A couple of weeks ago, Josh, a high school senior, volunteered for service is the US Army and presented to me at the Military Entrance Processing Station for a qualifying physical exam. He was well groomed, smart, friendly, and handsome except for his left eye which was pointing towards his nose.
Unfortunately, vision in his left eye was very limited. I asked him if he had ever seen a doctor about his vision or his crossed eyes. He answered that his mom had told him he did, as an infant, and the doctor told her there was nothing that could be done. (Misinformation)
I agreed that now, his vision cannot be improved, but he could have surgery to make him look better. He said he heard that if he had that surgery there was a good chance he could lose vision in both eyes and he didn’t want to risk it. (More misinformation)
Unfortunately, there was something that could have had been done when he was an infant to save vision in his left eye, but now it’s too late. Eyes must be exposed to light during the early months and years of life or they will never develop vision. If the eyes present two images to the brain – double vision – because they are crossed or otherwise not aligned, the brain will turn one eye off. Unless the brain receives good images by age 4 or 5, it will never be able to turn that eye on again. Surgery, patching, and/or prism glasses can be used to get good images to the brain. Josh’s eyes sent two separate images to his brain, so his brain turned his left eye off. That’s why he cannot see well at age 18.
There are several other problems that can be diagnosed and treated in infancy to preserve child eye health. Cataracts, glaucoma, and eye cancer can all be congenital and if diagnosed early can treated successfully.
To aid pediatricians in diagnosing these and other conditions that could cause blindness, the American Academy of Pediatrics with the help and cooperation of the American Academy of Ophthalmology has a written policy: “Visual System Assessment of Infants, Children, and Young Adults by Pediatricians”. The document was issued as two policies in 2012 and 2013 and was revised and combined as one this month. It is available for any doctor who requests it and is the standard all doctors who care for kids should follow.
If you have kids, especially preschoolers, you will know if their doctor is familial with this policy if she/he carefully examines your baby’s eyes and screens toddlers using a photo screener. The screener takes a picture of the toddler’s eyes which will be sent to an ophthalmologist who will determine if the child needs further evaluation. By age 4 or 5, kids can have vision checked by a standard wall chart using pictures or letters yearly or at least every 2 years.
I can’t emphasize enough the importance of visual screening. My stomach aches when I think about people like Josh who could be seeing much better if he had been treated early. We parents have the responsibility to make sure our kids don’t have such a problem.
If you would like a copy of the policy you can find it on www.pediatrics.org/cgi/doi/10.1542/peds.2015-3596. The companion scientific article is available at www.pediatrics.org/cgi/doi/10.1542/peds.2015-3597.
In the interest of full disclosure, my son Sean is the lead author of both these articles. He is a Professor of Ophthalmology at Vanderbilt University Medical School and the director of pediatric ophthalmology at the university. In the past decade he has lectured to doctors around the world on the importance of visual screening of infants and children. His associate author is Cynthia N. Baker, M.D.
Sean told me there was no way that Josh or any other kid could lose vision in both eyes if he had surgery to correct crossed eyes.
