- The Washington Times - Sunday, March 19, 2000

Allison Brake's daughter Alex was only a few weeks old when Mrs. Brake suspected her baby might have a vision problem.
"I noticed she never looked at my face when she nursed," the Reston mother says. "She would look at the plant ledge behind me."
Indeed, Alex was quite farsighted. She got her first pair of glasses at age 3. The world was a different place.
"The day we got her glasses, she looked at my husband and said, 'Daddy, you have blue eyes,' " Mrs. Brake says. "She had never seen his face."
A year later, Alex's twin sister, Blair, also was prescribed glasses for less-severe astigmatism and farsightedness.
Mrs. Brake was particularly vigilant in watching her daughters for signs of vision trouble. The twins were born six weeks early, putting them at greater risk than usual for nearsightedness and other eye complications that can accompany premature birth. Several years earlier, Mrs. Brake had had a rare and serious eye tumor removed from her left eye.
Even without obvious signs or a genetic history of a vision disorder, it is important for parents to get children's eyes checked routinely, says Dr. Harold Koller, chairman of the American Academy of Pediatrics' section on ophthalmology.
The best place to begin this is in the pediatrician's office, where simple eye tests can be done at checkups from infancy through childhood. A suspected problem can be referred to a pediatric ophthalmologist, who has sophisticated equipment and training in dealing with children's eyes.
Dr. Koller says it is important to know the stages of a child's visual development so parents can be on the lookout for any signs of trouble.

Newborns' eyes

When a baby is born, he can see forms and shadows. His mother's face will come into focus when the baby is between 1 and 3 weeks old. By 2 or 3 months, the child's color vision develops.
"Usually by the fourth month, a baby's vision will be in the 20/200 to 20/100 range," Dr. Koller says. "By age 3, a child's vision is usually 20/20."
By 3 to 4 months, a baby's eyes should work in alignment with each other. A pediatrician should check the child's eye alignment at a well-baby exam, Dr. Koller says.
A constant crossing of the eyes or an eye that turns out may mean the baby has strabismus, a condition that results from faulty nerve impulses between the brain and the muscles that control eye movement. The easiest way to determine whether a baby's eyes are in sync is to hold a toy about 12 to 18 inches in front of his face and move it back and forth. Both eyes should simultaneously track the toy.
Strabismus affects about 4 percent of American children. Its treatment varies. It sometimes can be corrected with glasses or an eye patch over one eye, but often surgery is needed, Dr. Koller says.
Premature infants, particularly those born more than eight weeks early, need to be examined in the hospital and tracked weekly after release for signs of retinopathy of prematurity (ROP), says Dr. Mohamad Jaafar, chairman of the department of ophthalmology at Children's National Medical Center in the District.
ROP is a disorder in which blood vessels in the retina develop abnormally, causing bleeding and, in the worst cases, detached retinas and blindness. Mild ROP often heals on its own, but sometimes laser surgery is necessary. Even if ROP heals, the infant has an increased risk of nearsightedness.
Dr. Jaafar says it is not neces-sary to furnish a baby's room with the red-black-and-white toys on the market that are promoted as stimulating to baby's visual and brain development.
"The very fact that a baby is using his eyes is good enough stimulation," he says. "Babies like to watch mobiles. They like to watch parents' faces. They are very much attracted by human faces. They don't really need anything extra."
There also is little value, he says, in a University of Pennsylvania study released last year that said babies who sleep with a night light until age 2 may be as much as 50 percent more likely to develop myopia (nearsightedness) when they grow older.
The researchers pointed out that they had failed to take into account factors such as heredity or the proximity of streetlights to the bedroom window in the study of 479 children.
"It is an interesting concept," Dr. Jaafar says, "but not a good theory."

Preschool problems

Observing a young child's playing habits may offer clues to a vision problem. "Get an eye exam if there is something that doesn't look right," Dr. Jaafar says. "A child sitting close to the TV or holding books too close or complaining of headaches may indicate a problem."
Besides myopia (nearsightedness), a common problem at this age is amblyopia, also called lazy eye. Amblyopia, which affects about 2 percent of children, is what occurs if strabismus escalates and the eyes never learn to focus together.
"Lazy eye is really lazy vision," Dr. Koller says. "When one eye does not see as well as the other, the brain relies on the stronger eye, which causes the weaker eye to atrophy."
A symptom of amblyopia is covering or closing one eye when trying to focus on something.
It is very important to discover and treat this condition early, Dr. Koller says. The typical treatment for amblyopia is for the child to wear a patch over or drops in the good eye for a period of time to retrain the bad eye.
"If we catch it and begin treating a child by age 3, he has a good chance of treating it," Dr. Koller says. "By age 5, it is difficult. By age 9 or 10, it is almost impossible."

Growing in, out of eye problems

As children begin to learn to read, vision troubles may become more apparent.
Signs of a vision problem or visual-processing problem could be frequently rubbing the eyes, having frequent headaches, performing below potential in school and having poor hand-eye coordination.
If a child says nearby objects look blurry, he may be farsighted. (Farsightedness also is called hyperopia). Hyperopia is less common than myopia (nearsightedness), and many children outgrow it by age 12, Dr. Koller says. Many children also have some degree of astigmatism, which is an irregular corneal shape that may result in blurred vision.
A child who squints and complains she can't see things far away, such as a movie screen or the blackboard, may be nearsighted, Dr. Koller says. Nearsightedness usually starts in the early school years. While it can be corrected with glasses, the degree of nearsightedness usually keeps increasing until the midteen years, so frequent exams by an ophthalmologist or optometrist are necessary.
Myopia, which affects an estimated one in four children, is on the rise, but ophthalmologists are puzzled as to why.
"We are seeing more and more nearsightedness than we did a generation ago," Dr. Jaafar says. "It may be because we are doing so much more 'near work' than our parents did. While there is no evidence at all that working on a computer is harmful, the suspicion is that excessive near work is making children even more nearsighted."

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