Issues That Could Affect Your Child’s Vision

boy-with-glassesVision loss is feared more than the loss of any other sense and is considered to affect the quality of life more than most other issues. When it comes to children, even partial vision loss can be damaging because it can affect the way that your child learns and develops. There are several different types of issues that may affect your child’s vision. Awareness is key to prevention and treatment.

Refractive Errors

Refractive errors such as nearsightedness, farsightedness, and astigmatism are the most common types of issues that affect children’s vision. Since children are working to constantly adapt to their surroundings, they may not realize that they have a vision problem and the issue may manifest as an inability to focus, chronic headaches, or poor eye-hand coordination. In most cases, these issues can be corrected with glasses or contacts, but extreme cases may require surgery.

Alignment Disorders

Alignment disorders are generally more obvious than other types of issues. One eye may drift to the side, an eyelid may droop, or the surface of an eye may appear cloudy, affecting the vision. In some cases, however, the condition may be intermittent, so it is important to continually look for these symptoms and alert an eye doctor to any concerns. Alignment disorders may be corrected with surgery, an eye patch, eye drops, or a combination depending on the cause.

Pediatric Retinoblastoma

Pediatric retinoblastoma is a type of kid’s eye cancer that usually affects children under six years of age. About 95 percent of children diagnosed in the US are able to be treated successfully and a majority of these children retain most or all of their sight. The prognosis for retinoblastoma improves greatly with early diagnosis and treatment. One of the most common warning signs that you can look for is a white glare on the pupil when it is directly exposed to light.

Diseases and Infections

Diseases and infections such as conjunctivitis, styes, and blocked tear ducts are usually minor problems that are easily resolved. However, these issues may develop into larger problems that affect the vision if care is not taken. Conjunctivitis may resolve on its own depending on the cause, but the child should be kept away from others during the healing process to avoid infecting others or being exposed to other contaminants while the eye is sensitive.

Blocked tear ducts may be opened up using massage techniques recommended by a pediatrician or ophthalalmogist. Allowing the eyes to dry out may be dangerous for the vision, so drops may be needed to keep the eye moist while the tear ducts are blocked. Styes are caused by an infection in the eyelash follicle, so it is important to keep the area clean so that the infection can clear without causing damage.

By working to spot potential issues, you can help to preserve your child’s eye health and vision.

 

amanda-duffyAmanda Duffy
Freelance blogger

Cataracts, Cradles & Canines: Is My Child or Dog At Risk?

Many of us associate cataracts as a condition that affects mostly the aging human population, but animals can also be at risk for developing this vision robbing affliction. Cataracts is a disease which causes the lens to become opaque. It can result in partially or severely decreased vision, but it can usually be corrected with surgery.

While we know that most cases of cataracts affect the older generation of people, what about  younger children and dogs? Are they at risk of developing this dangerous disease?

A Dog’s Genes Genetics

The most common form of cataracts found in dogs is purely genetic, it can be present at birth or present itself at any time later in life, and the same is true for humans, which is called congenital cataracts. Be sure to check your dog’s eyes regularly and look for signs of irregularities, especially a cloudiness in their pupils.

A Dog With Diabetes

The second form of cataracts common in canines is associated with diabetes. Statistics share 80% of dogs who have diabetes will develop cataracts within one year of being diagnosed with the disease. Diabetes has also been linked with obesity, which is just one more reason we should be feeding our dogs a healthy diet and exercising with them regularly.

Rare With Human Children

Thankfully, when it comes to congenital cataracts, which can be present at birth or during childhood, statistics are in the favor of the child, since only about 0.4% of infants are born with this condition or could develop it later on in life.

While it’s recommended that infants have their first comprehensive eye examination at six months of age, parents should still be on the lookout for signs of this disease. The next recommended time for an eye exam performed by a professional is before a child enters school, usually at five or six years old. During these formative years, parents should be extra vigilant in watching for signs of vision problems in their children.

For more information on eyes for the rest of your two-legged brood, check out this infographic:

cataracts

6/2/16

cataracts

Tara Heath
Health Professional
Freelance Writer

Common Pediatric Eye Diseases

8/21/14

In the third of this series, Buddy Russell, from the Emory University Eye Center, provides a great overview of common pediatric eye diseases.

Some Conditions Frequently Seen in Pediatrics

A basic understanding of some of the conditions that may be present in pediatric patients is important to not only know what they are but also understand well enough to explain to the parent or caregiver. The following is intended to be an overview of some of those conditions and not a complete explanation.Girl with eye chart-common pediatric eye diseases

