Spectacles for children and infants Guidelines for parents/caregivers
What is refractive error?
Refractive error is a condition wherein the rays of light do not form a focused image at the correct plane in the eye. Myopia or ‘far sightedness’ is seen in about 30 out of every 100 persons in the population, with a much higher prevalence in school going children. Hypermetropia or ‘near sightedness’ is less common, but if not detected early it is more damaging to vision. Both show a familial tendency. So families with history of these disorders should get their children evaluated early.
Why is it important to treat it at the earliest?
This is usually a minor disorder, as it can be easily rectified with the use of glasses. However, if undetected for long, it can permanently affect development of vision.
What is the treatment?
Use of spectacles is the simple answer in a vast majority. However, if it has been detected late in a child with either a ‘high number’ or a significant difference in the spectacle number between the two eyes, there may be a significant weakness in the vision of the eye with the larger number-the so called ‘lazy eye.’ This may need occlusion therapy. (Described below)
When should you suspect that your child has a refractive error?
If you find that your child is unable to see things that are at a distance clearly, rubs or squeezes his eyes often, has repeated styes’ in the eye, adopts a different head posture with tilting of the head or chin when focusing on anything intently, it is quite likely, that your child needs to be evaluated to rule out a refractive error.
Can a baby’s eyes be tested satisfactorily for glasses?
Yes, after using dilating drops to dilate the pupil, the baby’s eyes are checked up with an instrument called retinoscope. This method can assess accurately if the baby has a need for glasses.
What are the kinds of frames that are suitable for children?
Plastic glasses with plastic frames are safe for children, though plastic is more prone to scratches. Rolled or flared nose pads ensure that the glasses do not slide down the child’s nasal bridge.
Cable temples secure glasses by curling around the ears. They are very convenient especially in hyperactive children.
In infants’ glasses, straps are used in place of ear pieces. These straps go around the back and over the top of the head. This ensures stability of the glasses in all positions.
Plastic or polycarbonate lenses are lighter and safer than glass lenses and hence preferable in children.
Those children who play a lot of contact sports or activities associated with a high risk of injury, should get special protective glasses and frames.
How can you care for your child’s glasses?
Children should be taught to remove their glasses with both hands, to avoid wear and tear on the temples. Cleaning should be done with water or a liqiod soap and soft cloth.The glasses should not be kept with face down.
When should your child undergo a regular eye check- up to assess vision and the need for spectacles?
According to the guidelines laid down by American Academy of Ophthalmology, all children should have a comprehensive eye examination by their 4th birthday, if vision appears to be developing normally, and every 2 years thereafter.
Certainly by pre-school your child should have regular eye examinations to maintain proper eye health.
When should you bring your child for a check-up?
Your pediatrician should examine your child’s eyes during the first year of life. If he suspects any abnormality or there is a family history of squint, childhood cataract or any other eye disorder , your child needs a thorough evaluation by a pediatric ophthalmologist at the earliest.
Even in a child with apparently normal vision a comprehensive eye examination by the 4th birthday is recommended and every 2 years thereafter. Certainly by pre-school your child should have regular eye examinations to maintain proper eye health.
Some of the warning signs that should prompt a visit to the ophthalmologist are-
One eye turns in toward the nose or wanders outwards, either constantly or occasionally; eyes that do not appear to look in the same direction
Child tilts or turns head or chin when looking intently
One eye closes occasionally, especially when the child is outside
Eyes vibrate
Child covers one eye to look at things
Squeezes eyes nearly closed to see
Cannot identify things across the room or farther away
Frequent rubbing of eye
Discharge from eyes or teary eyes, when not crying
Droopy eyelids
A white pupil in either or both eyes
Any difference in size, shape or color of any part of the eye (i.e. pupil) or eyelids
HOD – Optometry
Yogeshwari Bansal
Reffractive Error Low Vision, Contact Lens
MSc Optometry, FIACLE, FLVPEI
yogeshwari@icarehospital.org
The definition of myopia is “a condition in which the spherical equivalent objective refractive error is ≤ –0.50 diopter (–0.50 D) in either eye.• The definition of high myopia is “a condition in which the spherical equivalent objective refractive error is ≤ –5.00 D in either eye”.
Myopia and high myopia were estimated to affect 27% (1893 million) and 2.8% (170 million) of the world population, respectively, in 2010. According to published studies, the prevalence of myopia is highest in east Asia, where China, Japan, the Republic of Korea and Singapore have a prevalence of approximately 50%, and lower in Australia, Europe and north and south America (WHO). Myopia is the most common type of refractive error which is a trait including both genetic and environmental factors.
Access to correction for myopia is available to avoid vision impairment. All people with myopia should have regular access to appropriate, accurate refractive correction.
Myopia control
Although there is a widely held clinical view that undercorrection of myopia is beneficial in preventing its progression, the available evidence does not support this idea. Recent reports show that undercorrection is associated with a higher rate of progression of myopia.
Some initial published evidence indicates that time spent outdoors can delay the onset and perhaps reduce the progression of myopia, although more research is required, as it is also potentially a risk factor. If the evidence is proved correct, it will add beneficial eye care to the list of other health-promoting outdoor activities (e.g. reduction of childhood obesity through exercise, exposure to sunlight for vitamin D production, games for socialization). There is published evidence that excessive near work increases the risk of myopia.More outdoor activities should be promoted to delay the onset and timely change of glasses and regular follow ups are mandatoty.
