Children's Vision TESTING
Don’t forget kids’ sunglasses and kids’ goggles for eye protection. Children’s vision testing for all ages and kids’ glasses if required is provided at Peter D’Arcy ACBO Behavioural Optometrist Bega. Kids eye tests are too important to miss. Your child’s eyes and vision are so special! Don’t forget their eye care and eye checks as well as your own eye problems. Abnormal motor abilities such as inaccurate tracing, grasping and catching can be warning signs of vision issues.
As vision impacts learning often vision screening programs are relied on but comprehensive exams are more likely to uncover all the relevant issues and health problems. Some of the eye issues include
- Red or irritated eyes or frequent rubbing of eyes
- Difficulty concentrating
- Tilting head noticeably, or covering or closing one eye
- One eye turns in or out, or frequent blinking
- Holding a book very close when reading
- Omitting confusing words or moving lips when reading
- Difficulty with ball sports or hand-eye-coordination.
- Writing on a slant or having irregular letter and/or word spacing.
- Re-reading or skipping words or lines without realising.
- Headaches, blurred or double vision
- Reversing letters or words or questionable alignment of a lazy eye
- Squinting or sitting very close to tasks.
- Problems recognising people in the distance
Early detection of any eye condition through children’s vision testing is vital even before school age. Often children tend only to be examined if they have a problem reading a book. Only 8% of Australian children aged 0–14 have had a comprehensive vision assessment, despite an estimated one in four suffering from an undetected vision problem.
Reading fluency is just one measure of good vision and eye health.
We have full ranges of children’s glasses to cater for any optical correction in glasses or contacts, in addition to your child’s eye test.
Your baby’s eyes are already more than half of their adult size but not as light-sensitive at birth. By three months following, moving objects and starting to reach should be occurring. An eye exam by six months of age should occur to check vision and eye health, e.g. risk of cancers.
READ MORE ABOUT CHILDREN'S VISION TESTING
The famous child psychologist Jean Piaget recognised four stages of development. Along with exploring objects and sensations (e.g., through touch, taste, smell, or hearing) comfortable and clear vision is vital.
Babies see more shades of grey than details but within weeks colours. Within a few days after birth, infants prefer looking at a known face to a stranger. Potential vision problems can be determined to ensure their quality of life but sometimes are deferred until the child starts school. Every parent wants to ensure their child sees every opportunity to grow and enjoy and reaching their full potential. Vision is a skill that can be developed and improved through appropriate treatment. Addressing vision problems may only be one aspect of managing more complex learning difficulties. Visual acuity improves from about 6/120 at birth to approximately 6/9 at six months of age. Colour vision should be similar to that of an adult.
Children often assume their vision is just like everyone else’s, which means those vision problems, lazy eye or eye injuries can be undetected. A complete comprehensive examination can determine eye health and the need for any children’s glasses.
Babies also have better eye-hand coordination at 4 to 6 months of age. Most babies are born with blue eyes because darker pigments in the iris are undeveloped. Later dark pigment is produced in the iris, which will often change your child’s eye colour.
If your baby’s eyes are misaligned, an examination as soon as possible is advised to check for visual impairment for any child vision case.
Retinopathy of prematurity (ROP) is the abnormal placement in fibrous tissue and blood vessels’ retina. All premature babies are at risk of ROP.
Nystagmus is an involuntary, back-and-forth movement of both eyes and can be present at birth, or it may develop weeks to months later. Risk factors include incomplete development of the optic nerve, albinism and congenital cataracts. Babies with autism have reduced eye interactions.
Commonly children can have trouble tracking when reading; they lose their place often, or they move their head back and forth, rather than moving their eyes. Problems with recalling the information they have read or comprehension declines as reading continues (with fatigue).
Ensure Good Posture – the device should be no closer than the distance to the elbow.
Looking away after every 20 minutes of continuous near focusing, and a physical break every hour for children under the age of 9 years of age is recommended.
Stop screen use for an hour before bedtime.
Management of amblyopia and strabismus (turned eyes)
Assessment of vision procesing skills as well as refractive error.
Vision therapy services
Assessment of vision issues of children and adults with learning difficulties, Dyslexia, ADD, ADHD, Autism Spectrum Disorders, Parkinson’s and those with special needs or who are developmentally delayed and those who have had a stroke or head injury
MYOPIA
The World Health Organization (WHO) recognises Myopia as a severe public health issue. affecting 50% of the world population by 2050, with nearly one billion in the high myopia category. It has been established that managing myopia (correcting vision by employing treatments and strategies) in its early stages can slow its progression, reducing the potential risk of developing high myopia and its associated conditions later in life.
Peter D’Arcy Optometrist Bega is also accredited for MiSight 1 Day prescribing and dispensing.
Misight 1 day is the world’s first daily disposable soft lens specifically developed for myopia control.
This revolutionary lens technology is explicitly designed to slow myopia progression in children and teenagers.
READ MORE ON MYOPIA AND ORTHO K
We dispense as needed options such as the award-winning Hoya MiyoSmart spectacle lenses with DIMS technology and Coopervision MiSight contact lenses.
MiyoSmart lenses protect vision in children by slowing down myopia progression on average by 60% (compared with those wearing standard single vision lenses)*, at the same time as they correct myopic refractive error.
Is your child’s lens prescription changing for the worse each time they visit the Optometrist? MiyoSmart spectacle lenses may be the solution. They’re clinically proven to correct myopic refractive error and at the same time effectively slow down myopia progression on average by 60%, compared with those wearing standard single vision lenses. MiyoSmart lenses are an award-winning solution for managing myopia, developed by Hoya with the Hong Kong Polytechnic University.
Standard single vision lenses don’t treat your child’s myopia progression at all! New, award-winning MiyoSmart lenses with DIMS technology slow myopia progression on average by 60%, compared with those wearing standard single vision lenses.
MiyoSmart from Hoya won the prestigious Grand Prize, Grand Award and Special Gold Medal at the 46th International Exhibition in Geneva, Switzerland. Despite myopia rapidly becoming a serious public health concern worldwide, most parents do not know enough about myopia. High myopia (a refractive error of at least -5.00D in either eye) is also associated with comorbidities, including retinal detachment, glaucoma, cataracts and myopic maculopathy.
Myopia is blurry long-distance vision, often called “short-sightedness” or “near-sightedness”.
It can impact concentration and induce vision-related learning difficulties. It can be mistaken sometimes for other disorders such as ADHD.
The prevalence among Australian 12-year-olds has doubled in six years.
Evidence shows that:
• Children who spend more time outdoors are less likely to be or to become myopic.
• Increased study time of more than 2.5 hours per day can increase the risk of myopia.
• Half of children and youths exceed the public health screen time recommendation of 2 h per day or less.
• More than 2 hours of smartphone use produces greater chances of vision problems, and greater chances of multiple problems
• Most studies on the effects of screen time in children indicate that the odds of visual symptoms increase after 2–4 hours of use myopia in kids tends to progress and worsen throughout childhood. Higher levels of myopia are associated with higher eye disease risks in adulthood.
Genetics, environmental and social factors are significant influences on myopia. Evidence shows that time spent outdoors in childhood partially protects against the development of myopia. In countries such as China, where the condition is rampant, correcting policies are enforced in schools.
In areas such as dyslexia, bad advice or simplistic advice can abound for treating conditions such as amblyopia or visual dyslexia.
Efficacy in Myopia Control authored by Noel Brennan et al. 2020
Showed
• Axial elongation is the preferred outcome measure for myopia control
• Faster progressors and younger myopes don’t appear to show more significant efficacy response
• The initial myopia control response is not sustained over time
• Myopia treatment efficacy needs using a new metric
• There is no apparent superior method of myopia control, but some which are less effective
• Rebound should be assumed until proven otherwise
• All myopes under age 12 should be recommended treatment.