  1. Nystagmus – Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements, often resulting in reduced vision. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. As a result, both eyes are unable to hold steady on objects being viewed. Unusual head positions and head nodding in an attempt to compensate for the condition may accompany nystagmus. Most individuals with nystagmus can reduce the severity of their uncontrolled eye movements and improve vision by positioning their eyes to look to one side. This is called the “null point” where the least amount of nystagmus is evident. To accomplish this they may need to adopt a specific head posture to make the best use of their vision. The direction of nystagmus is defined by the direction of its quick phase (e.g. a right-beating nystagmus is characterized by a rightward-moving quick phase, and a left-beating nystagmus by a leftward-moving quick phase). The oscillations may occur in the vertical, horizontal or torsional planes, or in any combination. The resulting nystagmus is often named as a gross description of the movement, e.g. downbeat nystagmus, upbeat nystagmus, seesaw nystagmus, periodic alternating nystagmus. Having nystagmus affects both vision and self-concept. Most people with nystagmus have some sort of vision limitations because the eyes continually sweep over what they are viewing, making it impossible to obtain a clear image. If a refractive error is found, contact lenses may be the most effective way of obtaining best-corrected vision.
  2. Strabismus – Strabismus is any misalignment of the eyes. It is estimated that 4% of the U.S. population has strabismus. Strabismus is most commonly described by the direction of the eye misalignment. Common types of strabismus are esotropia (turn in), exotropia (turn out), hypotropia (turn down), and hypertropia (turn up). Eye misalignment can cause amblyopia in children. When the eyes are oriented in different directions, the brain receives two different visual images. The brain will ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, an eye that sees poorly tends to be misaligned. The goal of strabismus treatment is to improve eye alignment, which allows for better work together (binocular vision). Treatment may involve eyeglasses, contact lenses, eye exercises, prism, and / or eye muscle surgery.
  3. Amblyopia – Amblyopia, sometimes called a “lazy eye,” occurs when one or both eyes do not develop normal vision during early childhood. Babies are not born with 20/20 vision in each eye but must develop it between birth and 6-9 years of age by using each eye regularly with an identical focused image falling on the retina of each eye. If this does not occur in one or both eyes, vision will not develop properly. Instead, vision will be reduced and the affected eye(s) are said to be amblyopic. This common condition, affecting up to 4% of all children, should be diagnosed and treated during infancy or early childhood to obtain optimum three-dimensional vision and to prevent permanent vision loss. What causes amblyopia?
      • Misaligned eyes (strabismus)
        Misaligned eyes are the most common cause of amblyopia. When both eyes are not aimed in exactly the same direction, the developing brain “turns off” the image from the misaligned eye to avoid double vision and the child uses only the better eye — the dominant eye. If this persists for a period even as short as a few weeks, the eye will not connect properly to the visual cortex of the brain and amblyopia will result.
      • Unequal refractive error (anisometropia)
        Unequal refractive error is an eye condition in which each eye has a different refractive error and therefore both eyes cannot be in focus at the same time. Amblyopia occurs when one eye (usually the eye with the greater refractive error) is out of focus because it is more nearsighted, farsighted or astigmatic than the other. Again, the brain “turns off” the image from the less focused eye and this eye will not develop normal vision. Because the eyes often look normal, this can be the most difficult type of amblyopia to detect and requires careful vision screening of acuity measurements at an early age. Treatment with glasses or contact lenses to correct the refractive error of both eyes, sometimes with part-time patching of the better seeing eye, is necessary in early childhood to correct the problem.
      • Obstruction of or cloudiness (deprivation)
        Obstruction of or cloudiness in the normally clear eye tissues may also lead to amblyopia. Any disorder that prevents a clear image from being focused can block the formation of a clear image on the retina and lead to the development of amblyopia in a child. This often results in the most severe form of amblyopia. Examples of disorders that can interfere with getting a clear image on the retina are a cataract or cloudy lens inside the eye, a cloudy and or irregular shaped cornea, or a droopy upper eyelid (ptosis) or eyelid tumor.It is not easy to recognize amblyopia. A child may not be aware of having one normal eye and one with reduced vision. Unless the child has a misaligned eye or other obvious external abnormality, there is often no way for parents to tell that something is wrong. In addition, it is difficult to measure vision in very young children at an age in which treatment is most effective.To treat amblyopia, a child and their caregiver must be encouraged to use the weaker eye. This is usually accomplished by patching the stronger eye. This covering of the stronger eye with an adhesive patch, an cclude contact lens or temporary surgery often proves to be a frustrating and difficult therapy. Patching will often continue for weeks, months, or even years in order to restore normal or near normal vision and maintain the improvement in the amblyopic eye. Occasionally, blurring the vision in the good eye with eye drops or lenses to force the child to use the amblyopic eye treats amblyopia. In some cases, cataract surgery or glaucoma surgery might be necessary to treat form deprivation amblyopia. Patching may be required after surgery to improve vision, and glasses or contact lenses may be required to restore appropriate focusing.Surprising results from a nationwide clinical trial in 2005 show that many children age seven through 17 with amblyopia may benefit from treatments that are more commonly used on younger children.
        Treatment improved the vision of many of the 507 older children with amblyopia studied at 49 eye centers. Previously, eye care professionals often thought that treating amblyopia in older children would be of little benefit. The study results, funded by the National Eye Institute (NEI), appear in the April issue of Archives of Ophthalmology.
  4. Congenital Cataract – A congenital cataract, or clouding of the crystalline lens is present in 2-3 per 10,000 live births of children. The presence of a visually significant cataract in a child is considered an urgent disorder. The resultant form deprivation of vision requires immediate surgery to remove the obstruction, prompt optical correction and amblyopia therapy in unilateral cases. Until the 1970s, it was generally believed that there was no means of restoring the vision in an eye with a unilateral congenital cataract. However, subsequent studies demonstrated that excellent visual results could be obtained with early surgical treatment coupled with optical correction with a contact lens and patching therapy of the fellow eye. However, treatment results continue to be poor in some infants with unilateral congenital cataracts due to a delay in treatment or poor compliance with contact lens wear or patching therapy of the fellow eye. The Infant Aphakia Treatment Study (IATS) was designed to compare the visual outcomes in children 1 to 6 months of age with a unilateral congenital cataract randomized to optical aphakic correction with contact lenses or an intraocular lens (IOL). Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL had their aphakia treated with a contact lens. In previous publications we have shown that the visual results are comparable for these two treatments at 1 year of age, but significantly more of the infants randomized to IOL implantation required additional intraocular surgeries.
  5. Accommodative Esotropia – Accommodative esotropia refers to a crossing of the eyes caused by farsightedness. Accommodative esotropia is a type of strabismus. Children who are farsighted easily and automatically focus on objects at distance and near through accommodation. As a result, a child who is farsighted usually does not have blurred vision. However, in some children who are farsighted, this accommodative effort is associated with a reflex crossing of the eyes. Accommodative esotropia can begin anywhere from 4 months to 6 years of age. The usual age of onset is between 2 and 3 years of age.Full-time use of the appropriate hyperopic glasses prescription or contact lenses will often control the esotropia. When wearing the correction, the child will not need to accommodate and hence the associated eye-crossing reflex will disappear. However, after removing the prescribed correction, the crossing will reappear, perhaps even more than before the child began wearing the correction. Sometimes the correction will only cause the crossing to disappear when the child views a distant object. However, when gazing at near objects, crossing may persist despite the use of the correction. In these circumstances, a bifocal lens is often prescribed to permit the child to have straight eyes at all viewing distances. One potential advantage of contact lenses compared to spectacles when correcting hyperopic powers is the decrease in accommodative demand. The increased effort to converge the eyes with spectacles requires one to over come the resultant base out prism when viewing a near object.

