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What Parents Should Know Before They Bring Their Child to an Eye Exam
As children enter kindergarten and elementary school, good vision will become an important part of learning. Here are some key facts parents should know about pediatric eye exams, and the important role they play in a child’s overall health and development.
- Vision screening for kids isn’t one and done. Because kids’ vision can change over time, child vision screenings should be done at least once a year. Some vision problems, such as nearsightedness, may not emerge until kids are older, around age 8 or 9, and growth spurts can also contribute to a rapid change in vision.
- Many parents may not even be aware that their child is experiencing vision problems until a problem is detected by a vision screening.Vision screenings are important because young children often don’t realize what is or isn’t normal, and are not likely to speak up if they’re not seeing as well as they should.
- The signs that your child may be experiencing vision problems can be subtle and can include squinting; tilting or turning the head to see something; eye misalignment (strabismus); complaining of headaches when doing visual tasks; inability to see things that are far away as well as peers/parents; trouble concentrating or fatigue in school; and having a persistent, unusual spot in his eyes in photos taken with a flash (a white spot, for example, instead of the common red eyes), which can indicate nearsightedness or in some cases, a more serious eye disease.
- Sitting close to the TV or holding things such as books very close to the face could also indicate a vision problem, but since these are common kid behaviors in all kids, parents should look for these symptoms in combination with the other signs that their child is having trouble seeing well, says Mae Millicent W. Peterseim, MD, a pediatric ophthalmologist at the Storm Eye Institute/Medical University of South Carolina.
- It is very important to catch vision problems early. Some conditions, such as amblyopia, or “lazy eye,” are most treatable when caught at a young age, and are difficult to fix if it’s diagnosed when a child is older, around age 7 or more. For instance, a child may have poor vision in one eye but see well enough with both so that the problem isn’t detected; only a vision screening that tests a child’s vision one eye at a time would detect such a problem. (Amblyopia is usually treated with glasses and sometimes patching.) “It’s heartbreaking to hear a child say, ‘I thought everyone could see better with one eye,” says Dr. Peterseim.
- Once a problem is detected, a child should undergo a comprehensive eye exam. If a screening exam indicates a vision problem, a child will be referred to an ophthalmologist or optometrist for a complete eye exam. “At an eye exam, at the eye doctor’s office, the technician will check vision and should do a test of depth perception,” says Dr. Peterseim. The doctor will check to see how well the eyes track something and how well they move and focus on objects (looking at each eye independently by covering one first and then the other). She will also examine the retina and optic nerve and check the eyes for any signs of infection or disease.
- There are exciting new screening tests for children. “Newer instrument-based screening works well and can pick up problems in children earlier,” says Dr. Peterseim. “A child looks at the device with a twinkling light and the machine detects abnormalities in a moment, like a camera, so minimal cooperation is needed.” This method is a bit more expensive, but it’s fast, easy, and effective. New AAP policy is recommending instrument-based screenings for children as young as 12 months old, says Dr. Peterseim.
- Eye exams are particularly important for school-age children. Children learn a lot visually in the classroom, and poor vision can have a negative effect on how a child does in school. That’s why it’s particularly important for school-age children to continue to get regular vision screenings, whether at school or at the doctor’s office.
- Parents play an important role in protecting kids’ vision. Follow up on screening test results and/or if you spot any signs your child may have a vision problem. Look for a pediatric ophthalmologist or optometrist, or a doctor who is comfortable with children and is experienced in caring for kids’ eyes. For instance, kids tend to peek when asked to cover one eye, so a doctor should know to use a patch or cover an eye well during the exam. Doctors should also dilate pupils during an eye exam. “It is important that the child have drops to dilate the pupils to determine if he really needs glasses,” says Dr. Peterseim. “Some doctors skip this step. If your child’s eye doctor doesn’t do this, a parent should ask, or go somewhere else.”
By Christina Ianzito, AARP, May 15, 2019 | Comments: 0
The side effects of the shingles virus can range from extremely unpleasant to nightmarish, especially when the virus affects the eye. Unfortunately, shingles of the eye is rising dramatically, according to researchers at the University of Michigan’s Kellogg Eye Center who found that the incidence has tripled since 2004.
The study results were presented at the 2019 Association for Research in Vision and Ophthalmology meeting in Vancouver recently and given how dramatic the findings are, says lead author Nakul Shekhawat, “we are now looking at overall incidences of shingles in that time frame and seeing if there’s a similar pattern.”
Shingles is caused by the varicella-zoster virus, which first enters the body as chickenpox (which nearly every adult over 40 had as a child) and never leaves. It stays dormant in sensory nerve roots, and in about one-third of us, reactivates later in life as shingles. Its most common early symptoms are itching, tingling or pain, followed by an angry red rash along the nerve path traveled by the virus — the path depends on where the virus has been “sleeping.”
