Eye problems in childhood
Eye problems in childhood are extremely frequent. It is admitted that 1 in 10 children will present an eye problem in the first year of life. He 40% of children school age you will need optical correction and between 10-20% will develop a serious problem that can compromise vision.
These statistical data highlight the need to have or acquire a minimum knowledge about childhood eye problems and how to prevent or detect them before they can be irreversible.
Eye problems in childhood
Eye problems in childhood are extremely frequent. It is admitted that 1 in 10 children will present an eye problem in the first year of life. He 40% of children school age you will need optical correction and between 10-20% will develop a serious problem that can compromise vision.
These statistical data highlight the need to have or acquire a minimum knowledge about childhood eye problems and how to prevent or detect them before they can be irreversible.
What are eye problems in childhood?
When we are born, the visual system is not fully developed, like most functions and activities that depend on the brain. It is necessary a process of maturation that involves learning to see, just as we learn to speak or to walk. This period of learning and maturation lasts until approximately 9 years; although we can differentiate several stages with specific problems in each phase and with significant consequences.
The first 3 months are critical, any aspect that involves an alteration in visual development will lead to a visual deficit that is difficult to resolve. The next stage is from these first three months to the first year of life. Eye problems developed during this time will have less serious but very significant consequences. A stage will follow until the age of 3 and then a final period of childhood until the age of 9.
In general, we can say that when a problem that affects vision is established or to the anatomical or functional development of the elements that constitute the visual system (eye, optic pathway and visual brain), will have greater impact the sooner it appears after birth, reducing its importance as we approach 9 years of age, the phase in which the development of the visual apparatus will end.
A positive aspect is that it will be possible to recover the vision in this phase of development, if the problems are detected and resolved in time; because it coexists with the period of greatest plasticity of the brain, typical of these ages, and that does not occur in adults or, in any case, to a much lesser degree, which limits the functional recovery of many processes.
The main problem we find in children is their poor collaboration. A child does not know how to express an ophthalmological problem as an adult would, either because he still does not know how to speak or because he does not know what we consider a normal vision and can not judge whether he has an anomalous vision or suffers a loss of vision. It is difficult, then, to establish guidelines that help identify early problems in a newborn during its first year of life, especially due to the difficulty of communication and the misleading nature of some aspects. Consultation is frequent due to possible strabismus or deviation of the eyes, when, in many cases, it is a false perception, due to a very nasal septum. amplio (epicantus), physiological at this age and that usually tends to be reduced. But still, consultation reassures parents and reduces the possibility of deficiencies.
How to detect and diagnose an eye problem in childhood
As we have just seen, it is difficult to judge what is normal and what is pathological. So we recommend leaving it in the hands of experts. You must go to reviews according to the schedule indicated.
- An important issue is who should carry out the reviews. We recommend that during the first year of life the pediatrician performs the first eye exam. If there is a history of serious illness or suspicion of a possible specific problem, he will be the one to recommend go to an ophthalmologist.
- If there is no family history of eye diseases and the review by the pediatrician was normal, you can wait until the age of 3 to go to the ophthalmologist for the first time. If they exist pathological antecedents, we recommend going directly to a center that has a pediatric ophthalmology.
- One of the most important signs to detect a possible visual problem in a young child, is the fact that carries out his games with difficulty, difficulty that is expressed, basically, in the by y select objects, trip on with home furnishings, etc.
- It is considered a serious alarm factor to observe a white spot centered on the pupilas it can indicate a congenital cataract or a retinal tumor.
In general, we recommend that if you suspect a possible ophthalmological problem or when an accident occurs that affects the eyes, you go to the pediatrician or pediatric ophthalmologist as soon as possible.
One of the most important problems for parents is knowing what we consider normal vision for each stage of childhood. Although there are no fixed parameters, we could establish a table to better clarify this point.
Stadiums in vision development
- Nacimiento: Response to light.
- 6 Weeks: Ability to recognize faces, which is equivalent to a vision of 5%.
- 3 Months: Tracking of objects and faces (20% of vision).
- 4 Months: focuses on objects and distinguishes small figures (3 x 3 cm), which supposes a quantitative vision of 50%.