 

Buddy Russell - pediatric contact lensesBuddy Russell, FCLSA, COMT
Associate, Specialty Contact Lens Service
Emory University Eye Center

Pediatric Contact Lenses

8/14/14

Because August is Children’s Eye Health Month we are pleased to present a four-part series on pediatric vision issues and contact lenses by Buddy Russell, FCLSA, COMT. With over thirty years experience fitting contact lenses, Buddy is currently an associate of the specialty contact lens service at Emory University Eye Center in Atlanta, Georgia. Buddy is a clinical instructor in Emory’s Ophthalmic Technology Program and teaches students and ophthalmology resident’s contact lens technology. 

Child refractive exam - pediatric contact lensesHe is a licensed dispensing optician, a Fellow member of CLSA and has been certified by JCAHPO as a Certified Ophthalmic Medical Technologist. He lectures at national and international meetings on contact lens related topics. Buddy has written articles for a number of publications, two chapters for CLSA’s advanced training manual and is a peer reviewer for the Cornea publication. He is also a contributing editor for CLSA’s Eyewitness journal. His current areas of research include pediatric aphakia and keratoconus. He joined the faculty at TVCI in 2006.

The first article will examine that pediatric contact lenses for children go beyond vision correction, the second will explore lenses as a treatment option, the third will look at a variety pediatric eye conditions and the final post will discuss the contact lens fitting challenges you face when you work with children.

Introduction

Working with the pediatric patient and their caregivers / family can be challenging, rewarding, fun, and yet sometimes frustrating. Many of these cases often include factors that are unique to the young patient. In addition to the technical challenges of obtaining the objective data, the fear of uncertainty is often present. The uncertainty of the unknown can either paralyze you or motivate you to step up and simply do what must be done.

The Definition May Vary

The definition of pediatric contact lens fitting can be different to different people. The fitter who works with the occasional twelve-year-old neophyte wearer will define pediatric fitting different from the person that works with babies on a routine basis. Pediatrics is generally defined as a branch of medical care that deals with infants, children and adolescents. The word pediatrics is derived from two Greek words (pais = child and iatros = healer), which means healer of children. Are you a “healer of children” or do you tend to feel better about someone else assuming the challenge and responsibility? This article will discuss some of the conditions, contact lens indications, fitting techniques and challenges that are present with the young patient.

