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Svjetlost is the leading ophthalmology Clinic in the Southeastern Europe, offering complete ophthalmic services.

World Sight Day - Vision problems to be handled in early childhood!

World Sight Day - Vision problems to be handled in early childhood!
Every child should be ophthalmologically examined up to the third year of their lives. In any suspicion of a child's poorer vision or crossed eyes, the examination should be urgent, regardless of age and child’s co-operation.
When to take your child to first ophthalmic examination?

Every child should be ophthalmologically examined up to the third year of their lives. This is referred to healthy children who didn’t notice vision problems or eye disorders. In any suspicion of a child's poorer vision or lazy eye, the examination should be urgent, regardless of age and child’s co-operation. Most children diagnosed with refractive error or strabismus have a positive family history, meaning that every child with a family history of strabismus, short-sightedness, high dioptres, or various ophthalmologic illnesses should be ophthalmologically examined regardless of the symptom manifestation.

Examination and tests are adjusted to the child's age, and it is necessary and undelayable with first signs of crossed eyes, regardless of age and child’s co-operation. That is why it is important to educate parents, as well as nursery educators, and all medical staff who meet the child, in order to take the child to an ophthalmologist in any doubt of poorer vision or strabismus. Child’s age is not important, as no child is too small to have an ophthalmologic examination. 

The basic ophthalmologic examination involves taking orthopaedic status with binocular and stereovision tests, determining visual acuity and peripheral vision, and, along with complete examination of front and back segments of the eye, unavoidable pupil dilation and determination of objective refraction by sciascopy. Examinations are repeated on several occasions, especially after the diagnosis had just been made, to get as accurate picture of vision function as possible. One of the side effects of strabismus is the exclusion of the deviated eye, which develops visual impairment (low vision) or laziness of the eye. Strabismus in childhood is often a result of uncorrected refractive error and mostly occurs because of farsightedness. Since children have enhanced acclimatization ability, and conjugated convergence, the deviated eye will move toward the nose.
The basic goal of treating strabismus in children is timely diagnosis, correction of refractive error with optical aid, initiation of pleoptic treatment, and, if necessary, do the surgery to potentiate/allow binocularity and stereovision development along with said conservative treatment. That is why it is always extremely important to take a child to ophthalmological examination in time to determine a refractive error and to arrange the glasses necessary to wear.

Given that the plasticity period of vision development and function lasts up to the third year of the child's life and ends almost completely to school start, it is extremely important that refractive error and strabismus are diagnosed as early as possible in order to initiate treatment of refractive error correction by optical aids and to start pleoptic theraphy by closing a “better” eye at low vision. Wearing the glasses is very important here and it must be constant, as well as closing a “better” eye. Low vision s treatment is long-lasting and requires daily involvement of parents.

What does it mean when the child has crosses eyes?

Strabismus is a disorder of mobility and eye position. When having crossed eyes, the visual axes are not aligned and the picture is not onefold, and so the brain uses the image of only one eye that becomes the leading one. Since the exclusion of one eye is a neuroadaptation mechanism that prevents double vision, the excluded eye becomes lazy. Strabismus can cause disturbance in the development of binocularity and stereovision. With synchronized and conjugated eye movements, the perfect co-operation of both eyes, called binocular vision, is achieved. That is viewing both eyes, whereby two individually perceived images of the brain are united into one. Such a common image is clear and onefold.
Binocularity is a prerequisite for stereovision or deep vision or third dimension sense. Thus, apart from the development of low vision, the consequence of strabismus is also the inability to achieve binocularity and stereovision. Since the plasticity period of vision and visual function is most pronounced between the second and the fourth year of life, the best results are achieved precisely in this period, indicating the need for early diagnosis and treatment as a basic precondition for the objective achievement of binocularity and stereovision development. Most importantly, it is important to take the child to the ophthalmic examination as early as possible to get a diagnose and treatment instructions that include closing a “better” eye in case of low vision, wearing optical aid in case of refractive error, and In some cases of strabismus, operative treatment with goal to achieve binocular vision, and later stereovision.
Therefore, treatment is long-lasting and complex and requires daily engagement and support from parents and doctors because even after surgery, it is necessary to continue to wear glasses and to perform occlusion or closing a “better” eye. Therefore, one type of treatment does not exclude others, but complement each other with the clear support of the parents who should daily monitor and encourage occlusion.

How to notice child’s low vision?

If visual acuity is reduced to both eyes, the child clearly shows signs of lower vision, such as bringing books closer, watching the TV at short distances, or squeezing and frequent blinking when attempting to focus distant objects. However, if the sight is lowered only at one eye, parents and the environment do not notice the problem, as the child is using a better eye. In doing so, the brain takes over the information coming from a better eye, and information from another eye is suppressed, leading to low vision.
Parents who have vision problems themselves, refractive errors, low vision in their own or family history should bring their child as early as possible to examination with a pupil dilation to gain visual insight and timely diagnosis and begin treatment.
doc. dr. sc. Ivana Mravičić, ophthalmologist, subspecialist of children's ophthalmology and strabismus.
Head of the Department of Pediatric Ophthalmology at the Svjetlost Clinic