Children’s Eye Care – Common Question of Parents

Ideally at 2.5 to 3yrs of age. At any case it should be before the age of 5 years. Certain problems such as unequal spectacle number or a number only in one eye can be detected by the doctor even at that age and rectified by correct glasses or even a contact lens in one eye if there is a number only in that eye. This will prevent the development of a “lazy” eye. Remember the doctor does not need the co-operation of the child. It is also not necessary that the child know how to read the alphabet to test for spectacle numbers!

It is the parents’ attitude, which often governs the child’s like or dislike of wearing glasses. The parents should use large dollops of love and patience to convince the child to wear the prescribed glasses. Let the child get used to them gradually – to wear for 10 minutes on the first day, half an hour on the second day and so on, instead of insisting that the child wears it during all waking hours from day one.

Excimer laser surgery to correct spectacle number is not recommended till the child is at least 18 years of age and the number has stabilized i.e. it has not increased in the past one year.

No, usually as the child grows up, the eyeball also grows in length. Thus, plus numbers have a tendency to decrease with time.

NO. Minus numbers is referred to as ‘myopia’ or short sight. This means that the child can see well for near but has problems seeing for distance. This is because the focusing system of the eye i.e. the cornea and the lens bend the rays of light too much so that they focus in front of the retina. Hence myopia means the eye is too strong or powerful and certainly not weak.

As the eyeball grows, the retina moves further back in relation to the cornea and lens. Hence it is likely that a minus number may increase with time. There is no medically accepted method by which this can be prevented, including use of contact lens. In fact this is like making your child wear a hard hat over his head to prevent the height from increasing! However, it is a fact that numbers, like height are genetically predetermined and so a child’s minus number could stop increasing suddenly at say age 12 or 14. If at that time, the child was doing natural exercises or wearing a contact lens or putting honey in the eyes or even practicing urine therapy, that particular treatment is given wide publicity by gullible parents. This results in neighbours, friends and relatives insisting that this or that therapy is incredibly successful in preventing increase in numbers!

There is growing evidence that children who spend more time outdoors in physical activity have less increase in minus number.

To a large extent, minus numbers are genetically predetermined and their extent of increase not in our control. However, in an interesting study done in Japan, children from similar genetic stock were divided into 2 groups. One group studied only in English for 10 years while the other studied only in the complicated Japanese script. At the end of the 10-year period, there were more students wearing minus numbered glasses in the Japanese script group. Thus there is an environmental component perhaps to an increase in numbers – though there is no universal agreement on this subject.

NO. The child should be encouraged to grow up normally and in fact encouraged to take up physical activity. Most children who are shortsighted end up preferring indoor activities and books rather than outdoor sports. It is up to the parents to push the child to explore the world outside the house with their glasses on. It is true that myopes are more prone to retinal detachment. However, an annual retinal examination by your eye doctor will reveal any thinned out areas of the retina requiring preventive treatment. If none exist, no restrictions need apply in spite of there being a “high” minus number. In fact, as mentioned in an earlier answer, outdoor activities seem to benefit children with minus numbers.. the number increases less rapidly!

If the change in numbers is slow and steady, once a year may be sufficient. However, if the child has visual complaints or headaches, it means the numbers have changed and the child may need to be taken for a checkup oftener, Remember, the optician can only check for numbers –he is not qualified to examine the retina, which the eye doctor will do at every visit. Also, many opticians rely on fancy “computer” machines to prescribe glasses in children. These suffer from many inadequacies in children and are not a substitute for the old fashioned manual examination that most eye doctors will carry out.

NO. ‘Shaking eyes’ or nystagmus as it is called is a to and fro searching movement of the eyes, as the central portion of the retina, which deals with fine vision, is not fully developed. This is common in albinos or children with a deficiency of skin pigmentation. It also occurs in some other conditions. In most of these conditions, the vision improves with time and the nystagmus decreases in extent and amplitude over the years.

Children should be taught correct visual habits:

1. They should watch TV or read always being in the sitting up position, not lying down either on tummy or on back.
2. They should always view TV or the computer screen directly and not be placed at an angle
3. They should take breaks every 30-45 minutes for at least 30 seconds to a minute, whenever they use their eyes with concentration such as while reading, watching TV or the computer. By taking a break is meant looking far out into the distance or simply gently shutting their eyes.
4. They should read in a room with adequate light. Generally speaking bulbs are better for the eyes than tube lights. This does not mean that every parent should change the light fixtures in the room. Many children forget to switch on the room lights at dusk, so engrossed are they in their reading. Reading in poor light causes a strain on the eyes. This should be avoided.
5. Whenever the child has extra studying to be done, such as during examinations, it is better to wake up early and read when the eyes are fresh rather than read late into the night, when the eyes are already tired having been strained throughout the day. The old grandmother adage of “early to bed, early to rise” is excellent advice for kids appearing for exams.
6. Children should avoid reading or playing video games in moving vehicles, such as cars, trains etc. It is difficult to concentrate on the matter being read or looked at with so many bumps on the road- this causes more strain on the eyes. Reading in an airplane is OK, of course!