- 6 Months: Differences objects in 3D and starts the perception in relief.
- 8 Months: Qualitative and quantitative vision capabilities are improved, reaching what we consider to be 100% angular vision (able to identify the smallest shapes on vision cards).
- 4-6 Years: Reaches a high level of understanding of the figures on the vision cards, with a quantitative level of 100%.
- 8-9 Years: Maximum qualitative and quantitative vision, with perfect tracking of moving objects.
Eye diseases in childhood
- Dyslexia
- Squint
- Retinopathy of prematurity
- Albinism
- Use of glasses to correct visual problems
Dyslexia and reading and learning problems
What are learning problems?
The specific problems of learning (PEA) refer to the difficulty in understanding and using written and spoken language. But under this general concept used in education, there are various diagnoses that are the cause of these difficulties. Children who suffer from this type of disorder may have problems with reading, writing, speaking, concentration and alterations in mathematical calculation.
Dyslexia, a specific type of learning problem. It is characterized by difficulties in reading that certain children present, despite having an intelligence quotient (IQ) considered normal. Dyslexia is often inherited and affects 5 to 10 times more boys than girls. When a child has reading difficulties, it can often be related to the possibility of incorrect vision; but the eyes are not usually the cause of dyslexia, rather it is the inability of the brain to correctly interpret the images received by the eyes.
Let's think, for a moment, that we should read a complicated legal contract. We recognize most of the words; But, right in the middle of the first sentence, we realize that we do not know how to interpret what we are reading. So, we go back to the beginning and read the first paragraph again. We continue without understanding it and we go back one or two sentences trying again. After a lot of effort, we ended up reading the contract until the end without fully understanding its meaning.
Children with learning disabilities have experiences similar to this one. They do not possess the capacity for continuity in reading and, often, present a distortion in the anchoring or correct pronunciation of the syllables, because they confuse the order of the letters or do not even distinguish it. It is not difficult to understand why they end up frustrated, with a loss of interest in school work and, on the whole, they quickly try to avoid difficult exercises.
Reading and learning problems can also affect the development of their self-image and cause emotional disorders (introversion, anxiety, depression or aggressiveness). Parents should be aware that "poor readers" can develop these personality and behavioral problems. And it is necessary to be by their side and try to help them solve them, remembering that the presence of learning problems has nothing to do with intelligence.
What are the indicators of learning problems?
It is difficult to diagnose learning problems in preschool children. But, we can be guided by the following indicators:
- Failure to get reading skills expected for their age and school level (average) or presence of problems in other academic areas, despite having an adequate IQ.
- Speech or language problems that persist over time. For example, a child may present with "late speech" and later develop problems in pronouncing words and using them correctly to express her ideas.
- Bad letter and slowed writing.
- Memory problems or with a decreased level of attention.
- Low self-esteem, frustration because of poor school performance.
- Family background of learning and language problems.
What is the cause of the learning problems?
There is little scientific evidence to confirm that these learning problems arise as a result of poor vision or problems that strictly affect the visual apparatus, although we know that poor vision can be the cause of poor school performance. For this reason, it is necessary to differentiate what type of problem each child presents, in order to establish the most appropriate treatment regimen in each case.
Although the exact causes of these learning problems are unknown, current research points to the possibility that the origin is the brain involvement of certain areas related to language.
The functions of the eye are similar to those of a camera. After the "image capture" in the eye, it is sent to the brain through the optic nerve. The eyes do not understand what they are seeing, in the same way that a camera can not understand the image it captures. Until the image is processed centrally, it does not acquire meaning. Until the brain interprets the images captured by the eyes, the image has no meaning.
Children can understand what they are reading thanks to the interpretive ability of the brain. The brain relates visual images with previous experiences and knowledge. Specific learning problems are a defect in this interpretive process and not in the capture of images by the eye.
The acquired form of dyslexia or other learning problems can be due to brain damage due to infections (such as encephalitis, meningitis, etc.), injuries (brain trauma, contact and/or abuse of some toxic substance, etc.), births premature infants or chemotherapy treatments.
Learning problems can also be a consequence of mental retardation, visual or auditory disturbances, emotional disorders, or environmental conditions (unstructured family situations, inadequate education or low school attendance). These problems are not generally considered specific learning disorders, although they influence its process.
