Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, November 23, 1993                   TAG: 9311230124
SECTION: EXTRA                    PAGE: 6   EDITION: METRO 
SOURCE: Jane Brody
DATELINE:                                 LENGTH: Long

VIGILANCE FOR PROBLEMS WITH A CHILD'S VISION IS VITAL

One child in four has a vision problem that would show up readily in a professional eye exam, and one child in five needs eyeglasses. Parents are often lulled into a false sense of security after their children "pass" the school eye chart exam, which is required by law in most states.

In fact, as many as 70 to 80 percent of problems are undetected by this useful but limited test.

Dr. Walter Fierson, a pediatric ophthalmologist in Pasadena, Calif., estimated that "of all children with correctable eye problems, between 10 and 15 percent of those in the upper socioeconomic groups and as many as 50 percent in the lower socioeconomic groups have not been diagnosed."

But even if only a small percentage of affected children were missed, it would have serious potential consequences. In some cases, failure to detect and correct eye problems in preschoolers results in permanent visual impairment.

Among children in school, learning and self-esteem may suffer as they fall behind in academic skills and physical pursuits that require good binocular vision.

To rectify this situation, the American Academy of Pediatrics will soon publish new guidelines for children's eye exams.

The academy has for years recommended that infants be examined for visual deficiencies and eye muscle imbalances during the first six months of life, and that regular vision screening be started in the preschool years. Preliminary checkups can be done by pediatricians or family care specialists, but when a potential problem is found the child should see an eye care professional, preferably an ophthalmologist, ideally a pediatric ophthalmologist.

Even though an infant cannot read an eye chart, the pediatrician using an ophthalmoscope can get an approximation of how well the baby sees and, even more important, whether the baby has a vision-impairing problem like cataracts (which can be present at birth), scarring on the surface of the eye, a congenital malformation of the eye or an eye muscle problem that prevents both eyes from working together.

When eye muscle problems go undetected or are detected but not corrected before the age of 6, the child may become functionally blind in one eye, a condition called amblyopia; although the eye can "see," the brain learns to block out the image and instead registers only the image from one eye.

Parents who resist treatment because they think their child will outgrow a problem like crossed eyes or lazy eye may end up dooming the child to a life of monocular vision. Dr. Jane Kivlin, a pediatric ophthalmologist in Milwaukee, said that three months after a full-term birth, "a baby should have straight eyes and should be looking at you intently."

Looking through an ophthalmoscope, a pediatrician can examine the retina and tell whether light is equally reflected from both eyes. If one eye is significantly worse than the other, the brain will block the image from the poorer eye, also resulting in amblyopia.

This vision problem can be detected and even corrected within the first six months of life.

Nearsightedness in infants is not usually considered to need correction, particularly since an infant's world is so close by.

However, if a 6-month-old baby is found to be extremely nearsighted, corrective lenses (eye glasses or in some cases contact lenses) may be prescribed even at that age, Dr. Rivlin said. Lesser degrees of nearsightedness might be treated with eyeglasses at the age of 2 or so.

Most preschoolers are slightly farsighted, which would make it easy for them to see an eye chart 10 or 20 feet away even if they could not see the words in a book on their laps.

The Better Vision Institute, an advisory council of eye-care professionals, points out that vital visual skills like focusing, gauging distance or following text on a page are not tested in typical in-school screenings, and problems in these areas may go undetected until the fourth or fifth grade, when textbook type gets smaller.

Nearsightedness, or myopia, which results in difficulty seeing words and numbers on the blackboard, tends to be a grade school problem and may be noticed by the child, the teacher or the school nurse doing an eye chart exam.

Still, an astonishing number of children with serious myopia manage to reach the sixth grade before the problem is detected and corrected with lenses.

Children born with visual impairments are not likely to complain about them because they have no reference point that tells them they do not see as well as other people do.

Dr. Robert Gross, a pediatric ophthalmologist in Fort Worth, Texas, who has helped develop the new guidelines for pediatricians, said screening tests for visual acuity should start at the age of 3 and be repeated annually well into the elementary grades. But parents and teachers, as well as doctors performing well-baby checkups, must be alert to potential problems.