It was all right in our grandmother’s time, when better remedies were not available. However, it is better to use simple lubricant drops which are sterile and available over the counter, without a prescription, whenever the eyes feel tired or sore, rather than putting any home made substance into the eye, for fear of infection.

There is no scientific rationale for walking bare feet on green grass. It is neither beneficial nor harmful for the eyes.

None of these are of any lasting benefit in reducing the number of spectacles, nor do they benefit the eyes in any way.

Our normal Indian vegetarian diet with pulses, vegetables (green and otherwise), chapattis and rice contains adequate amount of vitamin A for the growing child. All non-vegetarian diets also contain adequate amounts of vitamin A. If the child is a fussy eater, does not eat home food in adequate quantities, survives on junk foods from fast food restaurants, he/she is probably not getting adequate amounts of vitamin A. In such cases, 2 glasses of milk per day is recommended. Too much of vitamin A, such as by giving daily doses of carrot juice can actually harm the child – males can have a higher incidence of sterility or inability to bear children in adulthood!

Avoid sending him to crowded areas such as swimming pools. If there is a child with conjunctivitis (sore eyes) with discharge from the eyes and not just redness, he should not attend school till the discharge subsides as this child can infect others. If a sibling at home has the infection, he should avoid physical contact with the sibling till the discharge from the eyes subsides. Needless to add, a child with conjunctivitis should have his/her clothes, handkerchiefs etc washed separately to avoid spread of infection.

Ask your family physician or nearest eye doctor about the drops. Usually epidemics of sore eyes are due to viruses and are self limiting. You may use mild antibiotics to prevent or treat secondary bacterial infection. Avoid taking the opinion of the “all-knowing” chemist… in most cases he will prescribe drops containing steroids… which need to be used with caution and only under medical supervision. They can convert a simple “sore eye” into a fungal ulcer, resulting in blindness if the steroid use is prolonged! Only the infected eye should receive the simple antibiotic drops. There is no role of preventive drops as anti-bacterial drops will not prevent viral conjunctivitis. Sometimes abuse of these drops may do more harm than good.

Yes and No. You should be concerned enough to take the child to your eye doctor. After examination, he will tell you in most cases that the eye is absolutely normal. However, the pipes which take the waste matter from our eyes including our tears and deposit this at the back of the nose from where they pass down the throat are blocked or have not canalised since birth. In the womb, these pipes are solid rod like structures and turn into ‘pipes’ or develop a lumen shortly before birth. Sometimes this process is delayed and can happen a few months after birth. So he will reassure you. While waiting for nature to take its course, he will recommend “massage” over the area between the eye and nose, so as to loosen the plugs of cells still in the lumen of the pipes (called nasolacrimal passages-NLP)). He may recommend simple antibiotic drops whenever there is discharge.

In 90% cases of delayed opening of the NLP, they open and the watering ceases before the child’s first birthday. In case there is no reduction in watering by the time the child is 9-10 months of age, your doctor may elect to do a simple procedure called “probing” under a short general anaesthesia. In this, sterile fine blunt probes are passed to ‘unclog’ the NLP. This is much like the plumber passing probes to relieve a choked up basin outlet. Most eye doctors recommend this procedure before or around the child’s first birthday. The later it is done, the less the chance of success.

Your doctor may still attempt a probing, with less than 50% chance of success. If it does not work, the passage may need to be opened by use of lasers or by a regular surgery to create a new passage and ‘bypass’ the old one. This procedure is known as DCR or Dacryocystorhinostomy.

This is a very common problem in India. For “Allergic Conjunctivitis” avoid doctor shopping! Understand there is no magic cure. However, most children outgrow the disease with time.. may take a few years. There are many non-steroidal eye drops that work in a majority of cases. It is important to use steroid drops as sparingly as possible and under strict supervision by your doctor. Many a time, the allergic conjunctivitis may leave no permanent defect in the eye, but abuse of steroids can cause cataract, glaucoma, corneal infections and even blindness!