Refractive Indications

What age is “appropriate “ to fit a contact lens on a child? In the absence of a medical indication, Jeff Walline, OD and his colleagues have addressed the answer to this question in the published literature. In addition, the American Academy of Optometry published a position paper in 2004 that stated that by the age of eight, a child was able to handle contact lenses and assume some degree of responsibility. We are all aware that not all eight year olds are capable of dealing with contact lenses. For that matter, not all eighteen year olds are mature enough to assume responsibility for anything. Some of the concerns that a contact lens practitioner may have in fitting these young children include the risk of safety to the child’s health, too much chair time, physical limitations, lack of hygiene, and lack of maturity. These are all legitimate concerns when you consider the child can see well with spectacles.

What does the literature reveal concerning these questions and concerns? Are the answers there?

CLIP Study

The Contact Lens In Pediatrics study compared 169 neophyte wearers in two age groups (children age 8-12 and teens age 13-17) over a period of three months. The summary of the clinical findings in the publication is that adverse events was low and the younger children took a little longer to train application and removal of the contact lenses. The more impressive outcomes from this study was determined by a tool used more frequently in child psychology referred to as the Pediatric Refractive Error Profile (PREP) survey. The PREP survey is a clinically validated quality of life instrument to assess how a child “sees” him or herself. This 26-question survey revealed that contact lenses improved the child’s self image in regards to their appearance, increased confidence in themselves while participating in activities and overall satisfaction of their form of vision correction. These findings were consistent in both age groups. More than 80% of both age groups found contact lenses easy to clean and take care of as all participants were fitted with 2-week disposable soft lenses and used a multipurpose disinfection care system.

The ACHIEVE Study

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) were published in 2009. Jeff Walline, OD and his colleagues designed this study to find out the effects that glasses and contacts had on the self-perception of the child. This study examined 484 myopic children 8-11 years. The participants were randomized to spectacles (n=237) or contact lenses (n=247) and followed for three years. The children were evaluated at baseline, 1 month and every 6 months for three years by a validated psychology tool for self-perception referred to as the Self-Perception Profile for Children (SPPC). The SPPC instrument allows a 4 point self-assessment in 6 categories; scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct and global self-worth. The participants revealed the most dramatic areas of improvement with contact lenses compared to spectacles in the areas of physical appearance, athletic competence, scholastic competence and social acceptance. Similar to the low occurrence of adverse events with contact lens wear found in the CLIP study, over the three year period there were only 13 adverse events among 9 subjects. In addition, the ACHIEVE study found very similar rates of myopic progression in both groups of patients over the three year period (1.08D spectacle group and 1.27D contact lens group).
What can we conclude from these two studies?

One is that we are in a position to not only help a young person see but we are also in a position to do it safely and assist the child by instilling more confidence in themselves at a young age that may impact them as they mature into an adult who feels good about themselves. Young children are accustomed to following rules. When properly trained, these same young patients may grow into some of the most compliant patients that we have in our practice. There are some practical considerations for prescribing contact lenses to the younger patient. Mary Lou French, O.D. has stated the three M’s are important for success; Maturity (good hygiene, good communication skills, signs of responsibility), Motivation (why do they want contacts? Does the child want them or just the mom or dad? Are they active in activities where freedom from spectacles is important?), Mom (is the mom / dad / older sibling willing to help?). Don’t let age be the deciding factor. Consider your position as one that may positively impact the young patient in how they “see” and feel about themselves.

Buddy Russell - pediatric contact lensesBuddy Russell, FCLSA, COMT
Associate, Specialty Contact Lens Service
Emory University Eye Center

Nystagmus In Children

8/7/14

Nystagmus is a condition of uncontrolled eye movements. Patients with nystagmus are unable to maintain their eyes in a fixed position of focus. The movements can be pendular, swaying evenly side to side, or, jerk into one direction and drift toward the opposite direction. It can be present early in life or acquired as an adult. It can occur in eyes with poor vision from other anomalous development, or eyes that appear perfectly normal. In almost all patients the vision is compromised to some degree. In some patients, the eye movement is less, and the vision better, in an eccentric position that causes the patient to adopt a face turn, tilt or head posture so they can use this quieter position (“null point”) to navigate during their daily activities. To date there have been no consistently effective treatments for this condition.

Lingua and Grace - nystagmus
Dr. Lingua and Grace Nassar

Treatment efforts have been either medical (drugs to reduce the amplitude of the nytagmus movement) or surgical (to move the “null point” into straight ahead gaze to eliminate a head turn, or, directed at reducing the effective contracture of all the eye muscles to reduce the amount of movement). In general, surgical treatment of nystagmus has been disappointing.

