Friday, July 15, 2016

Vision Health/ when does your child need to see an eye doctor?

Please see the updated Post March 2018

Doing an eye exam on a young child can be challenging but more entertaining than you might think. I used to get a kick out of the creativity of some of the kids when I would point to a picture on the eye chart. A circle could be anything from a simple circle, to a zero, a bagel or a donut (my kind of kid), The crescent could be a moon or a banana.
I fondly remember a little 4 year old who had just finished testing his first eye. He stood there with his hand over his right eye waiting for directions.
“ Okay, great job, now cover your other eye” Without removing his right hand from his right eye, He quickly raised his left handup. He stood there for a moment with both eyes now covered before I figured out what was going on.

Early intervention for eye abnormalities is very important.
Parents are often the first to note if there is something abnormal going on.
There are always individual variations with developmental milestones,  but many babies eyes don’t track too well until they are about 3 months. Once they are old enough, watch to see if they can follow an object with both eyes. If one eye wanders , that is something we want to get checked out.
Check the pupil size. Are both the same? There are some kids with normal variations, but it is worth noting this ahead of time.
I have had parents frantic after a mild head injury when the pupils were noted to be of mildly different sizes. It turned out that this was just the baseline. Noting it in advance would have saved some stress!

If you take a photo with flash and there is “red eye” make sure the reflection seems to be equal in both eyes.

Are the eyes watery or gooey? This could be a blocked tear duct. That usually resolves in a few months, without any intervention

In our office we actually start doing eye screenings for our patients as early as 6.months. We can screen for a variety of abnormalities with our iscreen machine.
Dr Good, one of our favorite pediatric ophthalmologists says he has been pretty impressed so far with issues that have been discovered early. While some of the conditions don’t actually require any intervention, having the patients identified so young is very valuable, because we can now know to monitor them closely

Once the kids are four or five years of age and old enough to cooperate, we do the Snellen eye test. This screening for nearsightedness is usually  done in conjunction with the routine annual well child check up.
The operative word here is screening. Farsightedness or astigmatism are usually not picked up without a full eye doctor exam.

The gold standard recommendation  is a complete eye exam by an eye doctor at 3 and 5 years. At that point, the decision for how often routine exams are needed may depend on your child. Obviously if your child seems to be squinting it is worth getting them in sooner.
There is a genetic component to eye issues, but kids should be checked even if the parents have perfect vision.

What is difference/ need between ophthalmologist or optometrist for basic child eye health?
Ophthalmologists are specialists that deal with the full range of eye care, but they are also surgeons who can deal with any eye abnormality or condition. Optometrists might be your best bet for any simple vision issues. Finding someone who regularly works with kids is pretty important.
If there is a medical diagnosis some insurance companies will cover the cost of an eye exam.
It is worth checking in advance with the eye doctor's office as well as your insurance or vision plan  to see if there is an advantage to seeing one or the other.
I don’t think people necessarily need to add vision and dental plans for the kids the first year, but after that, especially if they come bundled, it is probably worthwhile.

There are some common sense things you can do promote good eye health.
Get outside!
Of course, get in the habit of wearing sunglasses when outside during the day. Ideally they should be made out of a strong poly-carbonate plastic that is shatterproof. Floppy hats or visors are also a good idea.
Recent studies show a 30-40% decrease in myopia (nearsightedness)  with daily time outdoors.
Try to minimize the “blue lights” that we are surrounded with by screens in our world.
The American Academy of Pediatrics recommends no more than 2 hours of recreational screen time/day.
Eat well!
Carrots and foods with Vitamin A are good, but the dark green leafy vegetables are the real super helpers of the eye because they have lutein and zeaxanthin (go ahead and impress people at your next cocktail party with that one)
These two eye nutrients help replenish the pigment in the retina and can prevent diseases of the eye. Peppers turnips and paprika are also a good part of an eye healthy diet.
Avoid smoking or exposure to secondhand smoke.

If your child does need glasses, make sure they get their vision checked yearly (or more frequently as needed)  to make sure the prescription is correct. If the myopia is getting progressively worse, believe it or not multi-focal contacts may help slow things down. They can be started with some cooperative children as young as 5!

You might not make an obvious connection but headaches, dizziness, motion sickness and ADD can all be associated with eye problems.

I have sent more than one patient who were having trouble concentrating in the classroom to my favorite optometrist Dr Vincent Penza. The difference that he was able to make for them was astounding.

Josie takes her son down to Dr Kim Cooper and loves the care she receives there
Dr Cooper shares that her most important eye tip is the need for quality safety goggles. If your child is playing any sport where there is danger of getting hit in the eye by a ball or body part, they should be wearing eye protection. Not a week goes by that she isn't dealing with a sports related eye injury. Most are minor, but the serious ones are devastating.
Her office happens to be great resource for getting quality goggles. In fact, they are having a trunk sale on August 1st.
Dr Cooper also told me about another good office.
Dr David Grisham and Dr Jeremy Shumaker at Vision Academy and Rising Star Optometry are terrific and do see pediatric patients.

Dr Good and Dr Martin are another office where we send a lot of our patients

Berkeley Eye Institute is a great resource. It tends to be lower cost because it is associated with the school.

Fun Facts:
You may not be able to know your child's ultimate eye color until they are a year!
Your baby might be crying, but they usually don’t develop actual tears until they are between 4-13 weeks

The eyes are the fastest muscle in the body and blink an average of 17 times/minute

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