Common vision-related challenges in children with special needs

It is entirely possible it is a problem with short sightedness. However to be sure you need to get a one-on-one doctor consultation with an ophthalmologist.

If my child has trouble seeing how can I tell if the problem with his eyes is due to a problem with vision or an allergic reaction to some substance? This is especially hard to differentiate when the child is non-verbal.

If the child constantly rubs his eyes then it indicates itching and hence attributed to an allergic response. However, if a child cups or presses his eye then it may be indicative of a vision problem.

What is the difference between a lazy eye and a squint? Both share similar characteristics. How can I differentiate between the two?

Squint is a result of improper eye alignment. Either one eye’s angle is turned towards the nose, or away from the nose. This can be noticed to occur in either eye alternately, or only in one eye. It can be seen at all times, or more often when the child is inattentive or outdoors in sunlight.

Lazy eye is when the weaker eye is suppressed, while the dominant eye carries out visual functions. It can result from any cause that results in poor vision in the affected eye from early childhood. Due to poor eye teaming, the better eye is the only functioning eye. In many cases, the lazy eye can lead to a squint. Conversely, a squint in the eye can lead to a lazy eye.

Both are problems associated with poor eye teaming.

This entirely depends on the severity of the condition in the child. It is also possible it is inconvenient for the child to be put on a patch for extended time periods. In such instances using a reward to reinforce his cooperation may prevent his dislike for it every day.

What do I as a parent do when my child complaints of frequent headaches?

First get a complete eye examination done to rule of vision-related problems. If that doesn’t solve the headache then go to an ENT to rule of ear problems. It can also be due to a migraine.

My child often complains of pain, which at times may appear as eye related pain or head pain. How can we tell the two apart?

If the pain is noted to occur after prolonged visual task, it can indicate a refractive error leading to eye strain associated pain.

If the pain is noticed to occur along with symptoms of eye pain, photophobia, motion sickness nausea or vomiting, it can indicate migraine. An eye pain can be indicative of an eye migraine as well, which if left untreated can lead to a squint later.

In some instances, we have observed that academic stress can also lead to children having complaints of headache and eye aches.

For many of our children we use gadgets to help them engage and communicate. But if using gadgets can cause problems with eyesight how can the two contradictors be accommodated?

Moving visuals are good for stimulation of the brain, and are the first line of help for non-verbal children for means of communication. Balance is the key here, where the advantages of visual media can benefit the child, but avoid complete dependency and excessive usage of the same.

Is B&W imagery preferred over colored imagery for children on the Autistic spectrum?

Not really. Usages of color are preferable for viewing objects  for children on the spectrum, but avoid using too many colours at the same time. It is preferable to use two colors at one time. As long as the child’s field of sight is de-cluttered and the contrast is enhanced in their sight of vision it shouldn’t cause him/her too much discomfort.

How can color blindness be detected in a child, especially if he/she is non-verbal or too young to comprehend the differences in colors?

It is hard to detect color blindness in children. It becomes easier when kids are older and can comprehend differences well so they can be tested using activities or toys.

It is possible that oscillations trigger migraines in the child. A child or for that matter any individual cannot tolerate too much movement when migraine is triggered.

Another possibility is altered field of vision in some children. Some children with Hypotonia can observe parts of their field of vision but not all in one go. This may lead to problems with visual perception, causing discomfort in the child.

If my child has seizures, can it affect his/her field of vision?

Yes, it is possible.

Seizures are common in children in the Autism spectrum. Seizure episode leads to decrease oxygenation in the brain tissue, which can have a profound effect on the visual system. It is also known that when the seizures are properly controlled, the effect of other therapies for the children is more rewarding and effective.

Lack of eye contact is a common concern in children on the Autism spectrum. How can it be improved through activities?

Lack of eye contact in a child on the spectrum has less to do with visual problems and more to do with behavioral problems. Working on his/her behavioral challenges can help address this issue, not vision-based care.

What are the most common causes of night blindness?

It is more often than not indicative of a retinal problem.  Some cases are due to Vitamin A deficiency. Unfortunately, there are no treatments if the blindness if due to a retinal problem. However, mindful management can help reduce unpleasantness of the condition.

For e.g. ensuring proper illumination in the child’s surroundings while studying or playing is beneficial. Also, parents and family members should be sensitized to the issue, and ensure that the child is never left alone in the outdoors at night. One can also instruct the child to carry some form of light with them at all times.

Some children with the following pre-existing conditions are at high risk of developing eye-related troubles –

Premature babies with one of the following insults –

hypoxic-ischemic encephalopathy (HIE),periventricular leukomalacia (PVL) and retinopathy of prematurity (ROP).

Cerebral visual impairment (CVI) in children with Cerebral Palsy

Down syndrome

Children with learning difficulties

Children with hearing difficulties

Children with other brain-systemic issues

Albinism

What faculties of development can visual impairment impact a child?

