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Vision Troubles in Kids Often Go Undetected


Most people accept the fact that their eyesight will eventually worsen. But vision problems are common among young children too, with about 5% to 10% of all preschool children having some sort of visual impairment. And because too few children are screened, many problems go undetected--and uncorrected.

Among the most common correctable visual problems in children are amblyopia (partial loss of vision in one eye) and strabismus (misalignment of the eyes). Early treatment is important--not just to restore normal vision, but to prevent permanent vision loss.

Regular vision testing in children is widely advised by pediatricians and ophthalmologists alike. The American Academy of Pediatrics recommends that all infants' eyes be regularly examined for evidence of eye disease such as misalignment and cataracts. The exams can be performed as a part of routine check-ups; the first examination, however, should be performed before six months of age. Formal vision testing should begin at 3 years of age when visual acuity can be evaluated more easily.

Often, screening tests are skipped simply because parents (and, sometimes, physicians) believe their children are too young. After all, how do you test an infant or young child who can't talk--or even sit still?

Child vision specialists have come up with some answers. For example, the classic vision test--the Snellen test--has been modified in several ways.

The "tumbling E" version, for example, uses only the letter E (the child must only identify the direction in which the "arms" of the E are pointing); the Allen card uses schematic figures that a young child would recognize, such as a truck, a house, a birthday cake, a horse and a tree.

Unfortunately, even these simplified tests cannot be used effectively until a child is at least 3 years old, and many children develop visual problems well before this age. For these children, an innovative new tool called photoscreening can help. Photoscreening uses a camera or video system to examine the inner eye, allowing problems such as strabismus or a refractive error to be detected with very little cooperation required of the child.

(While this technique is easier to use than typical vision acuity tests in younger children, doctors don't consider it superior to traditional vision tests for older children.)

Despite the availability of these screenings, surveys show that only about half of all 3-year-olds are currently being tested for visual problems. That figure could undoubtedly be improved if parents would discuss vision testing with their child's doctor, and, if necessary, request the tests.

Parents should also be on the lookout for telltale signs and symptoms of visual problems. Do the child's eyes appear straight? Or does one eye seem to gaze straight ahead while the other eye turns inward, upward, downward or outward? Does the child complain that it is difficult to see or that he or she has double vision? Certain behaviors could indicate a visual problem. For example, children may squint, tilt their head, or shut or cover one eye to try to bring things into focus. Any concerns that arise about a child's vision should be brought immediately to the attention of a physician. Although poor eyesight may be an inevitable and irreversible part of growing old, it is frequently a highly treatable and potentially reversible condition in children.


Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. Their column appears the second and fourth Mondays of the month. Send questions by e-mail to They cannot respond to every query.

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