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Bradley Davitt, MD

With the new school year getting under way, pediatric eye care specialists say now is an important time to watch young students closely for any previously undiagnosed vision problems.

Bradley Davitt, M.D., a pediatric ophthalmologist at SSM Cardinal Glennon Children’s Medical Center and professor at Saint Louis University School of Medicine, notes that kids are not likely to complain if they can’t see the blackboard.

Unlike adults whose vision may change over time, kids don’t know what’s normal.

“Kids typically are simply unaware that they have ocular problems,” Dr. Davitt says. “It’s really up to parents and other professionals to identify these problems and get them treated.”

Fortunately, children today are screened for vision problems as newborns and again during the pre-school years. Most youngsters also are screened before entering kindergarten.

But Dr. Davitt says that subtle problems can persist. Although most children have healthy eyes, an estimated one child in four has some vision problem or suffers from some degree of visual impairment.

The most common refractive error is near-sightedness or poor distance vision, also called myopia. Signs of a problem may include squinting at the blackboard, holding books very near and sitting close to the television.

Sometimes a youngster in class may seem to be “daydreaming” because he or she cannot see the board, so appears not interested in the material.

Dr. Davitt notes that family history can play a role in vision problems. “If a parent is myopic, a child is more likely to be myopic or near-sighted as well. So parents who have problems themselves should have a higher level of interest in getting their children checked out.”

In addition to refractive errors – children can be either near or far-sighted – it’s very important, Dr. Davitt continues, to diagnose conditions such as amblyopia (lazy eye) and strabismus (misalignment) as early as possible.

Sometimes amblyopia and strabismus can be mild and not be noted by parents, and early diagnosis allows treatment to begin, which can allow the child to recover normal vision.

“A child’s visual system is developing and so the sooner the problem is identified, the more effectively it can be treated, retaining improved vision for a lifetime,” Dr. Davitt says.

Newborns today are generally screened by a red reflex test – a basic indicator that the eyes are normal. A second screening should be done by a pediatrician or a family doctor between six months and the first birthday.

Between ages of 3 and 3 ½, a child’s vision and eye alignment can be assessed again, based on how well the child identifies and tracks familiar objects such toys.

Most children are screened again before entering kindergarten, either by a physician or by a person trained in vision assessment of children.

Whenever a potential problem is detected, Dr. Davitt suggests that parents have their child further evaluated by an ophthalmologist, a medical doctor specializing in the eye.  If glasses have been recommended (the screener should not have a vested interest), a thorough medical assessment can confirm whether glasses are needed.

While the school year serves as a reminder to monitor children’s vision very closely, Dr. Davitt emphasizes that even very young children can be screened effectively by professionals trained in assessing children’s vision.  Whenever a pediatrician or parent has a concern, he urges that the child be referred for further evaluation.

Even toddlers who cannot yet fully interact with the examiner can undergo retinoscopy, which is dilation of the pupils to allow assessment of refractive error, he continues.

 “No child is too young that we can’t do an exam on them. If they have high near-sightedness or high far-sightedness or something that is going to cause a problem later, we can identify it and begin to correct the problem early on when therapy is most effective.”

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