Treatment for dyslexia and learning problems
If parents or others suspect learning problems in a child, they should contact their teacher or educational professionals. Spanish legislation requires schools to assess any child suspected of having a possible learning disorder. Evaluation and diagnosis are in the hands of educators and other specialists in problems of this type, such as speech therapists, psychologists or neuro-psychologists.
Parents and teachers have a very special role in this process and need to be involved when decisions must be made regarding the educational needs of these children.
Treatment or support of children with learning delays is best done by trained teachers who are specialists in reading, in specific problems such as dyslexia, class tutors or teachers of specialized schools. It is very important to give them the understanding they need and that gives them the necessary emotional support. You have to help them to experiment, offer them opportunities for success so that the child strengthens his will to make an effort and patiently insist on all those activities not related to reading, but that will result in it. There are, for example, space structuring learning exercises, made through games, which help them in their reading accommodation.
El sport or artistic activities they can benefit the child as they help him to free himself from possible tensions and frustrations.
Learning problems are complex alterations. There are no quick remedies. Simple solutions like diet, megavitamins, sugar restrictions, eye exercises, glasses or vision training do not provide a cure for these disorders. Such therapies can provide parents with a false sense of security; but in the end, the only thing that is achieved is delaying appropriate educational assistance.
A child with learning problems needs practice reading with special assistance, just as an athlete needs to practice under the supervision of a trained coach. There is no reason to assume that children with learning disabilities who require specific help cannot achieve later in life. Albert Einstein, among others, in childhood, he had learning disabilities and continued to lead a very productive life.
Squint
What is Strabismus?
El squint It is a deviation of the eyes in the line of sight, one eye looks at a point or object of interest, while the other looks at a different point. Although it is a frequent condition that affects 4% of the child population, it can appear later during life. The deviation can be permanent and always appreciable (tropia), or it can appear on certain occasions (foria). One eye may be straight facing forward, while the other eye is as turned inward, outward (exotropia), up or down. In other cases, we see that the deviated eye and the one that follows the correct line of sight alternate.
Under normal conditions, the eyes are aligned when we look straight ahead, they appear parallel, a situation that is maintained when we look laterally, upwards or downwards. There is a constancy in the position of the eyes, which is due to the action of some muscles (extrinsic eye muscles), six for each eye, which work synergistically, like the bridles of a horse, maintaining the alignment of both eyes . When these muscles fail, either directly or by alterations in the nerves that control them, there is an imbalance that causes the loss of parallelism between the two eyes, causing the picture of strabismus.
Strabismus secondary to Hyperopia that is compensated for by optical correction.
Strabismus with internal deviation in the left eye.
The eyes are designed to focus images sharply on the retina and from there, send the generated signal to the brain. If both eyes are aligned on the same point or object, the vision portion of the brain can merge the two signals sent by each eye into a single, three-dimensional image. This creates in-depth perception by stimulating the eyes to work together and maintain the "image" of the outside world in the brain, even if the head or object we are seeing moves. When an eye deviates, as in the case of strabismus, two different images reach the brain. In children, the brain learns to ignore the image of the deviant eye, cancels it, and works only with the image of the aligned eye or the image of the best vision eye, dominant eye, that is, the brain adapts to that situation. This causes a loss in depth perception. The adults who develop strabismusFor example, after a trauma, they will have double vision (diplopia), because their brain is not trained for this situation and does not know how to ignore or suppress the image of the deviated eye.
Normal alignment of both eyes during childhood allows for the development of good vision in each eye. An abnormal alignment of the eyes, as in the case of a strabismus, can be the cause of a reduction in the level of vision or a amblyopia (lazy eye). Amblyopia occurs in about half of children with strabismus. The brain will recognize the image with better vision and ignore the image corresponding to the eye with less vision or amblyopia.
As we have noted, amblyopia can often be treated by occlusion of the dominant eye, in benefit of the weaker eye vision. And we have also noted that if amblyopia is detected during the first years of life, the treatment is usually satisfactory. And that, on the other hand, if the necessary treatment is not applied at the right time, the amblyopia or reduction of vision will usually be permanent or more difficult to resolve. As a rule, the sooner amblyopia treatment is instituted, the more likely it is to regain vision.