In 2002, Dr. Robert Sinskey, noted cataract surgeon and phacoemulsification pioneer, proposed a revolutionary concept, that nystagmus could only be truly effectively controlled by removing the forward portion of the eye muscle and detach it completely from the eye. Since the twitching eye muscles were controlled by nerves sending that pulsatile information, any operation that allowed the muscles to remain attached to the eye would never quiet the movement. He performed this novel surgery in 2000 and published the results in 2002. It did not receive attention in the nystagmus surgery community, as most experts worried that the surgery would limit normal eye movements excessively. The operation does remove the forward portion of the eye muscle but, surprisingly, the eyes are still able to move to allow reading, computing, and driving.. In 2012, I had the opportunity to view a patient he operated 10 years prior and was impressed with how successful the results were even after 10 years. Coincidentaly, I was caring for a 17 year-old patient with nystagmus who had already undergone the 2 currently accepted eye muscle procedures for nystagmus without success. His movements remained uncontrolled, he could not maintain eye contact with anyone, and is his vision was less than that needed for a drivers license. In 2013, I offered him the Sinskey procedure and the results were remarkable. His nystagmus was quieted, his vision improved (20/25) enough to qualify for a drivers license and to return to school.

Since 2012, we have adapted, augmented and perfected the procedure and performed the surgery on over 12 patients with similar remarkable results. All patients experience a marked reduction in the amplitude of the nystagmus (60-100%), and all patients demonstrate improved vision (1-8 lines of the acuity chart), especially at the reading position.

Visit the YouTube posting “Meet Grace for an example of how this surgery can impact a child’s life and the hopes of their parents. Visit www.eye.uci.edu for further information, contact information and scientific data on the procedure.

Robert Lingua, MDRobert W. Lingua, MD
Director, Pediatric Ophthalmology and Strabismus
Gavin Herbert Eye Institute, UC Irvine

Learning-Related Vision Problems

7/29/14

Next month is Children’s Eye Health Month, and to kick it off a little early we are taking a look at learning-related vision problems. Next month children start heading back to school, so now is the perfect time to make sure you child has had a recent comprehensive eye exam.
child eye exam - Learning-related vision problems
Vision and learning are closely related. About 80% of what a child learns in school is presented visually, and 25% of school-aged children already have vision problems (5-10%of preschoolers do). By scheduling a comprehensive eye exam for your child before school starts, you will help your child be more successful and happier in school.

When children have difficulty in school, from being able to see what is written on the whiteboard to learning to read, it not only makes the learning difficult, but it also makes the child frustrated and can affect their love of learning as well. While most schools perform a quick eye check at some point during the school year to determine simple refractive errors such as nearsightedness, farsightedness and astigmatism, there are other visual disorders that can make learning difficult.

Vision is a complex process that involves the eyes working well with the brain. Specific learning-related vision problems can be classified as one of three types. The first two types primarily affect visual input. The third primarily affects visual processing and integration.

  1. Refractive vision problems. Your child holds a book close to their face when reading or they have difficulty seeing things that are far away. These are generally refractive issues and include nearsightedness, farsightedness and astigmatism, but could also include more subtle optical errors called higher-order aberrations.
  2. Functional vision problems. This type of problem refers to a variety of specific functions of the eye and the brain’s control of these functions, such as eye teaming (using the eyes together), fine eye movements, and focusing skills, peripheral awareness and eye-hand coordination. These issues can cause blurred or double vision, eye strain and headaches.
  3. Perceptual vision problems. Visual perception includes understanding what you see, identifying it, judging its importance and relating it to previously stored information in the brain. Examples would include recognizing words that you have seen before and being able to form a mental picture of the words you see.

Because most routine school and pediatrician eye exams evaluate only the refractive vision problems, it is wise to see optometrist who specializes in children’s vision problems to evaluate functional vision problems and perceptual vision problems that may affect learning.

Color blindness is not considered a learning-related vision problem, but it can cause problems for very young children if color-matching or identifying specific colors are part of the classroom activities. For this reason, make sure your child’s eye exam includes a color blind test prior to starting school.

Symptoms of Learning-Related Vision Problems:

  • Headaches, eye strain, excessive blinking or rubbing the eyes
  • Blurred vision or double vision
  • Crossed eyes or if the eyes move independently of each other
  • Holding a book very close to their face for reading
  • Bending way over a table to get closer to what they are drawing or writing
  • Using only one eye by tilting the head or covering the other eye
  • Losing their place while reading, or needing to use a finger to stay on line
  • Slow reading speed or poor reading comprehension
  • Omitting or repeating words, or confusing similar words
  • Persistent reversal of words or letters (after second grade)
  • Difficulty remembering, identifying or reproducing shapes
  • Poor eye-hand coordination
  • Distracted in class

If your child shows one or more of these symptoms, they could indicate a learning-related vision problem. To find out see an eye doctor who specializes in children’s vision for a comprehensive evaluation. If no vision problem is detected, your child’s problems could be caused by a non-visual issues, such as dyslexia or a learning disability, in which case you would need to contact an educational specialist for an evaluation.

Treatment of Learning-Related Vision Problems

If your child is diagnosed with a learning-related vision problem, treatment generally consists of an individualized and doctor-supervised program of vision therapy. Special eyeglasses also may be prescribed for either full-time wear or for specific tasks such as reading.

Remember that when children have a difficult time learning, especially while other classroom friends have no visual issues to impair learning, they may experience emotional problems as well, such as anxiety, depression and low self-esteem.

