Vision and Development: How do I know if everything’s OK?

Birth to Three Article: Carol E. Marusich, OD, MS, FCOVD

There is a wealth of research about the important role vision plays in early childhood supporting appropriate sensory, motor, spatial, behavioral and cognitive development. During the first three years babies learn how to use their senses together in a way that is unique to this phase of development and unmatched during all the rest of their years combined. They are learning how to learn and laying the foundation from which all other understanding and experience will develop.

How much and how well our child learns throughout his life is determined largely by the variety of beneficial experiences in which he participates in his first years of life. It is up to us to arrange the conditions in which our children can learn best. Healthy vision is an important one of those conditions.

Vision impairment, even small irregularities, can have a profound impact on development. Early diagnosis and prevention are the best approach to infant vision and eye health care because most conditions respond best to early treatment, before additional complications arise.

Vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in children according to a recent survey of Vision Screening Policy of Preschool Children in the United States. As many as 5% of preschool children, amounting to nearly 4 million children nationwide, are estimated to have impaired vision according to the American Academy of Pediatrics. They also state that as many as one third of children who receive a late diagnosis of amblyopia (Lazy Eye) had been screened as preschoolers but the amblyopia had gone undetected. Of the children who failed a screening, 50% of the parents were unaware of it two months later.

The American Public Health Association encourages a complete vision and eye health examination at the age of six months as does the American Optometric Association which also advises that screening does not replace a comprehensive examination. The goal of early examination, diagnosis and treatment is to prevent vision and eye health conditions that can impede normal child development.

Many infants can have eye problems without any family history, predisposing condition or event. These, unfortunately, are the ones we often see long after the damage is done because there was no easily detectable sign of trouble. Amblyopia with no eye turn; high nearsightedness, farsightedness or astigmatism which no one suspected; even a small tumor way off to the side in the retina which could not be seen during a screening; these could all be diagnosed during a comprehensive examination.

Some conditions and events could increase your baby’s risk of vision problems. These include the following: infection, fetal drug or alcohol exposure during pregnancy; prematurity; birth weight less than 5lb. 8oz.; medical conditions such as drug sensitivities, Down’s syndrome, Cerebral Palsy, Fragile-X syndrome, or deafness.

Family history of congenital or acquired conditions such as Retinoblastoma, congenital cataracts and metabolic or genetic disease increase risk. Any history of eye or head injury or abuse as an infant or toddler can lead to accompanying eye health and vision problems.

Our baby’s eyes should look clear and healthy, without crusty eyelids, redness or excessive tearing. They should look about the same size and color. Eyelid openings should be about equal and the eyes should appear symmetrical. Frequent eye rubbing, excessive blinking or a tendency to close or cover one eye could indicate a problem. The eyes should be still when your child looks at you, not shaking or vibrating side to side. They should not be excessively sensitive to light.

By six months of age, the eyes should line up and work together at all times and when looking in all directions. A “wandering eye” is not normal after six months of age.

Your baby should be able to follow objects with their head and eyes, make eye contact, respond to facial expressions, look toward objects and accurately reach for them. They should be able to look toward sounds, favorite toys, and especially Mom and Dad.

The is not always an obvious correlation between behavior and underlying vision problems. More than once I have seen an infant with significant visual impairment where the only symptom was delayed motor development. If you can’t see what is out there, you are not very motivated to creep and crawl around to reach anything.

We only get answers to the questions we ask. If we want to know if our baby’s eye health and vision are developing normally, it makes sense to have that early eye examination.

So, as parents, grandparents, guardians, aunts & uncles, what can we do? Now that we better understand the need for early vision and eye health care, we can advocate for the children in our lives. If our toddlers and preschoolers have not yet been examined, make the necessary arrangements to do so. For those little ones from six months to one year of age, I encourage you to take advantage of the American Optometric Association’s National InfantSEE Program where we provide an assessment at no charge for ALL infants in this age group.