You will rarely hear children complain about their vision. Yet the Childhood Eye Cancer Trust estimates that one million in the UK have an undetected eye condition. This means that one in five children are unlikely to reach their full visual, learning and social potential because they missed out on something as simple as an eye examination.
In the UK, screening is recommended for premature babies and children with diabetes, who may be at risk of vision problems, says Professor Christopher Lloyd, chairman of the Royal College of Ophthalmologists’ paediatric sub-committee. Screening is also advised for new-borns and six to eight-week-old babies to identify problems such as cataracts, and for pre-school children to detect amblyopia (lazy eye), he adds.
Kids are missing out
The UK National Screening Committee recommends the latter for all four and five year olds. But, the reality is, thousands of children are missing out on these tests, says Dr Susan Blakeney, clinical adviser to the College of Optometrists. A recent investigation by the college found fewer than a third of English councils provide eye tests at school entry. Plus, there are no national guidelines for the screening of school-aged children.
One in five children are unlikely to reach their full visual, learning and social potential because they missed out on something as simple as an eye examination
Things are no better for the 100,000 disabled pupils in special education, who are 28 times more likely to have serious vision problems than other children. A report by SeeAbility and Cardiff University suggests that nearly four in ten never had an eye examination.
“The main message from these findings is that parents should look out in their children for signs of vision problem, such as excessive eye-rubbing or watering, holding objects close to the face, clumsiness, avoiding drawing and closing one eye when looking at things,” says Dr Blakeney. “And, if they have concerns, they should visit an optometrist.”
Seems pretty straightforward. But new research from Blind Children UK shows one in four parents surveyed have never taken their children for an eye test. This figure rises to nearly one in two for parents of children under five.
Dr Anna Horwood, a vision scientist at the University of Reading, says it’s particularly important to ensure a child’s near-sight is properly assessed because pre-school screening usually looks only for problems with distant vision. She is conducting a study, supported by Fight for Sight, which explores the potential link between poor near-vision (long-sightedness) and educational development in children aged six to ten.
Ian Flitcroft, a consultant paediatric ophthalmologist at Children’s University Hospitals, Dublin, notes: “Refractive errors such as long and short-sightedness don’t normally cause health problems in childhood, but can hinder education if left untreated. It’s difficult fully to take part in learning, keep pace with your peers and fulfil your potential if you cannot see properly.
“Affected children should be diagnosed and get their glasses, very quickly. If the problem is not correctible with glasses, parents and teachers should plan for the child’s education, by assessing needs and getting the necessary support in place, as soon as possible. Time is of the essence.”
Many councils and schools across the UK provide specialist teachers, adapted reading materials and IT equipment, as well as advice for parents on how to enhance learning at home.
Regular eye examinations are particularly important for conditions such as retinoblastoma, a rare eye cancer, often caused by non-inherited gene mutations, which primarily affects children under five. About 50 to 60 cases are diagnosed annually in the UK.
“Retinoblastoma is life threatening, but around 98 per cent of affected children are successfully cured thanks to timely treatment, including surgery and chemotherapy. So spotting the condition early is paramount,” says Joy Felgate, chief executive of the Childhood Eye Cancer Trust.
“Opticians and GPs can usually detect retinoblastoma and can refer to the appropriate specialists for further investigations. An eye test is, therefore, a vital first step, especially if any of the potential early signs of this cancer, such as a white glow in the centre of the eye or, more rarely, a squint when the eyes point in different directions, are present.”
Time is of the essence
Mr Flitcroft adds: “It’s also important to consider that children are still growing, so any delay in detecting problems can affect their adult eyesight. For example, there is a window of opportunity to treat amblyopia, when vision doesn’t develop properly in one eye. Missing that window can result in permanent vision impairment in the affected eye.”
Amblyopia is the most frequently treated disorder by paediatric eye specialists in the UK. Normal vision can be restored, but treatment needs to start before the age of seven when vision development stops.
Other eye conditions commonly occur in childhood. A 2014 study in Ophthalmic Epidemiology found 53 per cent of children referred to a specialist following pre-school screening needed glasses for long or short-sightedness, astigmatism or squints.
Preventing eye illnesses
These problems can potentially have long-term consequences. Take for instance short-sightedness (myopia). A review published in Progress in Retinal and Eye Research concludes that the condition increases the risk of developing serious eye illnesses later in life, including glaucoma. This occurs when pressure builds up inside the eye, damaging the optic nerve, which carries visual information to the brain.
The finding is significant given glaucoma is a leading cause of blindness and the number of 12 and 13 year olds with myopia in Britain has more than doubled, from 10 to 23 per cent, over the past 50 years.
The risk of myopia leading to glaucoma is comparable to that of having a heart attack from smoking, explains Mr Flitcroft, who carried out the review. Detecting the condition in childhood can lower this risk through interventions that delay myopia progression and eye tests which help diagnose glaucoma early, when treatment is still effective.
Dr Blakeney concludes: “Eye examinations are accessible and straightforward. Children don’t have to be able to talk or read. And all NHS tests are free under the age of 16. There is really no excuse for overlooking the eye health of a child.”