Reassure your child that learning-related vision problems do not relate to how smart they are and with the proper treatment and/or eyeglasses, things will become easier.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Children Can Wear Contact Lenses Too

7/24/14

Several studies have shown that children as young as eight years are able to wear gas permeable,[1-3] corneal reshaping,[4-8] and soft contact lenses.[9-12] Gas permeable (hard) contact lenses were originally thought to slow the progression of nearsightedness, but two randomized clinical trials have shown that they do not slow the growth of the eye,[1, 3] so they are primarily fit on children who have difficulty handling soft contact lenses or who have highly irregular corneas (the clear window on the front of the eye) possibly from trauma or eye problems such as keratoconus. children - contact lens for childrenCorneal reshaping contact lenses are worn during sleep only. They temporarily flatten the cornea so that a nearsighted child can see clearly throughout the day with glasses or contact lenses. These contact lenses have been shown to slow eye growth in children.[4-7] Typical soft contact lenses have no effect on the progression of nearsightedness,[13] but soft bifocal contact lenses (typically worn by adults over the age of 40 who otherwise have difficulty seeing clearly at near) have been shown to slow the growth of the eye.[14-17]

Children also benefit from contact lens wear other than slowing the progression of nearsightedness. Children feel better about their athletic abilities, their appearance, and their peer interactions when they wear contact lenses than when they wear spectacles.[11] They even feel smarter if they wear contact lenses than if they wear spectacles, but only if they originally didn’t like to wear spectacles. Children also report that they prefer to participate in activities while wearing contact lenses more than while wearing spectacles, and the most-preferred vision correction is contact lens wear.

It has even been shown that most children (8-12 years of age) require only about five extra minutes to learn how to insert, remove, and care for their contact lenses when compared to teenagers (13-17 years of age). They also show similar benefits as the older group. In fact, children between the ages of 8 and 18 years of age are less likely to require discontinuation of contact lens wear due to problems encountered and also less likely due to experience irritation of the eye due to contact lens wear than college students between the ages of 19 and 25 years.[18, 19] After wearing soft contact lenses for 10 years, those fit as children (7 to 12 years of age) reported similar rates of painful red eyes that required visits to the eye doctor than those fit as teenagers (13 to 17 years of age), and those fit as children as exhibited similar eye health as those fit as teenagers.[20]

Personal experience, backed up by scientific evidence, shows that children as young as eight years can routinely wear contact lenses. When considering contact lens wear for your child, determine the primary reason you would like your child to wear contact lenses. If it is to slow the progression of nearsightedness, then corneal reshaping and soft bifocal contact lenses are the most effective methods. Unfortunately, neither of these contact lenses comes in a daily disposable modality. If your child doesn’t like to wear glasses or finds it difficult to participate in recreational activities with glasses, then daily disposable contact lenses may be best for your child. Contact lenses that are thrown away daily eliminate the need to clean and care for the lenses, reducing care of the lenses to insertion in the morning and removal at bedtime.

Some doctors believe that children should not be fit with contact lenses until they are teenagers. However, there is considerable evidence that indicates children are very capable of contact lens wear, and they experience significant benefits, visually and socially. Talk to your eye doctor about contact lens wear for your child, and if your doctor says that children should not be fit with contact lenses, consider a second opinion.

References
[1] Katz J, Schein OD, Levy B, et al. A randomized trial of rigid gas permeable contact lenses to reduce progression of children’s myopia. Am J Ophthalmol 2003;136:82-90. (Go Back)
[2] Khoo CY, Chong J, Rajan U. A 3-year study on the effect of RGP contact lenses on myopic children. Singapore Med J 1999;40:230-7. (Go Back)
[3] Walline JJ, Jones LA, Mutti DO, et al. A randomized trial of the effects of rigid contact lenses on myopia progression. Arch Ophthalmol 2004;122:1760-6. (Go Back)
[4] Cho P, Cheung SW. Retardation of Myopia in Orthokeratology (ROMIO) Study: A 2-Year Randomized Clinical Trial. Invest Ophthalmol Vis Sci 2012;53:7077-85. (Go Back)
[5] Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Curr Eye Res 2005;30:71-80. (Go Back)
[6] Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. Myopia Control with Orthokeratology Contact Lenses in Spain (MCOS): Refractive and Biometric Changes. Invest Ophthalmol Vis Sci 2012. (Go Back)
[7] Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol 2009;93:1181-5. (Go Back)
[8] Walline JJ, Rah MJ, Jones LA. The Children’s Overnight Orthokeratology Investigation (COOKI) pilot study. Optom Vis Sci 2004;81:407-13. (Go Back)
[9] Rah MJ, Walline JJ, Jones-Jordan LA, et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci 2010;87:560-6. (Go Back)
[10] Walline JJ, Gaume A, Jones LA, et al. Benefits of Contact Lens Wear for Children and Teens. Eye Contact Lens 2007;33:317-21. (Go Back)
[11] Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci 2009;86:222-32. (Go Back)
[12] Walline JJ, Long S, Zadnik K. Daily disposable contact lens wear in myopic children. Optom Vis Sci 2004;81:255-9. (Go Back)
[13] Walline JJ, Jones LA, Sinnott L, et al. A randomized trial of the effect of soft contact lenses on myopia progression in children. Invest Ophthalmol Vis Sci 2008;49:4702-6. (Go Back)
[14] Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011;118:1152-61. (Go Back)
[15] Lam CS, Tang WC, Tse DY, et al. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol 2014;98:40-5. (Go Back)
[16] Sankaridurg P, Holden B, Smith E, 3rd, et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci 2011;52:9362-7. (Go Back)
[17] Walline JJ, Greiner KL, McVey ME, et al. Multifocal contact lens myopia control. Optom Vis Sci 2013;90:1207-14. (Go Back)
[18] Wagner H, Chalmers RL, Mitchell GL, et al. Risk Factors for Interruption to Soft Contact Lens Wear in Children and Young Adults. Optom Vis Sci 2011;88:973-80. (Go Back)
[19] Wagner H, Richdale K, Mitchell GL, et al. Age, behavior, environment, and health factors in the soft contact lens risk survey. Optom Vis Sci 2014;91:252-61. (Go Back)
[20] Walline JJ, Lorenz KO, Nichols JJ. Long-term contact lens wear of children and teens. Eye Contact Lens 2013;39:283-9. (Go Back)