Causes and symptoms of Strabismus
Strabismus is caused by a muscle imbalance, although there are discrepancies about the mechanisms that can cause this situation. We know that the strabismus has hereditary factors that favor a greater family incidence. No differences have been seen with respect to sex, affecting women and men equally.
The brain controls the eye muscles. This fact explains why children with cerebral palsy, Down syndrome, hydrocephalus or neurological disorders often suffer from strabismus. On the other hand, if the vision in one eye is blurred because of a cataract or other injury, then the eye will tend to wander because, if it doesn't see well, it doesn't have the proper stimulus to align the sight.
The first sign seen in a strabismus is that the eye is not straight or aligned with the other. It can be accompanied by changes in the position of the head that appears turned to one side or tilted looking for a posture that reduces the deviation of the eyes.
Strabismus detection and diagnosis
Children should be examined by the pediatrician or ophthalmologist, in order to assess the state of their eyes, especially if there is a family history of eye disease or strabismus. It is not always easy to expose a strabismus. Occasionally, parents or close relatives believe that the child voluntarily deflects his eyes and it is a strabismus; while, in other cases, this may be the case and it may be normal situations during growth that have no significance.
epicanthus
Young children usually have a wide base of the nose, leaving a superficial skin fold that gives the sensation that the eye tends to hide under it and gives us the appearance of a strabismus. It is what we know as epicantus. Only the ophthalmologist is able to differentiate and distinguish this physiological situation from a real strabismus.
In addition to the schedule of revisions previously proposed (in the "Eye Examination" section), if any alteration in the eyes is suspected, it is advisable to consult an ophthalmologist, especially in those cases in which a family history already exists . Fortunately, there is a wide variety of tests for babies and toddlers. If the visual examination is delayed until the child enters the school, it may be too late for the proper treatment of strabismus or amblyopia. A deviation of the eyes can be caused by a cataract or by a tumor inside the eye. Therefore, ophthalmological recognition is important as soon as possible.
The position of the eyes appears to be a strabismus, but it is not, they are close to the nasal fold because the nasal bridge is ampmess and it seems that they are deflected inward.
Strabismus Treatment
The objectives of treating strabismus are: maintain visual acuity, align the eyes and restore binocular vision. The treatment of strabismus depends directly on the cause that causes it. It can be directed towards the solution of a muscular imbalance, the extraction of cataracts or other conditions that can cause an eye to deviate. After a thorough examination, including the evaluation of the internal structures of the eye, the ophthalmologist should recommend the appropriate optical, medical or surgical treatment.
Both strabismus types more frequent are the endotropia (when the eye is turned towards the nose) and the exotropia (When the eye deviates out.) Esotropia is more common than exotropia. In many cases, early surgery will be necessary to align the eyes to ensure binocular vision and prevent vision loss in the child. The objective of the surgery is to adjust the muscle tension of one or both eyes so that they align and regain the ability to focus simultaneously.
A situation that we find with some frequency is strabismus associated with a refraction disorder. They are children who usually present inward deviation, esotropia and hyperopia.
Hyperopic children they have a greater than normal capacity to force the focusing mechanisms, to compensate for hyperopia, which allows them to see well from far and near. The over-effort they must make to focus the images is the cause of the deviation of the eyes. In these cases, the correction of hyperopia decreases the accommodative effort and with it, the ocular deviation.
The deviation of the eye out or exotropia, can appear in isolation or associated with a refraction disorder, myopia, similar to what happened in the previous case. Often, exotropia is intermittent; that is, it only appears at certain times, especially when the child is excited, tired or sick. The attitude of the specialist, in these cases, is to correct myopia, to verify that there are no other associated complications and, if there is no amblyopia, to evaluate the surgery to restore the correct alignment of the eyes.
