Eye Care, Eye Health, Safety, Wellness

August is Children’s Eye Health and Safety Month, and vision screening is the first step to ensure healthy eyes for your kids. But did you know that only forty states in America mandate some type of vision screening for school-age children, and only twenty-six states require vision screening for preschool-age children1? Pediatric offices perform vision screening to various degrees, but many Americans have difficulty accessing primary care. Some unscreened children have preventable causes of vision loss, the most common of which is refractive error (near-sightedness, far-sightedness, or astigmatism).

Uncorrected refractive errors in infants and preschool-age children are associated with deficits in cognitive and visual-motor functions that may, in turn, impede school readiness. Untreated refractive error can also lead to amblyopia, a condition where the brain never develops crystal clear vision because it never received proper input from the eyes. Proper screening in school or the pediatrician’s office and timely referral to an ophthalmologist are crucial in the fight against blindness in our children.

What can parents do to help prevent vision loss in their children? Remember SCREEN, SPEAK UP, and PROTECT:

Screen: Ensure your child receives proper vision screening, as recommended by the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology2:

  • Newborns receive a red reflex test. Any abnormal result or high-risk infant (premature infants, those with significant family history of heritable vision loss, etc.) should receive an URGENT consultation with an ophthalmologist to detect and treat preventable causes of blindness.
  • Age 1 month to 4 years: Ocular health should be assessed at each routine well-child visit, including an external inspection, pupillary examination, corneal light reflection, and assessment of fixation and following behavior. Some pediatric or family medicine offices will use photo screening or handheld autorefraction at these visits to estimate your child’s refractive error. Any abnormal result warrants a referral to an ophthalmologist.
  • 5 years and older: Visual acuity testing (i.e., recognizing shapes or letters on the chart) should be performed as soon as your child is cooperative enough for the assessment and repeated every 1-2 years. This is the best way to assess your child’s vision. Routine comprehensive professional eye examinations performed on normal asymptomatic children have no proven medical benefit. However, any abnormal screening result does warrant a referral to an ophthalmologist for a comprehensive eye exam.
  • Children with possible or diagnosed learning disabilities, such as dyslexia, should undergo a comprehensive eye examination to identify and treat any undiagnosed vision impairment.

Speak up! If you notice that your child has any of the following eye findings, please call your pediatrician for an evaluation. Proper treatment and referral can be initiated if needed.

  • Crossed eyes (Strabismus): Healthy eyes work together. When two adult eyes are not looking at the same target, our brains see double. A child’s brain prevents double vision by blocking the less clear image and favoring the image generated by the “stronger” eye. This selection leads to amblyopia–suboptimal development of the ocular pathways generated by the “weaker” eye. It is normal for eyes to cross symmetrically inward when fixating on a near target (imagine your baby holding an interesting toy); this crossing should be temporary and not persist with distant viewing (your baby looking at you from across the room).
  • White eye reflex (Leukocoria): It is normal to see a red reflex when shining light on a healthy eye. This red color comes from the blood supply to the retina, which receives the most blood flow per gram of tissue in the entire human body. If the reflex appears white in one eye, then something such as a cataract or tumor is blocking the light’s path to the retina. Sometimes, a white eye reflex in one eye is related to the angle that a light or camera was used, but repeatable white eye reflexes should be urgently reported to your child’s pediatrician.
  • Frequent squinting or inability to see clearly from a distance (Refractive Error): Children are often afraid to speak up or don’t realize that their vision is blurry, so parents and teachers need to advocate for them. Many kids go two or more years between vision screenings, enough time to go from 20/20 to legally blind. The initial treatment is wearing glasses, and children can consider contacts when they are responsible enough to clean their room. Those 18 and older can opt for laser eye surgery for a permanent cure.
Leukocoria (white eye reflex) in a child with a retinal tumor. Image courtesy of Eye Rounds

Protect: Even if your child’s eyes are healthy, you can adopt the following lifestyle modifications to protect their eyes and prevent vision loss.

  • Nourish their eyes with a balanced diet: Support your child’s eye health by filling their diets with a variety of fruits and vegetables, particularly leafy greens like spinach, kale, and collard greens. Fish rich in omega-3 fatty acids, such as salmon, tuna, and halibut, can also boost your vision.
  • Promote physical activity: Regular physical activity helps maintain a healthy body weight, which can lower your child’s lifetime risk of diabetes and related vision issues.
  • Keep germs at bay: Encourage hand washing before your kids touch their faces or eyes, particularly if they are inserting or removing contact lenses. Hand washing is the most important tool to prevent the spread of disease.
  • Protect their eyes during high-risk activities: If your children are old enough to mow the lawn or help with construction projects, make sure they always wear wrap-around eye protection to prevent projectile injury to their eyes.
  • Shield their eyes from the sun: The sun’s UV rays can harm our kids’ eyes, so it’s important they wear sunglasses that block 99% to 100% of UVA and UVB radiation. And remember, they should never look directly at the sun, even when wearing sunglasses.
  • Ensure breaks from screen time: Staring at screens for extended periods can strain our eyes, so use the 20-20-20 rule for your kids: every 20 minutes, have them look at something 20 feet away for at least 20 seconds. Even better, get your kids off the screens!

Your children’s eyesight is precious. By following the above tips, you can prevent blindness in your child and ensure healthy visual functioning.

Thanks for reading!

Jonathan Corsini, MD

Resources:

The National Center for Children’s Vision and Eye Health at Prevent Blindness Issues Updated National Report Outlining the Current State of Children’s Vision and Eye Health

https://www.aao.org/education/clinical-statement/vision-screening-infants-children-2022

https://www.aao.org/newsroom/news-releases/detail/research-half-of-childhood-blindness-preventable

https://eyerounds.org/atlas/pages/Retinoblastoma/index.htm#gsc.tab=0