It often appears as an angry red rash on the torso, but about 20 percent of cases show up in the eye area on one side of the face — typically with redness on and around the eyelid, and sometimes on the forehead and scalp.
“It can be confusing and is often misdiagnosed in the early stages,” says James Chodosh, an ophthalmologist with expertise in viruses at Massachusetts Eye and Ear in Boston. “Sometimes people complain of a headache, or think it’s a skin infection, or allergy. It’s only when the characteristic rash comes out that patients are more definitively diagnosed, and that can lag.”
It’s most dangerous when it affects the cornea (the clear, front part of the eye), which can result in vision loss, and, in rare cases, blindness. It’s also “very painful,” says Shekhawat, “Because the cornea has a dense concentration of nerves. It’s one of the most sensitive parts of the body.”
Shingles is typically successfully treated with antiviral medication, but in about 20 percent of cases results in post herpetic neuralgia — chronic pain that lingers long after the infection subsides. The treatment is more effective sooner than later, which is why it’s important see a doctor as soon as you suspect you may have shingles, preferably within 72 hours, says Keith Baratz, ophthalmologist at the Mayo Clinic in Minnesota: “Time is of the essence.”
Shekhawat says the increase in shingles cases may be attributed to the aging of the population — as we age our immune systems weaken and have a tougher time fighting off the virus when it tries to reactivate.
The good news: The shingles vaccine is extremely effective.
The CDC recommends that people 50 or older get the latest vaccine, Shingrix, even if they’ve already been vaccinated with the older vaccine, Zostavax. Zostavax is only about 50 percent effective in preventing shingles. Shingrix is 97 percent effective in people ages 50 to 69, and 91 percent effective in those 70 and up.
Shingrix requires two doses, the second dose two to six months after the first.
The bad news: The vaccine can cause flulike symptoms for a day or two. And a Shingrix shortage has recently left many people scrambling to get even one dose. (To find it near you, try the CDC’s vaccine finder or the Shingrix vaccine locator.)
The side effects are small price to pay, notes the Mayo Clinic’s Baratz. “I’ll take some fever and chills for 24 hours over a one-in-three chance of getting shingles. I think it’s an easy decision.”
Eye-Opening Study: Relationship Between Glaucoma and Poor Sleep
Glaucoma is a disease of the optic nerve. Damage to this nerve—which is responsible for sending signals from the eye to the brain so you can see—often goes unnoticed until an eye exam reveals the nerve damage and related vision loss caused by glaucoma.
The study examined data from the 2005-2008 National Health and Nutrition Examination Survey. The study participants were glaucoma patients with evidence of optic nerve damage and vision loss in some portions of their visual field. Participants were examined using fundus photography to see the optic nerve and automated visual field testing to check for areas of vision loss.
Respondents to the sleep questions of the survey reported their experiences with the following:
- Amount of time slept
- Difficulties falling asleep
- Sleep disturbances (waking up during sleep)
- Having diagnosed sleep disorders, including sleep apnea
- Use of sleep medication
- Problems with sleepiness during the day
The study found an association between having glaucoma and having various sleep problems. Among the findings:
- People who slept for 10 or more hours a night were three times more likely to have glaucoma-related optic nerve damage than those who slept 7 hours a night.
- People who fell asleep in 9 minutes or less, or those who needed 30 minutes or more to fall asleep, were twice as likely to have glaucoma than those who took 10-29 minutes to fall asleep.
- The odds of having missing vision were three times higher among people who got 3 or fewer or 10 or more hours of sleep per night, compared with those who got 7 hours a night.
- People who said they had trouble remembering things because of daytime sleepiness were twice as likely to have visual field loss than those who said they were not sleepy during the day and did not notice memory problems.
- People who said they had difficulty working on a hobby because they were sleepy during the day were three times more likely to have vision loss than people who reported no problems working on hobbies and no daytime sleepiness.
“This study is interesting in that it adds to other research looking at the association between glaucoma and sleep problems,” says Michael Boland, MD, PhD, one of the study’s authors and a glaucoma specialist at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine in Baltimore, MD.
“We already know that doctors should talk with their patients about the importance of healthy sleep for good overall health. With studies like this, we can add that glaucoma may be related to sleep health issues,” says Dr. Boland.
The American Academy of Ophthalmology recommends that everyone should see an ophthalmologist for a baseline medical eye exam at age 40. This is the age when early signs of eye disease (like glaucoma) and vision changes can begin.
Seniors who are worried about the cost of an exam can visit the American Academy of Ophthalmology’s EyeCare America program page to see if they are eligible for a no-cost eye exam.