By Dr Neeraj Jain, MD, DNB, MNAMS, FICO
Eyes are one of the most important sensory organs of the body. All babies are born with a well-formed but functionally immature visual system so they must learn how to see. At birth, their vision is pretty fuzzy, though they can make out light, shapes, and movement, but they are not able to see well for far and near vision. They can’t discriminate colours properly and can’t follow a moving object.
In the early months of life, the eyes not only grow in size but gain the maturity for many fine movements and tracking abilities. To obtain a perfect visual system for the rest of their lives a child should be free from all the defects not only at birth but while maturing also.
When should a baby have its first eye examination?
The first eye examination is done by the attending paediatrician at delivery. He scans for all congenital malformations. Any abnormality if present is assessed by him and then referred to an ophthalmologist. If the eyes are normal at birth, a normal eye check with ophthalmologist is advised at 6-9 months of age.
When to be concerned
Symptoms that require immediate attention from an ophthalmologist are:
– A white pupil (the centre of the eye) or one pupil appears larger than the other
– Sudden swelling or drooping of a lid, accompanied by a red eye
– Enlarged cornea (baby of the eye) in one or both eyes, any difference in shape or size of eye
– One or both eyes turning in or out
– Tearing, redness or discharge that lasts for a number of days
Visual milestones till 1 year
The focusing ability is the first visual mile stone at 2-3 months of age. You can very well see that your child is staring at any near bright, colourful object. A baby usually develops the ability to track and follow a slow-moving object by three months of age. Before this time, an infant will follow large, slow-moving objects with jerky motions. A three-month-old can usually track an object quite smoothly. A baby should begin to follow moving objects with the eyes and reach for things at around four months of age. A parent can check this by using a rattle; first allow the baby to focus on it and then look for tracking movements. Differentiation of object and colours comes at 4-6 months of age. By this time most babies can differentiate between their mother’s face and a stranger’s face.
At 4-6 months babies develop very good depth perception, so they can touch and hold many objects around. At about 8 months they have nearly 90% of adult vision in all aspects.
What is the right age for glasses?
There is no age limit for glasses. It can be given to as young as a 2 month old. The primary criterion is how useful they will be if recommended. Generally glasses are ignored for smaller refractive error till the age of 4-5 years, as the visual requirement is not great. For amblyopia (reduction or dimness of vision, where there is no apparent pathological condition of the eye), larger refractive errors and astigmatism (refractive error due to abnormal curvature of lens and cornea), the prescription is required even at younger ages.
So if your kid needs a pair of glasses make sure that he wears them all the time. Always follow up every 6-9 months for any change in prescription as it changes very fast in growing kids.
What to do if baby has watering all the time?
Babies generally have excess tears while they are crying; otherwise eyes should appear dry all the time. If your baby has watery eyes, there may be a blocked tear duct system. A blocked tear duct occurs when the nasolacrimal duct (which drains tears from the eye into the nose) is blocked. This happens due to a developmental delay of the tear drainage system. It is estimated that up to 10 per cent of newborns are born with a blocked tear duct and one out of every 100 will need an ophthalmologist’s help to cure the condition. Symptoms include constant tearing for the affected eye; there may be associated cold and redness.
The important thing is if this condition is treated in time, it can save your child from undergoing surgery. Initially this is treated with massage. If massage fails then a small probing can be useful in as many as 95% of cases. So instead of waiting, a timely intervention is easy, quick and more successful. If the same approach is used to treat it at 2 years of age, the success rate is less than 20% and a major surgery may be required to cure the child.
What to do when you notice your child squinting?
Any squint after the age of 6 months is considered abnormal. If you notice that your child has cross eyes, don’t wait to visit an ophthalmologist. The popular belief that the kid will be ok when he grows, is a myth. Let the ophthalmologist decide when the right time is for the surgery, if it’s needed. A surgery at the right time is the best thing for your kid to establish binocular vision (3D vision).
Premature babies
All premature babies who are on oxygen should receive their retinal screening from an ophthalmologist to diagnose and treat a condition called retinopathy of prematurity. This is a potentially blinding disease and mostly seen in babies born before 32 weeks of gestation.
Any mother who had fever and rash, any major illness or any infection while pregnant, should get her child’s eye examined at birth and 3-4 months.
Any child with a sibling who had retinoblastoma (eye cancer) should be under constant screening till the age of 7 years.
