Visual impairment in children: Early detection and treatment

Visual impairment in children, medically referred to as amblyopia or functional visual disorder, affects about 5-7% of all preschool-aged children. The vision of one or both eyes does not fully develop, even though the eye structures themselves are healthy. The visual impairment occurs due to a disrupted development of the visual pathway between the eye and brain in the early years of life.

Common forms of childhood visual impairment

Amblyopia (lazy eye)

Amblyopia is the most common form of visual impairment in children. The brain favors the signals from one eye and suppresses those from the other, which impairs the visual development of the weaker eye.

Refractive errors

• Nearsightedness (Myopia)Difficulty seeing things far away
• Farsightedness (Hyperopia)Problems with near vision
• AstigmatismDistorted vision due to irregular curvature of the cornea

Cross-eye (Strabismus)

Misalignment of the eyes where both eyes do not align parallelly. This can lead to double vision and amblyopia.

Recognizing Signs and Symptoms

Parents should look out for the following warning signs:

Early Signs (0-2 years):

• Lack of eye tracking of objects
• Frequent eye rubbing
• Light sensitivity
• Whitish pupil reflection

Symptoms in young children (2-6 years):

• Frequent blinking or squinting
• Head tilt when looking at objects
• Stumbling or unsteadiness when walking
• Difficulty reaching for objects
• Covering one eye when seeing

School children (from 6 years):

• Complaints of headaches
• Fatigue after visual tasks
• Problems with reading or writing
• Poor academic performance
• Avoidance of activities that require good vision

Causes of childhood vision impairment

Genetic factors

Family history increases the risk for visual impairments. Children with nearsighted parents have a higher risk of developing myopia themselves.

Environmental factors

• Insufficient outdoor time
• Excessive near work (screen time, reading)
• Unfavorable lighting conditions

Developmental disorders

• Prematurity
• Oxygen deficiency at birth
• Infections during Pregnancy

Diagnosis and Early Detection

Preventative Examinations

The regular child preventative exams (U1-U9) include important eyesight tests:

• U5 (6th-7th month of life): First check of eye movements
• U7a (34th-36th month of life): Eye test with pictures or symbols
• U8 (46th-48th month of life): Detailed visual acuity test
• U9 (60th-64th month of life): Comprehensive ophthalmological examination

Ophthalmological examinations

Special examination methods for children:

• Retinoscopy (objective refraction determination)
• Slit lamp examination
• Fundus copy (Retinal examination)
• Stereotest for checking spatial vision

Treatment options

Occlusion therapy (patching)

The stronger eye is patched for hours at a time to train the weaker eye. The duration of treatment depends on the child's age and the severity of the amblyopia.

Glasses correction

• Correction of refractive errors
• Prism glasses for mild strabismus
• Special children's eyewear frames for optimal fit

Atropine drops

Alternative to occlusion: drops dilate the pupil of the stronger eye, temporarily reducing its visual acuity.

Surgical procedures

In severe cases of strabismus, eye muscle surgery may be necessary to correct eye alignment.

Prevention and precaution

Early promotion of visual development

• Adequate daylight and outdoor exposure
• Age-appropriate visual stimulation
• Limitation of Screen time according to WHO recommendations

Regular check-ups

• Participation in all preventive examinations
• Immediate ophthalmological consultation in case of abnormalities
• Annual check-ups if there is a family history

Healthy lifestyle

• Balanced diet with vitamins A, C, and E
• Omega-3 fatty acids for eye health
• Sufficient Sleep for regeneration

Long-term prognosis and development

With early detection and consistent treatment, the prognosis for childhood amblyopia is very good. The critical phase for visual development is between the ages of 6 and 8. After this period, improvements are significantly more difficult to achieve.

Success factors:

• Early diagnosis (before the age of 6)
• Consistent adherence to therapy
• Regular check-ups
• Support from family and school

When to see an ophthalmologist?

A visit to the ophthalmologist is urgently needed if:

• Abnormalities in preventive examinations
• Visible eye misalignment
• Persistent headaches
• School problems with unclear causes
• Family history of eye diseases

Conclusion

Vision impairment in children is a common but treatable issue. Early detection by observant parents and regular preventive check-ups are key to successful treatment. With modern therapeutic methods, most vision disorders in children can be successfully corrected, allowing for normal visual development.

If there is a suspicion of vision problems, parents should not hesitate and promptly consult an ophthalmologist visit. The sooner the treatment begins, the better the chances of a complete recovery of vision.