High Refractive Errors in Children often go Undiagnosed, leading to Visual Impairment
We had the pleasure of being introduced to the sweetest little girl at our office a few months ago. She came in to have an eye examination because her preschool teacher had sent home a note stating that she was holding things very close to her eyes in an attempt to see. The mother of the child had not noticed any visual problems and the little girl had not complained of any.
Upon visual testing, she was only able to count fingers across the room with her right eye, while she could see 20/400 (the big E) with her left eye. Her refractive error was determined to be approximately +10.50 D in the right eye and +8.00 D in the left. With this prescription in place, the child immediately noticed some improvement in vision, now able to see 20/200 with her right and 20/80 with her left.
This charming little girl has a very high hyperopic (far-sighted) prescription. Because she had probably been born with some degree of this refractive error the child had grown accustomed to seeing blurry. She knew no difference. Additionally, because her uncorrected refractive error had been present for some time before being diagnosed, her brain never developed neurons that gave her the potential to reach 20/20 or anything close to it. When ocular disease is absent and 20/20 can not be reached even with a spectacle correction, we call this condition Amblyopia. Amblyopia works on the principal that when one’s eyesight is blurred, the brain is never completely visually stimulated. Thus, the eye and brain are not able to develop visual neurons that are capable of seeing all the fine, detailed stuff. The good news is that if the refractive condition is caught early enough, the eyesight can be improved after being corrected with spectacle or contact lenses. An earlier diagnosis betters the chances of success, as the brain and visual system are dynamic and open to change when a child is still growing.
In this patient’s case, we chose to fit her in contact lenses instead of glasses as this would ensure that the child was visually corrected at all times without having to wear thick “coke bottle” glasses. Contact lenses are also the correction of choice if a significant power difference exists between the two eyes. We gave the mother a lesson on how to insert and remove the contacts then fit the child with a contact prescription that was slightly cut back on to allow her to adapt more easily to her new corrective lenses.
Within a month, the child returned to our office claiming that she “could see the cats across the street now!” Both mother and child were excited at the progress she had seen. Her new visual acuities with her full prescription were measured at 20/100 in the right eye and 20/40 in the left. Almost a three-fold improvement!! The power of her lenses were increased to full strength and we will continue to follow-up with her every few months until her best potential acuity is achieved. If full improvement is not achieved with visual correction alone, we may consider patching her better seeing right eye to allow full stimulation of the left eye. Because the mother and daughter are diligent and compliant, the prognosis for her is good despite the measured progress it may take to get there.
This case demonstrates the importance of complete eye examinations at an early age. Uncorrected hyperopia, myopia, astigmatism, an eye turn, or a congenital cataract can result in amblyopia and permanent visual impairment if not treated early enough. Like with this little girl, she did not know to complain of her vision being blurry, because this was the only world she knew. We encourage you all to start thinking about your children’s eyes and set up an exam today.
Thanks for reading!!