Eyeglasses in Children

Does my child need glasses? How do I know whether my child needs glasses? Can a parent always tell by observing the child whether glasses are needed? If glasses are needed, do the glasses improve the eye condition or will glasses be needed permanently? Do glasses make farsightedness (hyperopia), nearsightedness (myopia) or astigmatism "go away" or not. If my child needs glasses, should they be worn during all waking hours or only for distance vision or only for reading? Should the glasses be worn for television? And by the way, is it harmful for children to sit close to the TV, or "on top" of the TV as some parents maintain their children wish to sit?

These are all good questions. What are the answers?

First, some kids need glasses as early as four months of age. Which kids? Kids whose eyes are crossed at age four months may need eye muscle surgery but some children are extremely farsighted and glasses may straighten the eyes if prescribed promptly. There are children who need glasses for farsightedness at four months of age and have complete restoration of binocular vision. Glasses for children who have crossed eyes and are very farsighted should wear glasses during all waking hours.

Some children may have one eye that is in focus and one that is out of focus, that is, has excessive farsighted (hyperopic), nearsighted (myopic) or astigmatism. These children will seem to have normal vision judging by their behavior (it turns out that the vision demands of a toddler are not really that great-one can toddle around even with subnormal vision). But an infant or toddler that seems to see normally may have one eye that is very much out of focus. The brain will soon establish more connections with the better seeing eye and fewer connections with the eye that is out of focus. Vision will be further lost in the eye already out of focus. The out of focus eye may remain perfectly aligned with the normally seeing eye, so a physician (not an eye doctor) who looks at the eye will not notice any abnormality despite the fact that one eye has very poor vision.

This condition in which the brain connections are greater to one eye is called amblyopia. This is a common condition affecting one of out of every 40-50 children. In the past, this condition was often not detected until the child had the vision in each eye checked by covering each eye and reading letters or recognizing pictures at age 5 or 6 years of age. By then it was often too late to treat the amblyopia. Parents often feel very guilty they missed a condition in which one eye is legally blind and now the child is too old to treat.

Amblyopia can be detected earlier in one of two ways. First, your child will usually be verbal enough to talk to a stranger (one who is kind and friendly, like your local pediatric ophthalmologist or your pediatrician or family physician) by age three years. At that age the vision in each eye can be assessed using a picture chart. There are even home vision tests for assessing vision at age three years. It is VERY IMPORTANT that your child does not peek. He or she will try to please you by reading the chart with the bad eye, and the kid with one bad eye is the one who will peek. Many kids with amblyopia have escaped early detection when the kid did what he was asked to do: he read the chart, but he "peeked" using his or her good eye and the amblyopia was not detected and treated at an early age.

Second, amblyopia can be detected by a technique known as photorefraction. A picture is taken of each eye in the office of the pediatrician or family physician. By observing the camera reflex from the eye, a skilled technician or physician can detect that one or both eyes is out of focus and suggest a more complete examination by a pediatric ophthalmologist who can tell you whether your child needs glasses.

Third, you could opt for a complete eye exam for your child. When would be the best time for this initial eye exam? If you have a family history of an eye disease that begins at a young age, such as cataracts that develop in childhood or retinoblastoma (the most common malignant eye tumor in children), your child needs an eye exam in the first two months of life. If there is a family history of amblyopia (" lazy eye") or eye muscle problems, it would be best to have an eye exam between ages 6 and 12 months of age. If your child appears to see normally and the eyes line up and work together, the best time for a complete eye exam would be between ages three and four years. It may seem like a large expense if your child has normal vision and normal eyes; but remember, by age three or four years most parents will have already had their child's teeth checked. These are teeth that will come out and be replaced by normal ones. Teeth can be replaced with fully functional ones made of synthetic polymers. Once vision is lost to amblyopia. sight can usually only be regained during a critical period in childhood. That period may be only 2-4 years of life. The first two to four years, which are the most important years in visual development. Considering that the life expectancy of a child born today is probably about 90 years, an early eye exam or at least a screening test at a young age is an excellent investment.

Some children are extremely nearsighted (myopic) at a young age. By age two or three years, these kids will be really sitting up close to the TV as well as holding objects us close to their face. These kids usually take readily to glasses and wear them quite well.

Some other kids have larger amounts of astigmatism (eye is not shaped completely round like a basketball but is shaped more oval like a football). Kids with large amounts of astigmatism will often wear glasses well at age 1-3 years. Many other kids have only small amounts of astigmatism and do not require glasses at all. Sometimes the astigmatism" goes away" by itself, other times glasses are needed at an older age for reading and schoolwork. If the astigmatism is very large or present in a larger amount in only one eye, glasses may be needed during all waking hours.

Glasses do not make astigmatism "go away." Glasses do not change the shape of the eye. The eye undergoes natural slight changes in shape with age and astigmatism may increase or decrease in amount depending on the growth of the eye.

The most common form of nearsightedness (myopia: vision is better at near than distance) does not begin until about age 5-7 years of age, sometimes later. In general, the earlier the nearsightedness begins, the more nearsighted the child will ultimately become. Usually the nearsightness increases in amount every year as the child grows. The greatest changes occur between age six and twelve, but many children continue to become more nearsighted even as teenagers. There have been many, many forms of treatment to attempt to prevent myopia or nearsightedness from developing or progressing (for example, eye drops that keep the eyes dilated, bifocals or hard contact lenses). But the only therapy that has been proven effective is refractive surgery, such as LASIK (laser-in-Situ-Keratomileusis) and radial keratotomy in which multiple small incisions are made in the front clear part of the eye called the cornea. In general, this surgery is not done until the eye has finished its growth or age 18-21 years of age. A few children have undergone these procedures but most kids' nearsightedness is best treated with glasses or contact lenses.

Wearing glasses does not make your child become less nearsighted. In fact, the opposite may well be true: wearing glasses for nearsightedness may increase the nearsightedness by causing the eye to focus more at near than a child would without the glasses. This extra focusing at near MAY contribute to an increase in nearsightedness in some children.

If your child is only slightly nearsighted, it may well be best simply to avoid glasses and obtain another eye exam in six to twelve months. If your child needs glasses for small amounts of nearsightedness and can still see clearly at near, it is best for your child to remove the glasses for reading other near work. If your child is significantly nearsighted and needs glasses simply to get around well, it is probably best to wear the glasses almost all the time.

Who is the best person to check your kid's eyes? An ophthalmologist or optometrist is skilled at checking the focusing of the eyes. But the visual needs of children are far different from adults. Children may need glasses for all waking hours to treat amblyopia. Other children whose eyes are only slightly out of focus may be best served by not wearing glasses at all. Glasses for kids can be very expensive: a two year old may easily need new glasses every two to three months at $150 or more for each pair. So a parent should be very careful who makes the decision regarding their kids' vision.

The person with the most experience in making a decision regarding your child's need for glasses is a professional that sees only children and specializes in children's eye problems. This person is a pediatric ophthalmologist: this professional sees many children every day and studies only eye problems in kids: he is the best person to see for this important decision regarding your child's vision.