Focus on children’s sight preservation – Manila Bulletin


By Dr. Maria Victoria A. Rondaris

GET CHECKED Photoscreener applications are now available on mobile. It is always best, however, to consult with trusted ophthalmologists

Everywhere around the world, it is truly unfortunate that sight preservation has never been a priority.  Thus, we often wonder why this should be?

From birth until death, vision is essential. And life is easier when we are able to see.

As we move to the Universal Health Care era, every primary care provider must be empowered with the proper skills for eye care, and every family must be aware of the value of good eye health.

And where best to focus any discussion on preserving a person’s sight than on children—whose whole lives are laid out before them, hinging on a healthy and reliable eye sight.

In a joint statement of the Philippine Academy of Ophthalmology (PAO) and the Philippine Society for Pediatric Ophthalmology and Strabismus (PSPOS), regarding vision screening in children, it was underscored that children’s eye diseases can result in permanent visual impairment that will impact the child’s development, education, and the adult he becomes.

That child’s vision will greatly influence his or her employment, social prospects, and opportunities throughout his life. If a problem is recognized early, proper intervention can be rendered, permanent visual impairment can be avoided, and vision improved.

“There are certain serious eye conditions that will not produce early warning symptoms. Children are young and inexperienced to understand or complain that they might have an eye problem. Early detection and proper intervention are important for proper eye health, especially in the developing vision of a child,” the joint statement said. This was why the two organizations recommended regular eye and vision screening examination of the visual system of children from infancy until maturity. “The single and most effective way of determining a child’s eye health is through a non-invasive and simple Eye and Vision Screening test. This test can be administered by a primary care provider (pediatrician, family medicine practitioner), nurse, midwife, optometrist, a community health worker, a school teacher or anyone trained to check vision and examine eyes,” the statement noted.

It was underscored, however, that this Eye and Vision Screening recommendation was not a guideline for a comprehensive pediatric eye examination for which an ophthalmologist with special training in children can provide.

Different eye conditions

Common eye conditions that can be detected through eye screening include reduced vision due to amblyopia, uncorrected refractive errors, misalignment of the eyes, leukocoria, and other eye defects.

Amblyopia is a decrease in the child’s vision even when the structure of the eye is normal. The amblyopic eye does not function normally and does not see clearly as the good eye despite the use of glasses or contact lenses. The condition occurs during early childhood when one or both eyes send blurred images to the brain. If not treated, the brain only learns to see blurry. Amblyopia can lead to permanent visual loss, if left untreated.

‘There are certain serious eye conditions that will not produce early warning symptoms. Children are young and inexperienced to understand or complain that they might have an eye problem.’

EYE EXPERT Dr. Maria Victoria Rondaris

Refractive Errors such as nearsightedness (myopia), farsightedness (hyperopia), or astigmatism are also common in children. Like in adults, a refractive error would also give the child a blurred image. Vision usually improves with glasses or contact lenses. Strabismus is a condition in which the eyeballs are not aligned and point toward different directions. One eye can look straight while the other eye is deviated inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). Leukocoria is a condition where a white glow is observed through the pupil instead of a red orange reflex. This condition can be caused by a cataract, an intraocular tumor, or other diseases inside the eye.

It was noted that all high-risk infants should be referred to an ophthalmologist for comprehensive eye examination.

These include infants and children with medical conditions known to have associated eye problems, like Down’s Syndrome, idiopathic arthritis, neurofibromatosis.

Infants and children with history of “squinting,” “head tilt,” or “head turn,” and children with history of visual difficulties and learning problems should also be referred for an examination.

Those with family history of eye problems, such as Strabismus, Amblyopia, Congenital Cataract, Congenital Glaucoma, Retinoblastoma, Ocular and Systemic genetic diseases should also undergo examination.

The joint statement also said that a Visual Acuity Assessment be conducted with infants and children being checked for fixation behavior using a toy, picture, or other interesting object as a target with un-occluded eyes and with one eye occluded.

If a child fails to fixate and follow an object on each eye, the child should be referred to an ophthalmologist with training and experience in the evaluation and treatment of children’s eye diseases.

Over the past decades instruments to detect risk factors for Amblyopia and eye problems have been developed, validated, and have gained acceptance.

This is particularly useful if there is a need to screen non-verbal children and children with limited cooperation.

There are several devices and mechanisms of screening differ from each other. The principle behind these instruments is to be able to detect risk factors for Amblyopia development in younger children.

Photoscreeners detect risk factors for development of Amblyopia by obtaining images of the optical system of the eyes to detect the eye’s red reflex, estimate refractive errors, detect media opacity, and evaluate ocular alignment. This is evaluated against standard criteria by the computer or an evaluator.

Portable autorefractors measure refractive errors and measurements are compared to standard thresholds of eye grades, which may cause amblyopia. Newer instruments like vision screeners detect fixation of the eyes through retinal birefringes. It will give a pass or refer result.

It is recommended that before adapting any of the devices by any health care practitioner, a thorough evaluation of its sensitivity and specificity in detecting Amblyopia is considered, as well as its additional cost in the health care.

The author is the chair of the Community Ophthalmology Committee of the Philippine Academy of Ophthalmology






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