La strabismus surgery It is usually a safe and effective treatment; but it does not replace glasses or amblyopia therapy. During the surgery, a small incision is made in the conjunctiva that allows access to the muscles to be able to modify its position and with it, the tensile forces exerted on the eyes. The selection of the muscle or muscles that must be operated depends on the direction to which the eye is diverted. Despite a meticulous clinical evaluation and the selection of the appropriate surgical technique, it may happen that after treatment, the eyes are only partially aligned. In these cases, fine and precise adjustment depends on the coordination between the eyes and their interpretation in the brain, something that can be improved with exercise visual therapy. Some patients may need the use of prisms or corrective glasses after surgery.
The surgery is performed under general anesthesia in the case of young children, while local anesthesia can be applied in adults. One or both eyes can be operated on at the same time. Recovery time is usually quick and normal activity can be restored in a few days.
In cases where a significant deviation appears, it is usually indicated Surgical treatment in early phases, especially to avoid amblyopia as well as phenomena of deterioration of self-esteem. It is more and more common for children with a significant strabismus to consult a psychologist for problems of this type: loss of self-esteem, which are usually accompanied by other disorders of attention and school performance.
As with any surgery, in the case of strabismus, there are also certain risks. Although they are minimal, it is necessary to consider infections, hemorrhages and other complications that can lead to loss or decrease in vision.
In recent years, another type of surgery is being applied through the Botulinum toxin injection, a substance that relaxes the muscle, achieving similar effects to conventional surgery. However, the results are variable and it is necessary to repeat the administration of the drug to ensure that the effect is maintained in a lasting way. For all these reasons, this therapy is only indicated in special cases and is not performed routinely, as has been pointed out in some media.
Retinopathy of prematurity
La Retinopathy of prematurity (RDP), also known as retrolental fibroplasia (RLF), is a process of blood vessel formation and scar tissue inside the eye. It affects the retina and the vitreous humor of newborn babies, generally of low weight.
The cause of retinopathy of prematurity is complex and is not completely clarified. The factors that can influence the appearance of this situation are the degree of prematurity and birth weight. Other associated factors include respiratory problems, anemia, heart problems, hemorrhages in the brain and the need for oxygen supplements in premature infants. Initially, it was thought that oxygen therapy was the main cause of this pathology; however, there is no clear evidence that this is the case.
Despite advances in neonatal units, retinopathy of prematurity continues to occur. Its incidence has decreased very significantly; but, on occasions, it appears, especially because, at present, more and more premature children and with shorter gestation times are being saved.
Retinal changes can lead to visual impairment depending on their location, progression and severity. Sometimes, for no apparent reason, the overgrowth of blood vessels and scar tissue stops spontaneously. Unfortunately, in a significant percentage of cases, this vessel growth continues to progress with vision impairment that can even lead to blindness.
Treatment of retinopathy of prematurity
Although there is no medical evidence or fully effective surgical treatment for the primary condition, new alternatives are being investigated for its prevention and treatment. Occasionally, associated problems may appear, such as myopia, glaucoma, retinal detachment or strabismus. Most of them are treatable, although moderately satisfactory results are achieved. When the occupation of scar tissue is too great and blocks the passage of light to the retina, surgery is necessary (vitrectomy), aimed at eliminating internal fibrosis and treating the retina as if it were detached.
Fundus without presence of retinopathy of prematurity.
Fundus with retinopathy of prematurity with persistent primary vitreous
Ocular albinism
El albinism It is a hereditary condition in which the eyes, skin and hair have less pigment compared to what is considered normal. In extreme cases, a total lack of pigment can be seen and both the skin and the hair are totally white and the eyes have a slight pink color. In other cases, albinism affects only the eyes, and affected individuals have pigmentation of the skin and hair in a normal state. This is known as Ocular Albinism. In severe cases of albinism, the central area of vision, the macula, does not develop properly resulting in a very reduced vision.
The symptoms of Albinism begin in childhood and may be accompanied by decreased vision, increased sensitivity to light, involuntary movement of the eyes (nystagmus) and strabismus. The vision can vary from normality to a significant loss that can lead to blindness. The near vision is usually better preserved than the distant one; therefore, these children can have a normal development of their school activities.
Background of an albino patient's eye. The lack of pigment is appreciated.
Albinism is normally detected by general depigmentation or through family medical history. There are special tests on hair, skin or blood that can help make a specific diagnosis. There is a second form of Albinism, rare, which is characterized by being associated with hemorrhagic symptoms and a higher incidence of infections.
