly farsighted (hyperopic).

Q. Should my child be wearing protective eyewear when playing sports?

More than 90 percent of children’s eye injuries can be prevented with protective goggles. Children should wear sports eye protectors made with polycarbonate lenses for baseball, basketball, football, racquet sports, soccer, hockey, lacrosse, paintball and other activities with a risk of eye injury.

Also-Wear eye protection when doing or observing chores like mowing the lawn, using power tools, or cleaning with hazardous chemicals. If you are with your child while you are doing these things, be sure to wear eye protection yourself as well.

Q. How do I know if my child needs glasses?

The visual system in a child is still developing during the first seven to eight years of life. Undetected vision problems can impact your child’s performance both in and out of the classroom. Therefore, it’s important to understand eye health so you can recognize the signs that your child may have a vision problem and possibly need glasses. 

Here are a few signs that indicate your child may be experiencing vision problems and need glasses:

  • Squinting 
  • Tilting head or covering one eye
  • Sitting too close to the television or holding hand-held devices too close to the eyes
  • Rubbing eyes excessively
  • Complaining of headaches or eye pain
  • Having difficulty concentrating on school work

If your child needs glasses, there are a few tips to keep in mind. Younger children should have plastic frames for safety. All children should wear lenses made of impact-resistant plastic. To ensure safety, many states regulate what materials may be used in children’s glasses.

Q. What’s the difference between an eye screening and an eye exam?

Although both are important, a vision screening and an eye exam are not the same thing.

  • A vision screening is an evaluation used to identify children in need for additional eye care. It can be done by a family doctor, pediatrician, school nurse, or other health care professional.
  • A comprehensive eye exam is a thorough exam done by an eye doctor—a specialist called an ophthalmologist or optometrist. The eye doctor can diagnose your child’s medical or vision problem and provide treatment.

Q. Are there programs that offer assistance for screenings for children?

Family Focus Eyecare has 2 programs for free screenings for infants and children to age 3. 

  • Infant-SEE (free screenings for infants 6 months old to 12 months old)
  • SEE-to-LEARN (free screenings for 3 year olds)

We are proud supporters of the LION’s CLUB and KidsSight in Boone and Miller County. Both offer screenings at all the schools and daycares.  

At Family Focus Eyecare in Columbia and Eldon we offer reduced priced exams after referrals.  We reduced the eye exam by half ($89 for self pay for any referred/any child self-pay under age 9). Adult comprehensive eye exams are $175 and include all aspects of technology offered at Family Focus Eyecare.

Good vision is key to a child’s physical development, success in school, and overall well being. Don’t skip regular vision screenings. These are important for detecting and correcting eye problems early. In addition to screenings for infants, we recommend further visual evaluations for children when they are:

  • In preschool (between the ages of 3 and 4)
  • Entering elementary school
  • Experiencing a vision problem
  • Before and during growth hormone therapy

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Written by Dr. Joseph Rich

Dr. Joseph D. Rich moved to Columbia shortly after completing his doctorate at Southern College of Optometry in Memphis, TN. Growing up and completing his undergraduate work in biology, chemistry, and business management at the University of Central Missouri in Warrensburg, MO, Dr. Rich considers himself a full-fledged Mizzou fan and actively enjoys going to as many games as possible.
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