Children’s vision problems often go undetected, then get worse

Imagine seeing blurry images all the time. Now, imagine learning to read that way.

Vision problems can have a significant impact on a child’s overall development, including motor skills, behavior and ability to learn at school.

Early detection is key to correcting most issues, but a recent study published by JAMA Ophthalmology found thousands of preschool children had undiagnosed visual impairments.

According to the study, more than 174,000 U.S. children ages 3 to 5 were visually impaired in 2015, with the largest number of cases among Hispanic children. Of the overall cases, 69 percent arose from simple uncorrected refractive errors, which include myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (blurry vision up close, far away or both).

The study echoes similar findings by the Centers for Disease Control and Prevention, which reports that fewer than 15 percent of all preschool children receive an eye exam, and fewer than 22 percent of preschool children receive some type of vision screening.

By 2060, the JAMA study predicts, the number of children with visual impairments in the 3-to-5 age group will increase by 26 percent.

Dr. Roberto Warman, director of the division of ophthalmology at Nicklaus Children’s Hospital, said the issue is a rapidly growing, global phenomenon.

“There is a worldwide epidemic of high myopia,” Warman said. “We now have a potentially good treatment to decrease the progression of myopia, but it’s not standard treatment yet.”

Myopia, the most common of the conditions, is the result of an eyeball that is too long, a cornea that is too curved, a lens that is too thick or a combination of factors. High myopia is a severe form, causing the eyeball to become very long from front to back. It can increase the risk for retinal scarring and detachment, among other complications.

The new treatment was discovered in Singapore, where the rate of myopia is sky high. Studies have shown low doses of Atropine, eye drops used to treat amblyopia (lazy eye), may slow down its progression. Warman has begun using the treatment with some of his patients. Researchers have found increasing exposure to outdoor light also helps prevent and reduce myopia in children.

Visual impairments often go unchecked because children are not always able to communicate a problem.

“One of the main issues that we find is that children sometimes come to us for their first eye exam when they are older and the visual impairment has already set in,” said Dr. Tehilla Steiner of Pediatric Ophthalmologists of South Florida. “When children are older than 8, it becomes harder to treat.”

Parents and those who work with children should be vigilant of signs that may indicate a vision problem, including frequent eye rubbing or blinking, eye turning in or out, holding reading materials close to the face, short attention span, tilting the head to one side, covering one eye, and a child losing his or her place while reading.

Children usually receive an annual eye screening by their pediatrician, and schools generally provide hearing and vision screenings.

Jennifer Ozcoz, who has a 5- and 7-year-old with myopia and astigmatism, said basic screenings at school don’t go far enough.

“I wish someone had told me to see an ophthalmologist,” Ozcoz said. “Schools should inform parents, maybe send home a letter, letting them know screenings at school are not enough.”

Her oldest, Jordi, began wearing glasses two years ago after he was evaluated by an optometrist, a healthcare professional who primarily performs vision exams and prescribes glasses. She didn’t know her son should also follow up with an ophthalmologist, a medical doctor who specializes in eye and vision care.

Steiner recommends that every child get a baseline eye exam between the ages of 3 and 5, or earlier if the parent or pediatrician has a concern. If all looks good, she recommends annual follow-ups.

Comprehensive eye exams can also detect less common yet more serious visual impairments.

In the U.S., approximately one in 25,000 babies is born with congenital pediatric glaucoma. About one in 5,000 children develop it after birth. Common symptoms include excessive tearing, light sensitivity and a large, cloudy cornea that can cause the eye to appear hazy or dull.

“Pediatric glaucoma is treated with surgery in most cases,” said Dr. Alana Grajewski, an ophthalmologist with the Samuel & Ethel Balkan International Pediatric Glaucoma Center at the University of Miami’s Bascom Palmer Eye Institute. “If infants born with glaucoma are treated promptly, they will often have normal or near normal vision.”

This story was originally published July 24, 2017 at 7:00 AM with the headline "Children’s vision problems often go undetected, then get worse."