Eye treatment of eye albinism
Albinism is a chronic process. Although there is no specific treatment to palliate or counteract the poor or null production of pigment or correct the abnormal development of central vision, a good ocular evaluation and its control can be very useful.
The therapeutic attitude, in these patients, is aimed at improving their visual quality. For this, it is necessary to perfectly correct the graduation defect that they may have and should wear glasses with special filters. For a long time, it was thought that these patients had glare due to the lack of pigment in the iris, a phenomenon that, in addition to subjective discomfort, would be responsible for a decrease in vision. Currently, we know that this is only partly true. Patients with albinism do not usually present significant glare problems and the cause of their poor vision is due, in large part, to a disorder in the perception of contrasts; Therefore, it is very important that they use lenses with specific filters to improve their contrast sensitivity. The ophthalmologist or the optician may study each case to advise the most appropriate filter, usually the yellow ones that block the short bands of blue tones. For those patients who prefer to use contact lenses, they can also incorporate these filters into contact lenses (only in specialized ophthalmological centers). For cases in which there has been a significant impairment of vision, it will be necessary to study and resort to visual aids and optical augmentation systems for low vision.
A detailed study of the genetic history of affected individuals and their relatives is advisable. This will provide a detailed explanation of the disease including the possibility of it affecting their offspring.
Some individuals with Albinism may be entitled to financial assistance for partial or total disability. The ophthalmologist is the one who must prepare a report so that this person can manage the request for aid.
Glasses and contact lenses for children
Glasses in children
One of the main problems that parents encounter is when the ophthalmologist or optometrist recommends the use of glasses. There is significant confusion in popular knowledge about the convenience or otherwise of glasses in children and about when it is better to start using them and the number of hours they should be worn.
The first thing we must assume is that there is no situation that is repeatable for all cases. Each one is special, so what we hear from a friend or relative, even with very good will, should not be fully considered until it is consulted with an expert in the field. Children up to 4-6 years of age usually present a certain degree of farsightedness which causes a tendency to divert the eyes inwards, and may be accompanied by a certain instability in fixation, in the posture of the eyes when we look at something; that is, there may be certain lateral oscillations of the eyes, nistagmus, that they enter into an absolutely normal situation. For that reason, although we have verified it, it is not always necessary to correct it. It is a problem of immaturity of the visual system that will be resolved over time. This situation explains why sometimes the doctor does not prescribe glasses or seems not to value something that for us can be very important and we assume that it can be the beginning of a serious problem.
On the other hand, we recommend that, if the parents or those responsible for a child do not share the criteria or the proposal of the doctor who visits them, do not hesitate to request a second opinion; because doctors can also be wrong. And, if the other physician agrees with the first opinion, this is a way of reassuring us and assuming that what initially seemed to contradict our opinion of observant and responsible parents is surely a valid conclusion.
In a more or less generic way, we can say that myopia, especially the myopia in children, should be corrected as soon as they are detected, even at very early ages; since they represent a significant deficit of visual acuity and can easily induce what we know as lazy eye or amblyopia. In these cases, an eye develops normally, the one that does not have myopia, or has it to a lesser degree, while the myopic eye will not follow the process of maturation at the cerebral level, that is, it will not learn to see and will remain with a vision deficit that will not improve when putting on glasses or contact lenses with the corresponding graduation. Hence, the name of lazy eye. Occasionally, if the graduation is very high and is the first time it is detected and the child had never used glasses, the specialist will prescribe a graduation lower than the one that corresponds, for a better adaptation of the child to the corrected vision and will increasing this progressively over a period of a few months, until reaching the total value necessary for a correct vision.
When it is a hyperopia, if it is not very high, less than 4 diopters, in children between 1 and 4 years, it is usually postponed the prescription of glasses, provided that the vision is good and there are no symptomatic manifestations of headache or deviation of the eyes (strabismus). In these cases, the decision must always be made by the ophthalmologist and it is necessary to strictly follow reviews every 6 or 12 months to assess that there are no problems such as amblyopia of one of the eyes.
