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University Hospital of Brooklyn at

Long Island College Hospital

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Douglas R. Lazzaro, MD, FACS, FAAO
Chairman, Department of Ophthalmology

The Downstate Diagnosis:
Do You See What They See?

How will you know if your child has a vision problem? Parents are often alerted to eyesight problems when their children are between 4 and 6 years of age. The good news is that vision problems are generally easy to catch, and the sooner the vision is corrected, the better for the child's development. Bring your child to an ophthalmologist at around age four to establish a relationship and a baseline. "Eye MDs," as we're being called lately, have vision charts with shapes and animals – your child doesn't have to know the ABCs. Downstate LICH's Dept. of Ophthalmology has the finest eye doctors in Brooklyn.

What causes vision problems in children?

There are some estimates that one in 20 preschoolers has vision problems, and by school age the number is as high as one in four. There are three major causes of vision problems in children:

  • Genetics – if a child's parents both wear glasses there is a good chance the child will. It's not an absolute, but it does mean you should probably be more alert. But parents without vision problems shouldn't assume their child won't have any.
  • Prematurity – children who are born prematurely have a higher rate of certain vision problems.
  • Trauma – accidents, such as sports injuries, are a leading cause of vision defects in children.

What vision problems occur most often?

  • Nearsightedness (known as myopia) – this means your child only sees well at near distances; Farsightedness (hyperopia) is not seeing close objects well.
  • Strabismus – eyes that are improperly aligned; for example, one eye is turned either inward towards the nose or out towards the ear. You've probably heard this referred to as "lazy eye" and it affects up to three out of every 100 children.
  • Amblyopia – both eyes look normal, but in one eye the brain is not processing signals properly and so that eye isn't being used properly.

What signs should I look for?

  • Continually moving in closer to the TV set, computer screen or game console
  • Squinting when looking at distance objects
  • Tilting while trying to look at something
  • Holding a hand over one eye when trying to focus

What do we recommend?

  • For near and farsightedness, the treatment is simple: glasses. Polycarbonate lenses are less likely to shatter if they drop or if your youngster is engaged in physical activity. Wraparound glasses are an option for very young and/or active children.
  • Strabismus or amblyopia often respond to eye exercises and/or patching the good eye to force the "bad" to focus properly. Depending on the severity of the problem it may require surgery, although that's fairly unusual. Downstate LICH has designated pediatric anesthesiologists who take care of our young patients, should that occur.

My best advice, however, is to take steps to prevent vision accidents. You can't change your genes, but you can make sure your child wears protective goggles during sports and you can avoid buying furniture with sharp edges. Remember, something as innocent as a coffee table can cause vision damage if it's at the same level as a crawling child.

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