Refractive Errors (Children)



Category Pediatric Ophthalmology

Why is it important to screen children for refractive errors?
Uncorrected refractive error in children is an avoidable cause of visual impairment and is a common cause of vision problems in children. A problem in focusing light on the retina causes abnormal visual development in children, amblyopia, or squint. Timely detection and correction of refractive error allow for normal vision development.

What is myopia?
Shortsightedness or myopia is a very common eye problem that makes it difficult to see things at a distance. Myopia usually occurs because the eyeball grows excessively in childhood and is longer than normal. This causes light rays to focus at a point in front of the retina, leading to blurred vision.

Why should increasing myopia concern us?
People with high myopia (-5.00 DS or higher) are at risk of associated serious eye problems including glaucoma, retinal detachment, and choroidal neovascularization which can lead to a permanent loss of vision.

What can we do to prevent the onset or progression of myopia?
Multiple studies have shown that children who spend more time indoors reading, writing, watching T.V., playing games on tablets, computers and mobile phones are more likely to develop myopia and have a faster rate of progression. One of the best things you can do is to send your kids out to play every day. No particular outdoor activity is better than the other. So, let them run in the park, play on the swings, join a soccer group or just jump on a trampoline!

Is there any medicine or surgery which can slow down or reverse myopia?
There is a lot of recent research in this field. Promising solutions include a dual-focus soft contact lens which may reduce the progression. Orthokeratology is an effective recent technique where a special contact lens has to be worn at night and vision is clear in the day without glasses.
Low dose Atropine (0.01%) eye drops is an effective therapy to prevent the progression of myopia which has been extensively evaluated in different countries and is now commercially available in India. Children between the ages of 6-12 years with low-moderate progressive myopia are suitable candidates.
The eye drop has to be applied once a day regularly until the myopia is increasing which maybe till 14 years of age. The child also has to be kept on a regular 6 monthly follow-up.

How do I know if my child has myopia?
Children with shortsightedness may often

  • Persistently squint
  • Sit closer to the television, computer screen, or the front of the classroom
  • Seem to be unaware of distant objects
  • Blink excessively
  • Rub their eyes frequently

What happens in myopia?
Objects in the distance appear blurry, and become clearer the nearer they get to the eye.

What kind of glasses is prescribed for Myopia?
Myopia is corrected by wearing spectacles or contact lenses with concave, or divergent “minus power”. This improves vision in children with myopia.

Can children with Myopia get LASIK surgery to remove glasses?
LASIK and other refractive procedures can be considered in children once their eye power stabilizes. We do not recommend LASIK in children under 18 years of age except in rare cases.

Can children wear contact lenses?
Yes. Children can use contact lenses when indicated therapeutically with the support of their parents. Contact lenses are also an excellent option for older children with a high refractive error who are active athletes. If children are at an appropriate age to care for their lenses and eyes, lenses are an option that can be explored.

What is hyperopia?
Hyperopia (or farsightedness) occurs when light focuses behind the retina due to a short eyeball or low focusing (converging) power of the lens or cornea. It causes near and distant objects to appear blurry and signs and symptoms of farsightedness are increased as the object gets closer to the eye.
Some hyperopia is normal in childhood and correction is usually not required. This is because children can compensate for this on their own by using their natural focusing mechanism or accommodation. A large amount of hyperopia may require correction with converging or plus (+) power glasses. Children with hyperopia can also develop inward deviation of eyes and lazy eyes if left untreated.

What are the symptoms of hyperopia?

  • Nearby objects may appear blurry
  • You may need to squint to see clearly
  • You may have eye strain, including burning eyes, and aching in or around the eyes
  • You have general eye discomfort or a headache after doing close tasks, such as reading, writing, computer work, or drawing, for a time

How is hyperopia treated?
Farsightedness is corrected by spectacles or contacts with convex, or convergent “plus power” lenses. This improves farsightedness in children.

What is astigmatism?
Astigmatism occurs when the cornea or the lens is curved more in one direction than in the other. Rays focus at multiple points (in front and/or behind the retina) instead of one, distorting the vision in the distance and near. The prevalence of astigmatism is highest in infancy and childhood.

What is the treatment for astigmatism?
Astigmatism is corrected by spectacles or contacts with cylindrical lenses. If this is not done early enough, a child can be left with permanently blurred vision in adulthood. Children with high degrees of astigmatism may need an evaluation of associated corneal disorders like keratoconus.

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