Home » Eye examination, from the first months of life to adolescence: the stages of vision checks

Eye examination, from the first months of life to adolescence: the stages of vision checks

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It is never too early. Contrary to what one might think, even very young children can and should be examined. After all, pediatric eye examinations are already routinely conducted in neonatology wards in cases of prematurity, demonstrating that there are no age limits for having an eye check up. This is because the child’s visual development takes place from the first days of life up to 6/7 years. This period is defined as ‘plastic’ and progressively runs out until it ends at 10 years of age.

The eye signals

The role of parents as ‘guardians’ of their children’s vision is crucial especially until before school age when any visual defects are more likely to emerge. But first it is important that parents are able to intercept some eye signs that may require medical supervision: “Parents should check if the child often has red eyes, photophobia, frequent blinking associated with itching, profuse tearing and even a mucous discharge and / or purulent ”, recommends Andrea Piantanida, eye surgeon of the Lariano Ophthalmology Center, Cernobbio, Como and member of the Scientific Committee of the Salmoiraghi & Viganò Foundation. Other ocular signs to observe include bilateral or unilateral nystagmus (irregular jerking of the eyes), abnormal position of the eyelids (eyelid ptosis), large or small eyes or pupils of different diameter (anisocoria) or shape (corectopia) . “In all these cases – continues the expert – parents must report to the pediatrician and the ophthalmologist any doubts that may arise from observing the eyes of their children”.

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Abnormal behaviors of the child

In addition to eye cues, some abnormal child behaviors can also alert parents to the need for an eye check. “If the gaze is absent, if there is no reaction to the light stimulus, if there is difficulty in following moving objects or in grasping them – explains Piantanida – it means that there may be a visual defect and that an eye examination is necessary. regardless of age “. Other behaviors to keep an eye on are frequent falls and lack of attention to obstacles, excessive approach in observing objects, abnormal head position especially in situations that require attention and visual commitment, closing one eye to light, the difficulty in recognizing colors (after 5 years) or in coloring respecting the edges of the figures and, finally, a frequent headache.

The stages of eye checks

In the absence of ocular signs and abnormal behavior of children, when to have an eye check? “Today we know that beyond 6/7 years it is very difficult if not impossible to intervene for the recovery of a visual acuity considered normal”, began Piantanida. For this reason, the need arose to define stages in which it is useful to subject little patients to eye checks in preschool from the first days of life both to recognize diseases and ocular anomalies early, guaranteeing a timely remedy, and to overcome an amblyopia possibly present with therapeutic interventions that would be scarcely effective beyond the boundaries of the plastic age of the visual cortex “.

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First months of life: the red reflex test

To assess the presence of visual defects in very young children, ophthalmologists may use the simple red reflex test. “The visualization of the red reflex of the fundus present in the pupillary field obtained with an ophthalmoscope allows to diagnose in a very early way the presence of anomalous shadows or dark spots”, explains Piantanida who adds: “They can be a very probable sign of serious visual defects, of high differences of refractive defect between the two eyes, of congenital cataract or, in the worst case, of retinoblastoma, a tumor that can affect the eye but can cause invasion through the optic nerve of the brain structures “. This examination should be performed from the first days of life in all neonatology wards as well as by the pediatrician who in suspected cases must send to the ophthalmologist for a further diagnostic.

10-12 months: the corneal light reflex test

A second important step in the visual evolution is that of the development of binocularity and eye movements. It is, in fact, between the sixth and the tenth month of life that the optical pathways complete the development process of the synchronous eye movements and it is therefore essential to analyze the visual situation of the little child around 10/12 months of life. “At this age – explains the ophthalmologist – you can already diagnose the correctness of eye movements, the presence of any strabismus and refractive defects for which it is already possible to intervene”.

Three years: the right time to understand if there is amblyopia

The most important period in which to carry out an eye examination in the child, if the control is excluded within the first year of life, is undoubtedly around 3 years when it is possible to diagnose the amblyopia (lazy eye) that may be present and take the necessary measures therapeutic. “This is precisely the pivotal moment for the prescription of glasses if there are visual defects such as hyperopia, myopia, astigmatism, but above all for the treatment of lazy eye”, underlines the expert. The years of kindergarten are the most important for intervening: “Skin occlusion, filters to be applied on the lenses or optical penalization are therapies that can improve the visual and sensory situation and that allow us to intervene calmly only if the treatment starts in this period of time “.

5-6 years: the school age to understand if glasses are needed

Another important time to have an eye examination for children is just before or at the beginning of school because if early visual defects are detected, you must immediately intervene with the prescription of glasses. “In this way – says Piantanida – not only allows the little patient to see better but also allows a correct management of the evolution of the visual defects present. It should also be emphasized that it is precisely at this age that the first symptoms of allergy, associated or not associated with ocular involvement, often begin to arise. An accurate analysis and prompt intervention by the ophthalmologist will be able to keep the symptoms under control and prevent allergic reactions from worsening “.

8-11 years: the age of school myopia

The 8 years remain a fundamental step in the pediatric ophthalmological path. Often at this age the so-called school myopia occurs for which the total correction of the defect is prescribed. “In addition to the normal evaluation of refractive defects and their prescription, at the age of 10/11 years you have to pay close attention to the onset of astigmatism or to slight variations if it was already present”, explains Piantanida.

Adolescence: the age of contact lenses

The age of 14 represents the age in which contact lenses are most often used, abandoning glasses that can be experienced as aesthetically penalizing or for carrying out sporting activities. “Adolescents – explains Piantanida – adopt contact lenses both for the correction of visual defects present, and for the therapeutic monitoring of any irregularities of corneal curvature or high refractive defects, which could arise late and be progressive beyond 20 years”.

For more information visit the page edited by the Salmoiraghi & Viganò Foundation.

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