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Our eyes do much more than simply help us see. During the first few years of life, vision is developing rapidly and plays an important part in how children explore the world, learn, move and interact with other people. To mark World Sight Day (8th October), Dr Vijay Tailor-Hamblin, an orthoptist specialising in children's vision, answers some of the questions families commonly have about their child's eyesight and explains what to look out for during those crucial early years.
The first few years are a really important period for visual development. Babies aren't born with fully developed vision – the eyes and brain have to learn to work together, and that process continues throughout early childhood.
Vision is also incredibly important to a child's wider development. They use it to recognise faces, reach for objects, learn to crawl and walk, play, communicate and eventually to read and learn at school.
The important thing for parents to know is that children don't necessarily realise that their vision isn't normal. If one eye sees clearly and the other doesn't, for example, a young child may function perfectly happily and never complain.
That's why identifying problems early matters. Some childhood eye conditions are much easier to treat while the visual system is still developing.
This is something families understandably find confusing because we all look after eyes, but our roles are slightly different.
An orthoptist specialises in how the eyes work together and in the assessment and management of children's vision. We commonly diagnose and manage conditions such as squints, reduced vision and problems with eye movements. In a hospital children's eye service, an orthoptist will often be one of the main professionals a family sees.
An optometrist examines the health of the eyes and measures whether someone needs glasses. Community optometrists – typically based on the ‘high street’ – can examine children and refer them to hospital if necessary.
An ophthalmologist is a medically trained eye doctor. They diagnose and treat eye diseases and can prescribe medicines and perform surgery.
We work very closely together. A child might see one, two or all three depending on what they need.
Vision develops enormously during those first five years.
A newborn's vision is relatively blurred. They are particularly interested in faces and things close to them, which rather conveniently is about the distance of a parent's face when they're being held or fed.
Over the first few months, babies become increasingly able to focus, follow objects and coordinate their two eyes. They begin reaching accurately for things and developing depth perception.
As they become toddlers, their visual world becomes increasingly sophisticated. Vision helps them judge steps, navigate their environment, recognise increasingly fine detail and coordinate their hands and eyes.
By the preschool years, children can have surprisingly sophisticated vision – but importantly, the visual system is still developing. That gives us a window in which we can intervene if something isn't developing normally.
The tricky thing is that sometimes there aren't any obvious signs at all. Children are incredibly adaptable and don't have an adult's vision to compare their own with.
Things I would encourage families to look out for include an eye that frequently turns inwards or outwards, closing or covering one eye, tilting or turning the head to look at things, sitting unusually close to the television, holding objects very close, frequently bumping into things, or struggling to recognise things at a distance.
You might also notice unusual eye movements, persistent watering, sensitivity to light or a child becoming frustrated with visually demanding activities.
One particularly important sign is an unusual white reflection in the pupil, especially in photographs when taken with the flash on. That should be assessed promptly.
But parents shouldn't feel they need to diagnose an eye condition themselves. If something about their child's eyes or vision doesn't seem right, it's reasonable to get it checked.
One of the most common is refractive error, which simply means the eye needs glasses to focus clearly. Children can be long-sighted, short-sighted or have astigmatism.
Another is strabismus, usually called a squint, where the eyes aren't always pointing in the same direction.
We also see amblyopia, often called 'lazy eye'. This is where vision in one eye – or occasionally both – hasn't developed normally. It can happen because of a squint, a difference in prescription between the eyes or something preventing a clear image from reaching the developing visual system.
The encouraging thing is that these are conditions we know a great deal about and can often manage very effectively, particularly when we identify them early.
Children actually have several opportunities for their eyes to be checked from birth. The NHS newborn examination includes checks of the eyes, with another examination at around six to eight weeks.
In England, children should also be offered vision screening at around four to five years old, usually when they start school. This is designed particularly to identify reduced vision while there is still time to treat it effectively.
But parents absolutely don't need to wait until school if they're concerned.
Children can have an eye examination at a community optometrist at any age – they don't need to be able to read or even talk for us to assess aspects of their vision. NHS sight tests are free for children under 16.
If your child already attends a hospital eye clinic, the team will tell you how frequently they need to be reviewed.
This is something I really like reassuring parents about: we don't need a child to know their letters to test their vision.
For a baby, we can look at how they respond to faces, lights and interesting objects and whether both eyes are behaving similarly. With toddlers, we can turn vision testing into a matching game using pictures or symbols.
We'll usually look at how the eyes move, whether they're straight and working together and whether there's any difference between the two eyes. Depending on where the child is being assessed, they may also have their glasses prescription and eye health checked.
Sometimes we use eye drops to relax the eye's focusing system so that we can accurately measure whether glasses are needed.
A good children's eye examination should feel much more like playing games than sitting an exam. If a child can't complete one particular test, that's fine – we adapt.
I'd avoid making screens the villain. They're part of children's lives, and it's more useful to think about balance.
Long periods of close work can cause tired or uncomfortable eyes, and spending lots of time indoors doing near activities has also been associated with the development of short-sightedness in children. Outdoor time is particularly valuable.
For very young children, screen use is also a wider developmental issue rather than purely an eye-health one. Guidance generally encourages limiting sedentary screen time in the early years, particularly for very young children.
My practical advice is to break up close work, encourage plenty of outdoor play and avoid hours of uninterrupted screen use. For younger children especially, interacting, playing, reading and exploring the real world provide things a screen simply can't replace.
Yes, some eye conditions have a genetic component, although having a family history certainly doesn't mean a child will develop the same problem.
Short-sightedness, squint and amblyopia can all be more common in families where parents or siblings are affected. There are also less common inherited eye conditions where knowing the family history is particularly important.
If you or your child's sibling had a significant squint, lazy eye, strong glasses from a young age or another childhood eye condition, mention it when your child's eyes are being assessed.
And if you're concerned, there's no harm in arranging an eye examination rather than waiting for your child to complain.
There's a little bit of truth hidden inside the carrot story!
Carrots contain beta-carotene, which the body can convert into vitamin A. Vitamin A is important for the retina and particularly for vision in low-light conditions. Severe vitamin A deficiency can cause serious problems with vision.
But eating extra carrots won't give a child superhero night vision if they're already getting enough vitamin A!
For most children, the best thing for their eyes is the same thing that's good for the rest of their development: a balanced, varied diet. There's no single 'eye superfood' families need to worry about.
Don't wait for your child to tell you they can't see. Children often don't know there's anything wrong because the vision they have is the only vision they've ever experienced.
Make sure they have their vision screening when they start school, and if you notice something that concerns you before then – whether that's an eye turning, unusual eye movements, holding things very close or simply a feeling that they aren't seeing as well as you'd expect – get it checked.
Most of the time you'll be reassured. But when there is a problem, finding it early can make a real difference.
There are a few things where I wouldn't recommend waiting for a routine eye test. A new white or unusual reflection from the pupil, a sudden change in the position or movement of an eye, significant eye pain or injury, sudden loss of vision, or a very red and painful eye should be assessed promptly.
For babies in particular, parents should also seek advice if they feel their baby isn't responding to faces or visual objects as expected, or if the eyes are making persistent unusual movements.
These problems are uncommon, so I don't want parents examining their child's eyes every day and worrying. The simple message is: if something changes suddenly or doesn't look right, seek advice.
Dr Vijay Tailor-Hamblin, Orthoptist and children's vision researcher: https://www.orthoptist.co.uk
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