OD Q&A: Spotting vision issues in children

How to spot – and treat – vision problems in children

Taking care of your eye health is a life-long pursuit, and one that should start in early childhood.

After all, many vision issues can go undetected until they progress significantly, underscoring the importance of regular, thorough eye exams. And eye health looks different at every age and stage of life. In the early years, spotting vision issues early is crucial to reducing the chances of a negative impact on a child’s school years and development.

When it comes to eye health in childhood, optometrists agree that early eye exams at a young age are important to catch eye conditions before they develop further. Parents often believe that their child will let them know that they cannot see well, but children are rarely able to tell that they have poor vision because they have nothing to compare it to. Even if your child’s vision seems good to you, it is recommend that children begin having regular eye exams when they are six months old.

Here, optometrists Dr. Alia Merchant and Dr. Maegan Folk address some of the most common childhood eyecare concerns.

At what age should children first visit the optometrist?

Dr. Merchant: We recommend starting eye exams very early. There are tests that can be used on infants and preschool children, using images of shapes for kids who can’t read yet. We recommend visiting around six months old, again at about 18 months old, and then annually after that. Annual routine eye exams are an insured benefit in British Columbia, Alberta, and Ontario for children, subject to certain restrictions, meaning that your child can have their eye exam at no cost to you.

If you have any concerns about your child’s vision you should find a local optometrist who will test their vision as soon as possible. When children reach school age it’s worth taking them for an eye exam to ensure that there aren’t any issues with their eye health that are likely to affect their early school years. Treatment for common eye conditions in children can begin early and in some cases, correct vision.

What are the signs of eye problems in children? How can they learn good eye health habits?

Dr. Folk: Poor vision can lead to learning and behavioural problems, which might be blamed on other things. This is especially true for young children, who might not be aware of any difficulties they’re having or find it hard to explain.

It’s often difficult to tell if your child has vision problems, because either they may not notice it themselves, or they may not be able to verbalize the problem. This is why regular eye exams are so important. Here are some things to look out for: straining their eyes or tilting their head to see better; frequent eye rubbing; complaining of headaches or tired eyes; consistently sitting too close to the TV or holding a book too close; or closing one eye see better.

Follow the 20-20-20 rule. Your child should look away from their screen every 20 minutes, and look at something 20 feet away, for at least 20 seconds. You should encourage your child to follow this rule as it will relax their eye muscles and help to reduce the risk of many symptoms of digital eye strain.

We say below the age of two years old there shouldn’t be any screen time, but we recognize that’s not realistic. Try to limit exposure to screens and encourage activities that get them outside or looking in the distance more often.

Can children wear contact lenses?

Dr. Merchant: Yes! Generally, children must be old enough to handle contact lenses and care for them properly with minimal supervision. Often, we advise part-time wear to begin for younger children, while older children can wear contact lenses more regularly when they start out. Children are quick learners and often adapt to contact lenses very well.

What is myopia? Is it treatable?

Dr. Folk: Myopia, also known as near-sightedness, is a common visual condition where objects can be seen up close relatively well but those affected have difficulty seeing objects in the distance clearly.

Some factors that play a role in the increase in myopia in children across the world include genetics, birth circumstances, lifestyle habits, and environmental factors. Decreased time spent outdoors, increased digital screen time, and low birth weight are some examples of the above factors.

The younger the age of myopia onset, the higher the risk of increased levels of myopia, and therefore the higher the risk of eye disease and visual impairment in later life. There are some habitual lifestyle changes that can help to slow down myopia progression, such as increased time spent outdoors, reduced screen time, and use of good lighting. But in many cases, more intervention is needed to control myopia.

The good news is that myopia can be corrected with corrective lenses, such as glasses, contact lenses, or refractive surgery. Early detection is crucial for effective treatment.

Does my child have a lazy eye?

Dr. Merchant: Your optometrist is best suited to diagnose this condition in-person. Lazy eye (amblyopia) is a childhood condition that results in one eye not developing at the same rate as the other. Vision is weaker in the lazy eye and the child will begin to favour their stronger eye.

Amblyopia develops when the brain begins ignoring signals sent from one of the eyes. If left untreated, permanent loss of vision in the affected eye can occur. The condition is usually diagnosed in children when they are around four years old, but it can be difficult to spot, as they may not be aware something is wrong. In some cases, the child may also have a squint. This is where one of the eyes is looking in a different direction to the other.

Amblyopia will normally be diagnosed through a routine eye exam and there are several treatments available to help overcome the condition. First, any underlying problems that may exacerbate a lazy eye should be treated. Near and farsightedness can be improved by having the child wear glasses. The child will then be encouraged to use the lazy eye more. This can be achieved by putting a patch over the strong eye or applying eye drops to blur vision in the stronger eye.

Outcomes for a lazy eye are typically good, provided the condition is diagnosed and treated as early as possible. However, positive outcomes are less likely as the child gets older and may depend on how co-operative and motivated kids are in following the treatment. Treatment before the age of eight is important. An eye patch should be worn for several hours a day over several weeks. While wearing a patch, children should be encouraged to do a number of close-up activities to strengthen the weak eye, such as reading, colouring and writing.

Can an optometrist treat pink eye?

Dr. Merchant: Absolutely! Conjunctivitis, commonly referred to as pink eye, occurs when the membrane that lines the inner eyelid and eyeball becomes infected or inflamed. The treatment for conjunctivitis will depend on the cause and severity of symptoms. It’s important to see your optometrist when your child has the early signs of conjunctivitis as they will be able to advise on potential treatment as well as recovery time.


Taking a closer look:

All Specsavers locations are equipped with OCT allowing independent optometrists to detect and monitor a range of eye conditions at earlier stages.

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