Development of the visual system is one of the most important components of childhood development. Studies have proven with a high degree of specificity the inseparable link between vision and learning. Children with uncorrected refractive error have difficulty competing with their classmates, and thus struggle and fall behind, without proper correction, in the classroom environment. This can lead to behavioral issues and class disruption, as the student’s frustration level builds. That frustration could land your child in the principal’s office, rather than on the dean’s list.

So, when should your child be evaluated for signs of uncorrected refractive error, or for other conditions that may hinder the development of their visual systems?

The answer may vary from practitioner to practitioner, but most professionals agree that your child should be evaluated by a pediatric ophthalmologist initially between 6 months and 2 years of age to rule out conditions such as congenital cataracts, retinoblastoma, retinopathy of prematurity, strabismus, and amblyopia that may hinder their developmental progress. It is an important distinction here to note that a pediatric ophthalmologist is a vision specialist, and that a vision screening by the school nurse or a screen by your regular pediatrician is not a substitute for a full vision work up. Pediatric ophthalmologists routinely use preferential viewing screens, opto-kinetic drums, and other special set ups designed to make an accurate estimation of acuity, before the child is able to read a standard eye chart. If all the developmental milestones have been achieved after the initial evaluation, the child can be referred to the optometrist for annual exams, starting around age 4. It is important for school age children to be evaluated routinely for refractive error changes, given that uncorrected error is the biggest road block to learning and comprehension in the classroom. Children with myopia (nearsightedness) will struggle to see the board from the back of the room. Children with hyperopia (farsightedness) may have poor stamina and fatigue rapidly with sustained near point activity. Uncorrected astigmatism can cause the child to lose their place frequently, skip words, or even to skip lines while reading. All of these things can undermine the comprehension of text, and consequently, the student’s ability to learn and keep pace with their classmates.

There has been an explosion of myopia in recent years, especially in Asian populations. It is unclear if these findings are primarily genetic, environmental, or a combination of both factors. Multiple studies have been done over the last two decades, or are in progress currently to find the answers to the burning questions regarding the explosion of myopic individuals in the world population. The corresponding explosion of computers, laptops, cell phones, and tablets have all led to a dramatic increase in the amount of screen time almost everyone is exposed to, but especially school aged children. How much each of these changes factor into the phenomenon of global myopic progression is still being studied, and therefore, up for debate. Although, none of the studies regarding the emission of blue light from screen devices have established that blue light is harmful, it has been established that blue light disrupts sleep patterns and alpha wave sleep in susceptible individuals. As an example of how that might be harmful, a person with fibromyalgia (a form of soft tissue arthritis) needs to remain in alpha wave sleep for a certain number of hours a day for their tissues to heal, and thus avoid the excruciating pain of their chronic condition. In the case of a child, everyone knows how disruptive and harmful it can be when children don’t get enough restful sleep. Someone who is not fully developed physically, requires uninterrupted restful sleep for their growing bones, muscles, and developing brain tissue. Sound sleep and good nutrition are essential in the development of young healthy children.

The increased incidence of worldwide myopia has spawned the creation of a new branch of scientific medical specialty called myopia control. The evolving practice of myopia control comes currently in three main branches. Orthokeratology uses custom rigid gas permeable lenses that are worn while the patient sleeps, to mold and reshape the corneal surface, in an attempt to slow the axial (front to back) growth of the developing eye. Another branch of myopia control uses low dose atropine eye drops to inhibit axial elongation of the globe. These are administered in the form of once daily drops at bedtime, and are generally well tolerated. The third tool in the box of myopia control are the recently FDA approved Coopervision Misight daily disposable soft contact lenses. The lenses are made with peripheral defocus, which studies have shown to reduce or slow the stimulation for axial elongation of the eyes. A skilled myopia control specialist can assist in weighing all of the environmental and genetic factors at play for each individual, and determine the best course of action to help keep myopic progression to a minimum.

The goal of myopia control is not to eliminate myopia, but to reduce the final amount of myopia, after the patients progresses through their formative growth years. The importance of myopia control in future populations is clear, given the scientific method has determined that each diopter of final myopia results in an exponentially increased risk for glaucoma, cataracts, myopic maculopathy, and detached retina.

Since children between the ages of 8 and 12 exhibit the highest growth rates in myopic progression, this is the target age for the initiation of myopia control therapy. A skilled practitioner can guide you along the myriad of choices now available for your child. Scientific advances have given us options to explore in our modern world, rather than just relying on the kindness or cruelty of Mother Nature. Hopefully, this article has given you some basic knowledge that will at least guide you to asking the right questions of your eye health provider. There’s no time like the present to prepare for the future. Seize the day, cherish the moments, and live your best well informed life!

Rodger Battani O.D. (MiSight 1Day Certified)