Visual impairment can hamper the following abilities in the child –

Spatial awareness

Posture and movement skills

Use of hands and fine motor coordination

Early concept development, e.g. permanence of an object

Locating sound in space

Speech and language development

Social communication skills

Self-care skills

Some common challenges in children with special needs include –

Refractive errors – Myopia, Hyperopia, Astigmatism, Accommodative issues

Lazy eye

Retinopathy of prematurity and its sequelae

Squint, nystagmus

Retinal and optic nerve issues

Cataract

Lid inflammation, allergy

Ophthalmologist – Medical doctor with specialization in eye care who attends eye-related medical matters.

Optometrist – A professional well versed with the optics and refraction of the eye. Optometrist has direct contact with the patient during examination. They can measure the patients’ visual acuity, the refractive error. Some well-trained optometrists are also trained in detailed ophthalmic examination in specialized fields. One can see an optometrist for purely refractive and eye disorders associated with binocular single vision.

Optician – Manufacturing and dispensing spectacles and orthoptic devices.

There are many testing modalities that are employed to measure the visual acuity of infants and pre- verbal children.

The foremost thing that the examiner attempts to achieve is a good rapport with the child.

The overall alertness of the child is assessed, and ability or inability of the child  to make eye contact is measured.

One of the most commonly employed tests is the Teller Acuity Card (TAC) test. The child is shown a card with white and black stripes on one side while the other side is plain, and the examiner looks at which side the child focuses his/her attention. This test might be done with both eyes open the child does not allow one eye to be closed.

If this test elicits no response from the child, then a child is shown a bright colored object and examiner assess till what distance away the child is able to follow it and reach out to it.

This same test can also be done with an illuminated object in a dark room for those children with more severe visual impairment.

At the same time, the preference of the child to either eye is also tested by attempting to occlude one eye and to observe for the child’s response. If the child resists occlusion to any one of the eye, it implies poor vision function in the uncovered eye.

It is advisable for children with spectacles to use contact lenses in contact sports. However, in case of sports activities in the water, it should be avoided, as it can lead to increased risk of infection.

How can eye exercises benefit our children?

Eye exercises are mainly employed for conditions like, lazy eye and convergence insufficiency. These can be done under supervision at home. They help children to attain better visual function, with perception of 3D vision.

When and why would a child need vision therapy?

During the phase when the visual system is still developing in the brain, vision therapy always helps to improve visual function. The sooner intervention is initiated, the more beneficial the outcome of the therapy will prove to be. Parents must note that the results of vision therapy are not seen overnight. It requires diligence and persistence from the care givers and health professionals.

What’s the treatment procedure for eye migraine?

One needs to consult Neurologist who will prescribe some medication and most importantly suggest measures to prevent its recurrence, including awareness about factors that promote migraine.

My child’s eye frequently water waters. I was recommended to massage between the eye and nose joint, but the problem persists. What can I do to address it and why does this problem arise? (Child has Down syndrome in this case)

Children with Down syndrome have various anatomical disorders involving the tear drainage system of the eye. Up to the age of 1 year, eye massage can be employed as a treatment option. If the problem persists after that, it is advisable to visit an ophthalmologist as child would mostly require surgical intervention.

The fraction is the reading of the Visual acuity (or clarity) of a person’s eye. The sizes 12 and 60 are distances in meters that a typical person can visualize a given object from. The visual acuity of a typical individual is 6/6.

When vision of an individual is noted as 6/12 it means that an object  that a typical person is able to see at 12 meters, the individual with this visual reading has to be at 6 meters to be able to see the same. When vision of an individual is noted as 6/60 it means that an object that a typical person can see clearly at 60meters, the individual with this visual impairment has to be at 6 meters to be able to see the same.  This is indicative of a problem with far vision in the individual.

From these two recording, 6/60 means poorer vision.

Bigger font size can help children with lazy eye. It is also useful for children with poor attention span. Font size can also help individuals with many forms of cognitive visual dysfunction.

How do we identify vision problems in children at an early age? Any specific red flags to look out for?

The closest care giver can get several clues about poor vision in a child. In the early months of life, if child fails to engage with the mother’s face fails to smile it may be indicative of some form of visual impairment. Parents can also observe for abnormal roving movements or shaking movement of the eyes that may point towards poor vision. Inability of the child to reach out to colorful toys to play with is also an important red flag.

Parents also can also sometimes notice structural problem like white reflex in the pupil area, or cornea. However, get your child checked by a Pediatric Opthalmologist rather than draw conclusions based on these suggestions alone.

Dyslexia patients can have many eye issues including refractive error, squint. Yes, vision test and inventories are available at LVPEI. We can examine these children to find out if they any eye or eye related problems and advice accordingly.