Doctors Urge Testing to Catch Lazy Eye in Babies

 
August 10, 2004, Associated Press

Lazy eye is one of the most serious yet correctable eye disorders in babies: Catch it early, from age 6 months through preschool, and it's easily corrected -- but wait too long and one eye can go virtually blind.

But how do you test a baby's eyes?

The answer lies with that annoying red eye in flash photographs and a new computer software to test children. Scientists hope eventually babies and toddlers will get easy screenings not just from eye professionals, but from pediatricians and day-care centers.

"If all pediatricians could do this, you wouldn't need pediatric eye doctors," says Dr. Gerhard Cibis, ophthalmology chief at Children's Mercy Hospital in Kansas City, Mo.

"A skill problem and a manpower problem" means less than half of children today are diagnosed before kindergarten, when a cure is easiest.

That's not just a problem with lazy eye. One in four school-age children has some vision problem, yet experts say the vast majority don't have a true eye exam before starting school -- even though vision and learning are inextricably linked. Indeed, some studies suggest 80 percent of children who have trouble reading have eyes that don't properly coordinate or focus.

Typical eye charts, even with symbols instead of letters for the very young, aren't enough. They may catch serious nearsightedness, but don't test if eyes focus and shift properly between distances, if the eyes work together or are hooked up to the brain correctly to give realistic images.

Amblyopia, or lazy eye, afflicts up to 5 percent of children who have one eye so much stronger than the other that it eventually takes over and renders the weaker eye useless. Catch it young -- ideally before kindergarten but definitely before age 9, when brain-eye connections are set -- and it's fixable by patching over the strong eye for a few hours a day, thus exercising the weak eye's brain links.

To properly check children's vision, eye professionals shine a special instrument called an ophthalmoscope into the pupil to cause a red reflex
-- the same red eye your camera flash causes. Compare this reflection of light from the back of the eye to pupil size, distance from the light and the light's angle, and doctors can diagnose nearsightedness, farsightedness, astigmatism and other disorders.

If both eyes have the same problem, the child may just need glasses. But if one eye is nearsighted and the other farsighted, or if they don't focus together, the disparity can cause amblyopia.

Few people are skilled in such diagnosis. To compensate, Lions Clubs screenings shoot special black-and-white Polaroid photos of toddlers for experts to analyze. But if a child isn't looking directly at the flash, that doesn't work, Cibis says.

So with Lions Club funding, Cibis and University of Missouri-Columbia computer engineer Jim Kelley are creating software that scans videotape of babies' faces, pinpointing pupils and measuring the red reflex. For an extremely nearsighted eye, for instance, the computer shows greater brightness on the pupil's left edge; a farsighted eye lights up on the opposite edge.

The goal is to use the computerized test for routine screening, such as in day-care centers.

That could be several years away. Until then, make sure your children get a comprehensive eye exam from an optometrist or ophthalmologist before starting school.

And the American Optometric Association recommends an eye exam every two years starting at age 6 months -- more frequently if vision problems are detected.

For more information, go to the American Optometric Association's Web site at http://www.aoanet.org.