 | William L. Park, OD, FAAO is in private practice in Wichita, KS. He works exclusively with patients referred for low vision evaluation, low vision rehabilitation and neurological vision loss. He is a past Director of Low Vision Services, Lions Research & Rehabilitation Center, Wilmer Eye Institute-Johns Hopkins University. Dr. Park can be reached at William L. Park, OD, LLC, www.parklowvision.com, 610 N. Main, Suite 201, Wichita, KS 67203, (316) 440-1690 or drpark@parklowvision.com. |
Vision
2011-05-01 13:04:00
Visual acuity in youth
Question: My family has a history of poor vision that is not correctable to 20/20 due to something being wrong with the back of the eye. I have a 2-year-old daughter who seems to have difficulty seeing things that my other children could see at that age. What should I do?
Answer: A chronicle of your family’s history will be a valuable asset to the doctor while determining a diagnosis for your daughter. This history needs to include previous familial vision diagnoses, general health information, prenatal and postnatal conditions and at what age visual problems were first noticed.
An appointment with a pediatric optometrist or ophthalmologist should be scheduled as soon as possible, since this is a very critical time of development for your child’s visual system.
The initial eye examination should include visual acuity, fixation or attention pattern to contrast. The examination will involve a multitude of tests that will include pupil and external examination, a special cycloplegic retinoscopy, and/or refraction to determine the need for a correction for best visual acuity. This is necessary to determine the health of the eyes (including a dilated examination – to evaluate the inside of the eye) and should be completed as soon as possible. The question of whether both eyes are being used together is extremely critical at this age. Preference for one eye may result in strabismus, commonly referred to as a “lazy eye.” This initial work-up will most likely involve assessment by a multidisciplinary team.
You can help if you have photographs of your daughter that demonstrate the size of the pupils of each eye and the presence of a red reflex that demonstrates any lack of brightness or clouding of one eye versus the other eye. If you have a camera with videotaping capability, record her ability to travel in the environment, reaching for objects, and posture used to play with toys or respond to that toy or object.
Parents’ observations are valuable. Is your home cluttered or do you notice your daughter bumping into objects if it is cluttered? Do you notice strong contrast needs to be present for your child to see the things that are important to her? Does your child see objects placed within her field of vision? Do you need to have larger or smaller toys in order for your child see them and is the color of the toy important?
An eye examination and vision assessment are vital for the detection of conditions that result in blindness, signify serious systemic disease, lead to problems with school performance, or, at worst, threaten the child’s life. Since vision is often difficult to measure in a young child, I recommend teaching children the four symbols we often use to measure their vision as soon as possible.
The pictures we use are Lea symbols:
Visual acuity is only part of the concern. Because children do not complain of visual difficulties, visual acuity measurement (vision screening) is an important part of complete pediatric eye care and, in your case, should be initiated now.