Jeffrey Walline - contact lenses childernJeffrey J. Walline, OD, PhD
Associate Professor
Chair, Research and Graduate Studies
The Ohio State University College of Optometry

Caitlin Hernandez – Blind Actress and Playwright

7/8/14

Being a blind actress is many things: challenging and rewarding, cathartic and uplifting, fun and freeing. What most people don’t realize is that blindness, in and of itself, requires us to be actors every day. Of course, this is true of anyone and everyone, blind or not. We all wear masks, conceal truths, profess to feel things we don’t. But with a trait like blindness– something obvious and visible, which douses us daily in an eternal, inextinguishable spotlight — the play-acting invariably becomes more complex. Striving, constantly, to put others at ease, regardless of our own state-of-being, is an exhausting side-effect of blindness which few people recognize. In some ways, blind people are more accustomed to the pressures of acting than many sighted person will ever be.
Caitlin - blind actress
If I could grant anyone with special needs one wish, it would be the chance to be part of a company like CRE Outreach. For me, CRE’s magic comes in two forms. First, there’s the singular sensitivity of the sighted members of CRE: the directors, the assistants, the sighted actors who join us on certain projects, the audience members who have attended so many of our shows that they’ve learned about blindness by osmosis. Back home, as I catch my breath between answering the public’s questions and negotiating the logistics of graduate school as the only totally blind student in my program, I replay each little L.A. moment. The guiding hands and detailed explanations, so much more beneficial than the ever-present, ineffectual pointing, gesturing, and “over theres” which the rest of the world uses in abundance. The implementation of sound cues–taps on chairs, doorways, and obstacles in our paths–which become second-nature to those who know us best. The easy way we walk together. The empathy that only develops when a sighted person makes the choice to truly live blindness alongside us, even when it’s hard. And, always, always, the way they’re able to open their eyes wide enough to let us see, too.
Caitlin at piano - blind actress
Alongside our sighted compatriots, our “honorary blind people,” as we affectionately call those of the CRE contingent who can see, we’re a team of blind actors. The blind cast members are different ages and backgrounds; we have different levels of vision, different pasts, different families, different lives, different dreams. But being visually impaired binds us inextricably, regardless of our stories. We’ve all lived through those ups and downs of blindness that can sometimes feel so overwhelmingly difficult to share or explain.

CRE casts never leave shows and move on. Contact remains constant, through phone calls and texts and e-mails, voice-chatting and video-chatting and Braille letters, playing and replaying treasured recordings of the laughs, the triumphs, the moments of growth and change. It’s about so much more than putting on a show. When the curtains part on opening night, our plays almost feel like bonuses: beautiful things we were able to produce as a team, chiefly because we’re so deeply invested in this family we’ve created along the way.

Caitlin Headshot copy revCaitlin Hernandez
CRE Outreach
Actress and Playwright

Theater Company Gives Blind Actors Confidence

7/3/14

In this two-part blog post, you will learn more about an amazing program at CRE Outreach, which uses theater to engage and improve confidence among the blind participants, which is how the program started, later helping at-risk youth and military veterans. In the second post on Tuesday, one of the blind actors, Caitlin, will share her experiences as a member of the CRE Outreach troop and what it has meant to her.
theater - blind actors
When twelve visually impaired kids, ranging in age from eight to thirteen, are busy creating characters for their original play, silence is a rarity. Here, in the safe space of an acting class where everyone is visually impaired. I glance around the circle to see whose turn it is to suggest a character … and then I understand the silence. Eric is ten years old, totally blind, and autistic. He’s almost completely nonverbal. If he has ideas, which I often sense that he does, we never hear them.