While glasses and soft contact lenses can correct the condition, they have been unable to slow its progression rate. MiSight 1 Day contact lens is a unique dual-focus lens, meaning it has alternating distance correction and treatment zones. MiSight changes the peripheral optics at the front of the eye, thereby affecting the focusing of light in the peripheral parts of the retina and modulating the eyeball’s growth. The long-term effect is that eyeball elongation reduces, which minimises the chance of developing high levels of myopia (-6.00D or more). MiSight 1 Day may also lower the incidence of eye diseases associated with short-sightedness, such as retinal detachment, glaucoma and cataracts.
This innovative contact lens is for children or teenagers who have a myopia prescription from -0.25 to 6.00D. While there is no minimum age for a child to be prescribed with MiSight 1 Day lenses, younger children may need assistance from parents with daily lens insertion and removal. While MiSight is new to Australia, the lens has been available for about seven years in East Asian countries such as Hong Kong, Singapore, and Malaysia. The prevalence of childhood myopia is the highest in the world, and successful results have resulted. We know from children’s vision testing that myopia ( short-sightedness) tends to increase and often requires glasses or contact lenses for distance vision correction. Genetic reasons and too much time indoors are factors. Ultrasound A-scans and Optical Biometers measure axial length and are used to collate research data. The brighter visible light causes dopamine release, and this slows down the myopic growth of the eye.
The International Myopia Institute has developed clinical management guidelines, including tracking software and calculators (e.g. Brien Holden Vision Institute, UNSW ) to illustrate and predict evidence-based outcomes and strategies. There are many factors in myopic progressions
Of the fast and slow progressors in conventional lenses, the aim is to get those progressing quickly (particularly if young) into a myopia control option.
The SV control group in the prism lens myopia control study were those who were all progressing quickly.
If an individual isn’t progressing, corrected by single vision options ,unique myopia control treatments can be avoided. Even after cataract extraction, myopic progression or tendency can sometimes continue. The Brien Holden myopia calculator tries to estimate SV lenses’ progression that might occur, but it is an estimate only and not individual.
Progressive lenses sometimes can be used-
As an entry point for parents and patients who don’t want either soft multifocal contact lenses or ortho K types. Using corneal topography and anterior OCT the exact required lens parameters can be incorporated into the lens design.
ARVO2021 reports after the 3-year MiSight 1 day clinical trial, the control group children were switched to MiSight. A ‘virtual control group’ mathematical model, previously published, was utilized to demonstrate a continued myopia control effect across six years, plus effectiveness of treatment for children who commenced wear at age 11-15 years.
Other Ortho K lenses include Paragon CRT,GOV Eyespace Forge for more complex corneas. As an adjunct for when the patient is not wearing their contacts
As alternatives such as prism controlled executive bifocals
As alternatives such as Eyezen (extended near lenses) where higher concentrations of atropine are used, accommodation may be impaired.
In studies, the axial length is usually measured with optical biometers such as the Carl Zeiss IOL Master. Clinicians use either optical or ultrasound biometers in practice. By school age, it is believed that corneal shape is generally stable and therefore, any increase in dioptric refraction is due to axial elongation.
We can check in a practice setting whether peripheral myopic defocus has been achieved by either performing off-axis retinoscopy or open-field autorefraction and asking the patient to fixate left and right of instrument’s axis of measurement.
Researchers can take ultrasound images, carrying out ray traces as well as using models. There have also been a number of papers published on peripheral refraction including some from UNSW
There is still debate about ideal patient selection for any myopia management treatment and there is no refractive cut-off that would dictate one is better than the other. The published evidence shows that ortho K and MiSight 1 day have broadly equivalent myopia control efficacy.