As in the case of myopia, it is frequent that the first glasses also have a lower diopter value than the one marked by the refraction of the eyes and that, in later revisions, it increases progressively. In cases of mild hypermetropia (less than 4 diopters), it is common for the ophthalmologist to allow certain activities without glasses, such as sports activities or on the beach or in swimming pools, although specialists are increasingly reluctant to use them. these practices; since they easily end up reducing the number of hours of carrying them.
This circumstance is common in children because they have the ability to focus (accommodation), capable of overcoming the optical imbalance and are able to see correctly without the need to wear glasses, although making an effort that, later, can cause problems or lead to a deficit in school performance.
It is important to know that the degree of diopters that is prescribed, at any age, but especially in childhood, is not mechanical, but is adjusted according to other factors, generally accommodative instability, deviation of the alignment of the eyes and other factors. This explains why we should not trust the simple and isolated data provided by the devices that automatically calibrate or autorefractometers. The information they offer is an aid that, together with the rest of the examination, must be interpreted until a diagnosis and the most recommended therapeutic guideline are issued. For this reason, as we have pointed out in other sections ("The examination of the eyes"), although the optician or the pediatrician can help to reveal the ophthalmological problems, establishing the first level of detection, then, it must be the ophthalmologist who decides, ultimately, what is most convenient for that child.
When a young child has problems in school, due to a deficient follow-up, or due to hyperactivity with a decrease in overall performance, they must quickly examine their eyes; since, often, attention deficits or hyperactivity disorders are usually caused by a picture of hyperopia that causes a near visual deficit, with headaches when fixing nearby objects or trying to read. For this reason, the child is often distracted or unable to concentrate. And it is evident that if the child is treated through the refractive correction that corresponds to him, in most cases it will be enough to reduce the school deficit.
It has been shown that, although not always, some problems of poor school performance in children, as well as diagnoses of attention deficit or hyperactivity disorders, may be related to ocular processes such as latent or manifest hyperopia. In these situations, it is necessary to perform an ophthalmological examination to rule out its presence and possible relationship.
Contact lenses for children
One of the main problems that the ophthalmologist must fight when prescribing glasses in a child, is to convince parents and family members about the need and importance of using glasses, especially when dealing with children affected by hyperopia; because these children are able to see well without them or, even, they refer worse vision in the initial phases, when they have not yet become accustomed to them. We have already commented on the great capacity of adaptation of the visual system of children.
In these cases, it is important to explain well what is happening and the consequences of not wearing glasses: headaches, poor vision, poor school performance and/or induction of amblyopia (lazy eye).
In children who do not accept the use of glasses well or who have an unstable nasal bridge, etc., the alternative of eyeglasses may be considered. contact lenses. And this becomes a necessity if they are very athletic or naughty children. It is usual the belief that contact lenses can only be used after a certain age. And this belief is totally false. In fact, one of the therapeutic alternatives after the surgery of a congenital cataract, to prevent amblyopia, is the bearing of a contact lens, in almost newborn children, which shows that there is no age limit. Although it is true that contact lenses, being a structure in direct contact with the eyes, can cause problems or more complications than glasses. For this reason, they are usually reserved for special cases or for children from an age when they are minimally responsible and capable of taking care of them and following the recommendations of the optician or ophthalmologist. In most cases, It is necessary to carry out cleaning and disinfection care as well as handling to be able to place and remove them to store them in their case..
These requirements establish who can use contact lenses, and the age will be the one that shows the maturity of the child and their abilities to perform these maneuvers, unless they use long-term lenses, which do not require these manipulations, or have the help of an adult, as in the case of very young children after cataract surgery.
The contact lenses are usually prescribed when the child has problems with high graduations and the lenses of the glasses are thick, uncomfortable and the quality of the inferior vision by the aberrations that induce and the decentration of glasses poorly placed by the activity of children . We also prefer to adapt contact lenses in cases where there is an important graduation difference between the two eyes (anisometropia). In these children, the graduation difference determines that the sizes of the images that reach the brain are different (aniseiconia), which causes problems, usually fusion and binocular vision, and a certain degree of amblyopia may appear. To avoid this, we prescribe contact lenses that minimize these size differences, so they are recommended from the medical point of view.
