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Monday, May 20, 2019

Examining Indicators


How to know if your child needs glasses

Another school year has come and gone. Children are excited about being off and having their whole summer ahead of them. In no time at all, another school year will begin. Many things have to be taken care of, and many appointments are made during the summer to try to avoid missing school. One such arrangement is having a full eye exam. Children that are already in glasses and have been seeing an eye doctor know when they need to be seen again, but what about a child that has never had an eye exam? The question is, when should they have an eye exam and what are some signs that your child might need glasses?

It has not been shown that every child requires an eye exam. Depending on the age, certain criteria have been agreed upon by the American Academy for Pediatric Ophthalmology and Strabismus. For children from birth to 12 months of age, they should be sent for an eye exam for: not tracking well after three months of corrected age of birth, abnormal red reflex, or immediate family member with a history of retinoblastoma. From 12 months to 36 months, they should be referred for: strabismus (eyes not lining up), chronic tearing or discharge, or failing photo screening. For 36-47 months, they should be able to read at least 20/50 in each eye. For 48- 59 months, they should be able to read 20/40 in each eye. For greater than 5 years of age, they should be able to read 20/32 in each eye. They should also be referred if not reading at their current grade level. If any child is unable to do a vision exam, then photo screening can be performed.

Photo screening is a way to check for the need for an eye exam in nonverbal children. It consists of a machine that looks at light reflexes of the eyes and determines whether it is abnormal in one or both eyes and a picture is made that a person interprets. Current photo screening devices do an autorefraction and estimate the child’s refractive error. Once this is determined, the machine has specific parameters, programmed for different age groups, that output a prognosis as to whether the child’s doctor should refer the child for examination. This does allow some vision conditions to be picked up at an earlier age and treated in a timelier manner. Also, if the child is uncooperative for screening due to such conditions as autism, they should be sent for an eye exam.

With all screening, there will be false positives and negatives. This means that some children will test positive when nothing is wrong, and some will test negative and still have a problem. Screening programs are made to limit these as much as possible, but there is no way to eliminate errors completely. As a result, the parent should understand that just because their child failed the screening, it does not mean that they definitely have an eye problem. It means that the child should be seen by an eye doctor that is trained and comfortable with examining children. Also, if the child passes the screening but the parents still are noticing problems, an eye exam should still be scheduled.

All of this is helpful for the child’s primary caregiver but may not really give the parent an idea if their child may need glasses. There are numerous signs that a parent can look for that may help determine if the child needs to be seen by an ophthalmologist. The simplest symptom is if the child is complaining of blurred vision. If the child says that he or she cannot see well or complains of sudden onset of blurred vision, an exam should be scheduled.

Other clues include squinting when trying to look at objects at a distance, getting close to the TV, holding objects close to see, or tilting the head to focus on objects. If a child seems to do well at home but does not function well away from home, it may be due to the child not seeing well and becoming scared in unfamiliar situations. If a child is not doing well in school or having a great deal of difficulty with reading, they should have their eyes examined. It could be as simple as needing a pair of glasses to see better, or they may have another visual problem such as convergence insufficiency or accommodative insufficiency. The latter two conditions can cause significant trouble in reading and completing their school work.

If a child has any of these symptoms or fails a vision screening exam, he or she should have a full eye exam including a dilated exam. The child may be found to need glasses, or another eye problem not related to glasses may be found and treated. If there is an ocular problem, treatment can make a huge difference in the child’s life.

If no abnormality is found, sometimes the parent feels that they have wasted their time. This is not the case. It is good news that the child’s eyes are doing well, and no significant abnormality was noted. Also, if the child is having difficulties at school, this can be ruled out as one of the causes, and other problems need to be investigated. Your child’s first eye exam may take time, due to filling out paperwork and needing to wait to be dilated. This will be well worth the time if a problem is found that can be treated. It can make a world of difference in a child to go from decreased vision to normal vision.

Dr. John D. Hinrichsen is a pediatric ophthalmologist/strabismus specialist at Highland Clinic who devotes his practice towards the diagnosis and treatment of eye problems in children. He specializes in the treatment of strabismus, amblyopia, ptosis and nystagmus. He can be reached at (318) 222-8402, at his first-floor offices 1455 East Bert Kouns Industrial Loop, Suite 103, Shreveport, LA. He also sees patients at the Louisiana Eye & Laser Pineville office. To schedule an appointment, call 1-800-437-0153 or visit the website https://www.highlandclinic.com/staff/john-hinrichsen-md.


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