Screen time recommendations
AGE EXPOSURE
0 – 2 Years None
2 -5 Years 1 hour per day or less
5 – 18 Years 2 hours per day or less
Excessive computer and screen use has been shown to be associated with a greater risk of developing short-sightedness as well as increased symptoms of eyestrain, headaches, blurred vision, dry eyes, and neck and shoulder pain.
A Brock string is where one end is held on the tip of the nose while the other is tied to a fixed point. Three coloured beads are spaced out at various distances. The patient is asked to focus on one of the beads while noting the visual input of each eye and sensation of convergence.
The level of challenge can vary by bringing the beads closer\further to the nose and employing lenses and prisms. Although this procedure is usually associated with binocular vision and anti-suppression therapy, it can also be a valuable procedure for developing accurate fixation skills under binocular conditions.
Ambylopia
Amblyopia, commonly known as a lazy eye occurs when the brain does not fully acknowledge the images seen by the affected eye found in about 3 % of children.
It is also the most common cause of monocular (one eye) visual impairment among young and middle-aged adults.
Treating amblyopia lazy eye involves forcing more use of the eye with weaker vision. Pairs of glasses may be required to aid focus, concentration and to avoid suppression.
Patching treatment or medication to blur the non-amblyopic eye to allow more input from the amblyopic eye.
An adhesive patch is worn over the stronger eye for weeks to months or daily patching.
<3 hrs per day effective if < 4yrs age
>3hrs per day required if > 4 years of age
AMBLYOPIA FEATURES AND TREATMENT
Amblyopia features
- Dullness of vision
- Poor unilateral or bilateral visual acuity
- Abnormal macular OCT
- Abnormal submacular choroidal thickness on OCT
- Optic disc dysversion
- Optic nerve hypoplasia
- Gaze instability
- Fine motor skill deficits
- Abnormal saccades
- Reduced maximum reading speed
Treatment
- Corrective prescription glasses – symmetrise sensory input
- Atropine
- Opaque Occlusion
- Translucent Bangerter occlusion
- Alignment surgery alone, Surgery + patch/ atropine
- Acupuncture
- Magnetic brain stimulation CNS Drugs
- Liquid crystal glasses (allows alternate between transparent and opaque occlusion)
- Binocular sensory treatments
READ MORE ON AMBYLOPIA
Vision is responsible for around 80% of all learning during a child’s first 12 years^
Children’s vision testing is so essential with or without family history being relevant
Protect children’s eyes and help them learn by seeing and possible even before school age.
School vision screenings are not as comprehensive as an optometrist examination
We have to ensure eye care allows for distance vision and near vision is balanced, healthy and comfortable as possible. All kids can be prescribed glasses as necessary, and vision training instigated as required
^Vision council of America, making the grade, 2009.
A detected and treated lazy eye found from a children’s eye examination means vision problems will not limit a child’s learning potential. It may be as simple as a contact lens for balanced distance or near vision.
Amblyopia can result from any condition that prevents the eye from focusing clearly. Misalignment of the eyes (known as strabismus) include the eyes cross in esotropia or turn out in exotropia. Occasionally, a cataract can cause amblyopia
Even adults whose amblyopia persists despite the recommended two hours of daily patching may improve if daily patching occurs for 6 hours. The brain’s plasticity makes the condition most treatable.
Vision development is a vital concern of any eye doctor. Eye exams will detect eye problems, including vision or lazy eye, that require kids glasses or contacts. Such eye health checks need to be ongoing from young children as well as measuring refractive error, distance vision, teaming and the near performance
Erasmus Darwin introduced occlusion therapy for amblyopia. The Pediatric Eye Disease Investigator Group (PEDIG) Amblyopia Treatment Studies (ATS), including Monitored Occlusion Treatment of Amblyopia Study (MOTAS) have refined the techniques for treatment.
Vision therapy/training that integrates the brain, eyes and body can specifically target and enhance the quality of visual and oculomotor control for young children through to adults. Children with peripheral visual deficits performed significantly worse on tasks that required visual attention than the standard vision peers and children with low central vision (Tadin et al., 2012).
