Dr Nitin
Recently, while examining patients in the ophthalmic OPD room at AIIMS, Vijaypur, I examined a young child being brought in by his parents. This child was not able to see clearly. His parents informed us that he had poor grades in examinations this year. He was not going out to play and was mostly confined indoors. A detailed examination revealed that the child had bilateral Myopia (inability to see clearly for far, a refractive error). The child used to sit in the front row at the school to see the board and was not faring well in his studies. The parents were concerned about his vision and grades at school and more so about the treatment of the disease, which is glasses. The questions of parents included, “Will he require glasses?” He is so young; Why does he need glasses? “Can he do away with glasses?”, Will he get bullied at the school?” The parents were counselled and advised to make the child wear the prescribed glasses for far vision. The parents and the child complied with our instructions. The next hospital visit was a pleasant surprise; the child had topped his class, was jolly, playing with friends, was spending time outdoors, and his parents were relieved and happy.
This might be a common story in our households, but many children may not be wearing glasses. Uncorrected refractive errors among children are a common cause of visual impairment. This may lead to poor performance in studies and low self-esteem. A small intervention like wearing glasses can dramatically improve the quality of life. The myths associated with wearing glasses need to be debunked, and any bullying needs to be stopped. Moreover, smaller children may not even know that they are not seeing well or have any ophthalmic disease. Parents and teachers who spend most of their time with young children can suspect visual impairment or other eye diseases at the earliest. So, if parents or teachers notice that there are problems with the child’s navigation in his surroundings or that there is a decline in his performance at school, they should keep in mind that there may be something wrong with the child’s vision. Causes of refractive errors in children may be multi-factorial.
There may be a genetic predisposition (mother and father have refractive errors), or they are mostly confined indoors, leading to lesser utilization of far vision. These may also be linked to the changes in the size of the eyeball till the child reaches adulthood. While some of the factors, like genetics, are non-modifiable, encouraging children to adopt a healthy lifestyle and making them play outdoors rather than watching television and video games can be highly beneficial.
There needs to be limited, monitored screen time for most of the children, while “No” screen time for the youngest ones (less than 18 months of age). Routine eye checks can go a long way in detecting refractive errors to sight-threatening diseases in children. This will protect the vision of our future generations.
The Government of India has been proactive and initiated programmes like Rashtriya Bal Swasthya Karyakram (RBSK), a subsection of which deals with the universal eye screening of newborn children to look for any ocular abnormalities.
The other ocular abnormalities commonly seen in children include congenital cataracts, congenital glaucoma, retinopathy of prematurity (ROP), retinoblastoma, lid abnormalities, ptosis, amblyopia, squint and retinal diseases. ROP necessitates a special mention, as it is a disease affecting the retina of premature babies, any child born before 34 weeks of gestation or having weight less than two kilograms at birth or having adverse events at birth like exposure to oxygen, infections, prolonged NICU stay should be screened before the 30 th day of life. The Screening will help to detect the disease and manage the patient to avoid blinding complications.
A routine yearly eye examination of children can go a long way in the early detection of ophthalmic diseases and in preventing visual impairment of our young, loved ones. So, let us pledge to protect our children’s vision and encourage them to “Love” their eyes.
(The author is an Associate Professor of Ophthalmology at AIIMS, Vijaypur, Jammu).
