Our children are precious, and so is their eyesight. Basic vision screenings are part of pediatric health care, and primary care physicians perform these screening eye exams. They help catch developmental issues requiring a referral to a pediatric optometrist or ophthalmologist for diagnosis or treatment such as strabismus (misalignment), amblyopia (lazy eye) and anisometropia (asymmetric refractive error), as well as anatomic abnormalities like cataracts.
Primary care practices are increasingly using automated vision screeners. Children look inside these electronic boxes for a refraction and alignment test, providing data indicating whether they might require eyeglasses, patching or even surgery. This makes exams more efficient and reduces the number of unnecessary referrals.
“There is no evidence that all children need full, dilated eye exams, unless there is a strong family history of vision problems or the child has subjective complaints,” says Erin Salcone, MD, a Pediatric Ophthalmologist at the Children’s Hospital at Dartmouth-Hitchcock (CHaD). “The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) encourages the medical home [primary care practice] as the place to conduct pediatric vision screenings. Children are never too young for vision screenings. We can always get information, even in infants.”
Screen time strain
The popularity of online videos, television shows and gaming geared to children and teens has markedly increased the amount of daily time spent in front of screens. Salcone notes there is no hard data indicating screen time is damaging to the eyes, but there is a decreased blink time versus reading books. “We tend to look away from reading material more than screens,” she explains. “With much of today’s school work online, children are taking fewer breaks from screens—which is fatiguing to the eyes and contributes to dryness.”
Salcone says pediatric ophthalmologists have observed an increase in strabismus among teenagers, frequently requiring surgery to correct. “There is a lot of accommodation required by the eyes to concentrate on a small target (e.g. screen) for a prolonged period of time,” she shares.
In 2019, the World Health Organization (WHO) released the first guidelines on screen time for children under the age of five. WHO recommends zero screen time for children under two years of age, and only 60 minutes (or less) each day for two- to four-year-olds.
Protection is key
Unfortunately, pediatric eye trauma is common. According to AAPOS, “Close to 50 percent of [eye] injuries occur in sports and recreational activities—more often in children and teens than any other age group.”
Salcone has seen this first-hand. “Projectile eye injuries can be superficial to severe, and caused by toys, rocks and debris propelled by lawn equipment and household items like pencils, scissors and cleaning solutions. Everything is an eye injury waiting to happen,” she stresses.
She recommends children participating in sports and all children with poor vision in one eye, consider wearing eye protection featuring sports frames with shatterproof polycarbonate lenses.
For more information, visit the Pediatric Ophthalmology website.