Eye muscle surgery for strabismus can involve:
A recession is when an eye muscle is detached and then reattached further away from the eye’s front to weaken the strength.
Resection is the removal of a portion of an eye muscle to make it stronger.
KID'S EYE TESTS AND PROTECTING CHILDREN'S VISION
Children’s Vision is often assumed to be normal, which means that vision problems can easily go undetected such as amblyopia (lazy eye).
Poor vision can interfere with their ability to learn and develop. A developmental or paediatric optometrist that concentrates on the way vision is interpreted is known as a behavioural optometrist.
Your local optometrist Peter D’Arcy has attended the National Children’s Congress and is a Member of the Australian Behavioural College of Optometrists ACBO and is a foundation associate.
KIDS GOGGLES
Many parents find that it can be difficult to ensure that their child is wearing protective eyewear, especially in situations when they may not be present, like walking to or from school and during recess.
KIDS BLUE LIGHT PROTECTION
A children’s eye test is often forgotten in eye care as young children will not self report their eye condition. Establishing good vision means identifying children’s eye and vision problems by thorough eye checks in an eye examination.
Kid’s eyes need protection, too. In fact, children are more at risk of the eye-damaging effects of UV exposure than adults. The eye of a child under the age of ten allows more than six times the amount of UV light to penetrate than an adult’s eye, so it’s never too early to start protecting a child’s eyes.
Children’s eyes are more transparent and the UVA, UVB and UVC can all penetrate deeper into the eye structure than an adults eye. Most literature is based on an adults eye that has had changes to the transmission properties caused by sunlight. Transitions lenses can help. They block 100% of UV radiation and reduce glare. And they’re available in the sturdy, lightweight, shatter and impact-resistant materials that are best for children. A child’s retina can be damaged by UVB because the lens has only a small ability to absorb UVB, even though less than 2% of UVB is thought to penetrate through the lens of an adult eye.
Even if UVC does not penetrate beyond the lens, it can still cause damage to other structures of the eye. The conjunctiva is more sensitive to UV than the cornea and the skin around the eye can also be affected by the ultraviolet radiation
READ MORE ON PROTECTING CHILDRENS VISION
So for our kids, be they in Narooma or Eden, Tathra to Bombala, Bega, Merimbula or elsewhere, children’s vision testing is one test too necessary to miss.
Hundreds of thousands of Australians can be immersed for too long in virtual reality headsets, e.g. Google, Samsung, Sony.
Eye strain and dizziness can easily result as the focus and convergence are more disassociated and may require more prolonged and more frequent breaks than that do occur as the experience can be addictive for some, especially children.
Nowadays, most children (even preschoolers) report digital eye strain when using digital devices and often have dry eye issues from inefficient blinking and blue light from screens.
Digital eye strain is related to all digital devices, and computer vision syndrome (CVS ) is a subset
The Telsyte Australian Virtual Reality and Augmented Reality report predicts a quarter of Australian homes will have a VR headset by 2021.
At a minimum, use the 20-20-20 rule. Every 20 minutes, take a 20-second break and focus your eyes on something at least 20 feet (6metres) away, performing some clockwise and anticlockwise movements, stand up and blink completely!
Have your children’s eyes examined every couple of years as a general guideline. It can help with their development, such as autism and dyslexia cases. Even colour vision which is important to learning can be checked
Eye injuries including orbital contusions, fractures and retinal damage can occur especially in sport. In the US eye protection is now mandated for high school students for playing some sports.(US standard ASTM F2713-18)
Children receive more annual sun exposure than adults because many of their activities are outdoor-based. Children’s eyes differ from adults’ in that children’s ocular lenses cannot filter UV light and prevent it from reaching their retinas as effectively as can adults’ ocular lenses. This results in children’s retinas being exposed to more UV light and susceptible to retinal damage if they are not adequately protected. Damage is cumulative so should start early.