Eye Health in Children and Babies

The eye health of children and babies differs from that of adults. Some eye problems, such as lazy eye (amblyopia), can be treated during infancy and childhood, but if left untreated, they become permanent once the child grows, and treatment is not possible after childhood.

To ensure children develop good visual acuity, they should be taken for eye checkups from an early age, even without complaints, and protected from various eye accidents.

Development of Normal Visual Functions in Babies

From the first few months after birth, a baby’s visual functions undergo numerous changes and developments:

• Focusing and Object Tracking: Newborn babies are born with peripheral vision (seeing the surroundings) and gradually begin to focus on objects after the first few weeks. After the first month, babies can focus on objects and look about one meter ahead. From the second month, they begin to follow moving objects, and their visual coordination and depth perception begin to develop. After the third month, if the baby is unable to focus on objects or track moving objects with both eyes moving together, the pediatrician should refer the baby to an eye specialist.

• Light and Images: Newborns are highly sensitive to bright light, which causes their pupils to constrict to prevent excessive light from entering the eyes (miosis). After about two weeks, their pupils widen, and they begin to notice larger areas in bright light.

Human faces are always the most interesting images for babies. As their vision develops in the first months, they start to see human faces and differentiate facial expressions.

• Color Vision: After the first few months, babies start to notice the brightness and intensity of colors. They tend to look at dark and contrasting colors more than lighter tones. By four months of age, babies can perceive most colors.

• Convergence: Convergence, the ability of both eyes to focus on the same object at the same time, is fully developed around the age of 7. This is why children with focusing or eye alignment problems should be treated before this age.

Refractive Disorders (Focus Problems) in Children

Refractive disorders, one of the most common causes of blurred vision, often begin around the ages of 2.5 to 3 years. For this reason, even if there are no obvious complaints, children should be taken for their first eye exam around these ages.

Most Common Refractive Disorders in Children:

1. Hyperopia (Farsightedness): Farsighted eyes are shorter than normal. Light from near objects cannot focus properly on the retina, causing the words on a page to appear blurred and mixed up. In hyperopia, this defect can be corrected by a mechanism in the eye (accommodation). A person may see clearly for a short time, but soon the vision becomes blurry again, and symptoms like eye strain, headaches, and fatigue appear. This usually starts around 2.5 to 3 years of age.

2. Myopia (Nearsightedness): A myopic eye is longer than a normal eye, and the cornea (the transparent layer at the front of the eye) is steeper, so light rays focus in front of the retina. Near objects are seen clearly, but distant objects appear blurry. It typically appears in school-age children and can develop at any age between 6 and 18 years.

3. Astigmatism (Distorted Vision): Astigmatism causes blurred vision for both near and far objects. It occurs when the curvature in one meridian of the cornea is more pronounced than in others, making the cornea oval-shaped, like a football. Normal corneas are round, like a basketball. Astigmatism can occur alongside myopia or hyperopia. It usually starts around the age of 3 in young children.

Importance of Eye Exams for Children

Children’s visual acuity can be negatively affected by a variety of childhood eye diseases. The development of visual functions continues until the age of 7 to 8. Early diagnosis and treatment of common focusing problems and eye alignment issues (like strabismus) help preserve eye health without causing permanent damage.

Why are Eye Exams So Important?

Good visual acuity plays a key role in a child’s physical development and academic success. The visual system in babies and young children is not fully developed, so both eyes need to send equal visual signals to the brain for proper development. If a child’s eyes do not send clear images to the brain during early childhood, their vision will remain poor (lazy eye) and will not improve in later years. However, eye problems in childhood are treatable if they are detected early, between ages 0-6.

When and How Often Should Eye Exams be Done?

Childhood eye exams should take place:

• At birth

• During infancy

• Before school age and during school age.

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology recommend the following tests for healthy children:

1. Newborns: The Red Reflex Test should be performed by a pediatrician. If the red reflex from the pupil appears normal (red), it is healthy. If it appears white, it is pathological. Premature babies should also be examined for retinopathy of prematurity by a retina specialist.

2. Infants (up to 1 year): Eye checks by a pediatric specialist are necessary. Eye movements, accommodation-convergence relationships, and object tracking are examined. Infantile esotropia (inward eye turn) can be common during this age.

3. Preschool Age (3-3.5 years): The first eye exam should be performed by an eye specialist. Visual acuity should be tested using visual charts and various objects, and common issues such as strabismus (eye misalignment), hyperopia, or astigmatism can be detected.

4. School Age: Vision should be tested when the child starts school or if there is any suspicion of an eye problem. The most common visual issues in this age group are myopia and astigmatism, which can be easily corrected with glasses.

Focus Disorders and Eye Misalignment That Affect Vision:

If any of the following conditions are suspected, a child should be examined by an eye doctor:

• Amblyopia (Lazy Eye): Amblyopia refers to poor vision in one eye due to incomplete development of normal vision during early childhood. This is often called lazy-eye because one eye is used more than the other, and the unused eye becomes weaker. The most common cause of amblyopia in children is anisometropic amblyopia, where there is a significant difference in refractive errors between the two eyes.

• Strabismus (Eye Misalignment): Strabismus can involve either esotropia (inward misalignment), exotropia (outward misalignment), or vertical misalignment. Eye misalignments can be constant or intermittent, and they result from muscle dysfunction.

• Ptosis (Drooping Eyelid): Ptosis refers to the drooping of the upper eyelid, which can occur due to congenital or acquired conditions. If the lid covers the eye or pupil partially or completely, it can lead to amblyopia.

• Corneal Diseases: The front surface of the eye should be clear and transparent. If there is any cloudiness or, in particular, if there is whiteness or spots on the pupil, it could affect vision and lead to amblyopia. If there is a white spot in the pupil, congenital cataract or retinal diseases (such as retinoblastoma) should be suspected, and the child should be referred to a doctor immediately.

Protection Against Childhood Eye Injuries

Each year, thousands of children suffer eye injuries from accidents during play, sports, at home, or in vehicles. Chemicals or harmful rays can cause burns, and blunt or penetrating injuries (such as globe perforation) can lead to trauma.

Eye injuries or blindness can severely impact a child’s future physical and mental development. Therefore, protecting children from accidents and using appropriate protective eyewear can prevent up to 90% of eye injuries and harmful radiation.