It’s highly unlikely that Eric’s going to speak, or share, or rise from his hunched, self-protective crouch among the other students. I prompt him anyway. “Eric, it’s your turn. Do you have an idea for a character?”

Without warning, he lights up. A burst of energy seems to lift him right out of his hunched position, and with more clarity and volume than I’ve ever heard from him before, he declares, “I want to be a human telephone!”

Eric went on to be the lead in our show and now interacts socially with other kids. Acting has helped him build up his confidence and find his voice. And he isn’t alone.

CRE Outreach aims to transform lives one show at a time. From inception to performance, these actors play a major role in all aspects of the production. Inclusivity is the cornerstone of CRE Outreach. Our productions are based on authentic stories and rarely-heard messages, conveyed by the very people who should be sharing them.

CRE Outreach works with three different populations–at-risk youth, military veterans, and the visually impaired–using theater as an empowerment tool. For all participants, stepping into another character allows them to forget about themselves for a while. They feel new emotions, take on new experiences, and live a life which they don’t have the opportunity to live every day.

For blind actors, visual impairment is their common thread, but it’s their will to define their disability which truly binds them. To cement that bond, we introduce each new blind actor to our theater group with an exercise called “The Run.” One by one, each visually impaired actor races from one side of the stage to the other: an experience that they have never had before. Learning to use sound cues, along with textured mats on the floor, the actors break through their fears of movement and learn to navigate the stage independently. They learn to trust themselves and each other. As they run, they realize that the unknown isn’t half as scary as you’d think, when you have a family all around you.

Greg Shane - blind actorsGreg Shane
CRE Outreach
Co-Founder

6 Summertime Tips for Children’s Vision

5/20/14

Summer vacation is around the corner and for children this means more time spent outside playing, swimming, or going to the beach. All of this outside activity increases their exposure to ultraviolet rays which is of particular concern because the lens of a child allows 70% more UV rays to reach the retina than in an adult. This may put them at increased risk of developing debilitating eye diseases such as cataracts or macular degeneration as adults.
Children with sunglasses
If you are wearing sunglasses to combat the bright sunlight, then your child should be wearing them, from babies on up. Wrap-around sunglasses provide more sun and eye protection. Wearing protective goggles during sports activities is also important as the National Eye Institute reports there are more than 100,000 sports-related eye injuries every year with 42,000 requiring emergency care.

While it may be hard to get them to leave them on, or if they keep falling off, invest in a strap that can range from $4.50-$10.00. They can be made of neoprene with fun designs like Croakies or they can use an adjustable cord like Chums. In any case it also helps cut down on lost sunglasses.

Pediatricians offer the following five suggestions for children to enjoy a fun and safe summer:

1. Wear sunglasses – especially younger children

During our lives, almost half of the time we spend outdoors is before the age of 12. Sunglasses for children don’t have to be expensive, but make sure they are rated to block both UVA and UVB radiation. Glasses should also have a polycarbonate lens to withstand shattering.

2. Wear protective eye gear for ball or shooting sports

Every year there are 18,000 sports-related eye injuries in US hospital emergency rooms. The American Academy of Ophthalmology recommends that children wear polycarbonate goggles for baseball, basketball and racket sports, including tennis. It becomes even more important with shooting games like air-soft where the projectiles are so small, but can do major damage to the eye. Regular glasses are not recommended if they cannot be secured to the head or are not made from polycarbonate. Also make sure the goggles have proper sun protection for outside sports.

3. Don’t rub if sand gets in the eyes

If a child gets sand into his eyes, take the child immediately to a sink with running water. Do not allow them to rub their eyes as this can scratch the outer layer of the eye known as the cornea. Use a clean cup to pour water over the eyes to remove sand. Encourage blinking and do not discourage crying, because tears remove eye irritants. If flushing and blinking does not work, seek immediate medical attention.

4. Use a non-irritating sunscreen

While you can use adult sunscreens for children, make sure it is PABA free, since that chemical can cause irritation in some people. If your child gets a rash from his sunscreen, review the ingredient’s list and choose a different one. UVA protection from titanium dioxide or zinc oxide tends to be less irritating than avobenzone, another common ingredient.

5. Wear a wide-brimmed hat

Don’t just rely on sunscreen.  Have your child wear a hat with a wide brim.  It not only provides additional protection against sunburn on susceptible areas like the nose, neck and ears, but it also helps to protect their eyes from harmful UV rays.  Not all sunlight enters the eye direct from the front.  Wrap-arounds may help protect light from coming in the sides, but they do not stop sunlight from coming in the top or reflective glare from coming up from the bottom.

6. Check chlorine levels in your pool

Too little chlorine in a swimming pool can allow algae and other bacteria to grow, which can lead to eye infections. On the other end of the spectrum, be sure to check the levels of chloramines and the pH of the pool to avoid stinging and redness. Swim goggles are helpful to keep pool water from entering the eye. If redness and irritation persist after swimming, it could be a sign of a more serious infection and medical attention is needed.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation