Yes, children need eye examinations!

By Henrylito D. Tacio
PARENTS usually bring their infants for vaccinations.  As the kids are growing, parents also accompany them for dental check-ups.  But what about eye examinations – are parents aware of the importance of these tests?
Since she was four, Marianne has been wearing glasses, which was prescribed by an optometrist aunt who works in a mall.  Her parents do not have vision problems so they were surprised when they were told by their daughter’s teacher that Marianne’s left eye was inwardly turned when drawing on her notebook.  So, they mother decided to bring her daughter to a pediatric ophthalmologist.
On her first visit, Marianne’s visual acuity was 20/50 on the right and only 20/100 on the left, even while wearing the glasses.  (Visual acuity, of the measure of vision, is expressed as a fraction.  The top number refers to the distance you stand away from the Snellen eye chart, usually 20 feet.  The bottom number indicates the distance at which a person with normal eyesight could read the same line you correctly read.  The lesser the bottom number in the visual acuity ratio, the better the acuity; and the greater the bottom number, the worse the acuity.)
When Marianne’s ability to focus was relaxed and her refraction was measured, the mother was shocked to find out that her daughter’s glasses was just half the amount of correction that she should be wearing for hyperopia (farsightedness).
Most Filipino parents don’t know that their children need eye examinations because parents themselves are not educated on this.  “They didn’t go through such examinations and didn’t have a significant eye problem, so what’s the use of bringing their kids to the experts?” asked Dr. Alvina Pauline Santiago, a consultant in pediatric ophthalmology at the Philippine General Hospital. 
There is also that misconception that an eye examination cannot be performed until a child will cooperate for Snellen chart testing, and refinement of refraction.  Another is the lack of support from pediatricians “for whatever reason,” to quote the words of Dr. Santiago.  In some instances, ophthalmologists themselves are less than willing to perform pediatric eye examinations and recommendation of bringing back the child when he starts to read.
But the eyes of children must be examined before it’s too late.  A national survey conducted found that nearly seven out of ten children under age six have never had an eye examination. And, of those children who had been checked, only 30 percent had been seen by an eye expert.  This survey was conducted in the United States.  What about in the Philippines?
“Unfortunately, there are no national statistics on the prevalence of vision problems in children in our country,” admits Dr. Maria Imelda Yap-Veloso, an ophthalmologist at the Asian Eye Institute in Makati City. 
However, Dr. Barbara Roque estimates that about 20 percent of grade school children have vision problems, including refractive errors (nearsightedness, farsightedness, astigmatism), amblyopia (lazy eye), and strabismus (squint or eye deviation).  “Some children actually have all three,” the pediatric ophthalmologist with the Eye Republic Ophthalmology Clinic in Manila claims.
Without a comprehensive eye exam by eye experts, many children have vision problems that can go undiagnosed, and may even be misdiagnosed as a learning disorder like dyslexia or attention deficit hyperactive disorder.
The Philippine Society of Pediatric Ophthalmologists and Strabismus identifies kids with parents with eye problems in the high risk group of developing or having visual problems.  Children with siblings diagnosed with an eye problem should also belong this high risk group and should be screened early in life.
“Children with vision problems should be treated early in life,” says Dr. Yap-Veloso.  “This is because the future visual potential of a person develops during childhood.  Any problem interfering with the patient’s vision should be aided or corrected early so full visual potential in the future may be realized.”
Take the case of amblyopia, a condition where one eye cannot see well, and the other takes over for the both.  “It is very difficult to treat amblyopia when the condition is discovered after the age of 8,” says Dr. Roque.  “Clinical studies show that amblyopia therapy after this age results to minimal improvement in visual acuity, compared to when the treatment started earlier.  Most of the neurons connecting to the eyes to the brain are already fully developed or matured around this age.”
Ideally, when should parents bring their children for eye examinations?  “The first phase of vision screening should happen at birth,” says Dr. Roque.  Pediatricians could play a big role by including the following tests before discharging a baby from the hospital:  checking for symmetry of both eyes and eyelids, measurement of corneal diameters, checking of papillary reflexes, and checking for clarity of the visual axes (that is, look for opacities involving the cornea, lens and vitreous) while the pupils are dilated.  
The second phase of visual screening is around the age of 2-3 years.  “A child’s visual acuity can be tested at this age using picture charts or Snellen charts if the child is familiar with the alphabet already,” informs Dr. Roque.  “The last phase should be just before entering primary school.”
“I would definitely recommend an eye examination on the third and fourth year of life before pre-schooling starts,” says Dr. Yap-Veloso.  “If the exam is normal, every two to three years will suffice.  Any eye symptoms and strong family history for eye problems should however warrant an earlier check-up with an ophthalmologist or eye specialist.  Follow-up visits would depend on the nature of the problem.”
Parents don’t need a referral from their pediatrician or family doctor for their child’s eye check-ups.  “Similar rates are charge for both children and adults,” says Dr. Yap-Veloso.  Usually, it ranges from P500 to P800 per consultation.  “However, if extra tests/measurements or adjunctive diagnostic procedures are needed, there may be additional charges.”
Some insurance companies cover for consultations and eye examinations when the child is two years and older. “Different health insurances have different clauses,” says Dr. Santiago.  “As a general rule, the eye exam is usually covered.”
What if the examination is already too late – when the child is already nine years old or so?  “Once the developing years are over, for many eye problems late correction may no longer be beneficial,” says Dr. Santiago. 
“The developing visual system requires equal stimulation from both eyes and that the image obtained by the eye is clear and steady,” Dr. Santiago explains.  “The period when the visual system is most responsive to stimulation is the first two years of life, but the visual system remains plastic and moldable up to about seven years.  When the visual system is not stimulated, the visual system does not develop, and fails to achieve its full potential if intervention is late.”
Whatever happened to Marianne?  The doctor gave her a new prescription for the glasses and after six weeks of wearing them full time, her visual acuity improved to 20/20 on the right and 20/50 on the left eye.  Her eyes were also well-aligned.  The doctor then started amblyopia therapy on the left eye by patching the good (right) eye when doing her homework. 
Six month later, Marianne’s visual acuity on the left improved to 20/25.  Her mother now boasts that her daughter gets A’s in her art class and in math.  “I would never have thought to get my daughter’s eye tested, but I’m so glad I did,” she says.  — ###


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