Astigmatism in Children: Causes, Effects, and Treatment Options

Q: Astigmatism in Children: Causes, Effects, and Treatment Options

Hello, Miss： "Amblyopia" refers to a condition where, after the normal developmental period of the eyes, one or both eyes cannot achieve "best-corrected visual acuity" of 0.8 or higher with lenses, despite the absence of any pathological changes in the ocular structures. <br>The

Astigmatism in children can lead to amblyopia?

1) Frequent rubbing of the eyes, especially if it feels itchy, can potentially worsen astigmatism.
Conditions that may exacerbate astigmatism include eye strain, improper vision habits, or underlying eye conditions.
Astigmatism can develop in individuals as they grow, often due to changes in the shape of the cornea or lens.
The same factors that contribute to the worsening of astigmatism in those with congenital astigmatism may also apply.
2) Squinting while watching television may indicate that the screen is too bright or that the child is having difficulty seeing clearly due to astigmatism.
Squinting can temporarily improve focus.
If the child struggles to see clearly, it may be beneficial to have them sit closer to the screen to reduce eye strain.
3) Astigmatism can affect both near and far vision, and it may cause difficulties in seeing clearly under bright or dim lighting conditions.
If the child is consistently miscounting in schoolwork, it could be due to unclear vision, lack of understanding, or lack of focus.
Color perception can also be affected; for instance, if the child struggles to see certain colors, it may lead to frustration, as noted with the white crayon.
4) Learning to play the piano is not inherently unsuitable; however, after getting glasses, appropriate practice time can help with visual training.
Engaging in activities that require focusing on small text or playing handheld video games may stimulate the visual system.
5) If glasses are prescribed now, it is possible that by ages 9 or 10, the best-corrected vision may reach 1.0 (20/20), but this can vary based on individual circumstances.
6) After the age of 10, if there is no amblyopia and vision stabilizes, the child may not need to wear glasses continuously.
However, if astigmatism causes persistent blurriness, the child may prefer to wear glasses for clearer vision.
7) If astigmatism had been detected earlier, it might have been possible to manage it more effectively, potentially preventing it from becoming severe or leading to amblyopia.
8) It may be possible to monitor the condition or use eye drops before resorting to glasses, especially if there are concerns about incorrect prescriptions.
Typically, the results of eye examinations are reliable, and significant errors due to hyperopia or other causes leading to amblyopia are uncommon.
9) For a nearly 3-year-old, there are instruments available for preliminary astigmatism screening, but visual acuity tests may still require the child to cooperate with a vision chart.
Since the child may not fully understand the process, it can be challenging to assess their vision accurately.
I appreciate your detailed questions and will address each one thoroughly!

Liang ge xiao hai de ma, 30~39 year old female. Ask Date: 2005/11/21

Dr. Liu Jingxian reply Ophthalmology

Hello, Miss: "Amblyopia" refers to a condition where, after the normal developmental period of the eyes, one or both eyes cannot achieve "best-corrected visual acuity" of 0.8 or higher with lenses, despite the absence of any pathological changes in the ocular structures.
The visual development in children follows a reference standard known as "visual milestones," which is influenced by intelligence and eye development.
The minimum requirement for "best-corrected visual acuity" is as follows: for a three-year-old child, it should be 0.5; for a four-year-old, 0.6; for a five-year-old, 0.7; and for a six-year-old, 0.8.
The golden period for treating amblyopia is between the ages of 4 to 6.
If treatment is initiated after the age of 8 or 9, the results are usually not favorable.
Conversely, children who receive correction will not experience regression in visual function after the age of 10, provided there are no other external factors.
During the process of visual development, if the focusing ability of light entering the eye is disrupted on the retina, it can lead to insufficient visual stimulation, resulting in amblyopia.
For example, high refractive errors (high myopia, hyperopia, or astigmatism) can prevent light from focusing correctly on the retina, potentially causing amblyopia.

There are several steps to consider in the treatment of amblyopia: 1.
Correcting "refractive errors" such as high myopia, hyperopia, or astigmatism, which should be addressed first with glasses as prescribed by a physician.
2.
"Occlusion therapy," which involves forcing the amblyopic eye to see, typically requiring all-day patching.
3.
For those with poor responses to occlusion therapy, "amblyopia training" may be combined.
Based on your description, your young child can wait until the age of four for an eye assessment at the hospital.
Your older child has developed bilateral amblyopia due to high astigmatism (greater than 200 degrees).
The first step is to wear glasses with the correct prescription (most of the child's astigmatism is related to the natural curvature of the cornea, and excessive rubbing of the eyes should be avoided; in adults, astigmatism is more closely related to the lens).
Wearing glasses with the correct prescription can help improve the focusing disruption caused by high astigmatism.
There are three prerequisites for amblyopia training: appropriate time, light, and posture.
After every 30 minutes of viewing, the eyes should rest for 10 minutes to avoid adverse effects from overexertion; the brightness and direction of light are also crucial, avoiding overly bright, dim, or reflective conditions; maintaining an appropriate reading distance and correct posture is essential, avoiding lying down or leaning while viewing to enhance the effectiveness of "amblyopia training." If you have any related questions, feel free to visit the ophthalmology department at the City United Hospital.
Wishing you good health.

Ophthalmologist Liu Jing-Hsi, Taipei City United Hospital, Zhongxing Branch, Taiwan e-Learning Academy.

Reply Date: 2005/11/21

More Info

Understanding astigmatism in children is crucial for ensuring their visual health and overall development. Astigmatism is a common refractive error caused by an irregular shape of the cornea or lens, leading to blurred or distorted vision. In your case, your child has been diagnosed with congenital astigmatism of approximately 400 degrees in both eyes, which can significantly impact their visual acuity, as indicated by their current vision scores of 0.5 and 0.6.

1. Rubbing Eyes and Astigmatism Progression
Rubbing the eyes can indeed lead to discomfort and may exacerbate existing eye conditions, including astigmatism. While it may not directly worsen the astigmatism itself, frequent rubbing can cause irritation and potentially lead to other issues, such as keratoconus, where the cornea becomes progressively thinner and more conical in shape. Astigmatism can be congenital or develop over time due to various factors, including eye strain, improper visual habits, or other underlying conditions.

2. Squinting at Screens
Squinting is a common response to visual discomfort. If your child squints while watching television, it may indicate that they are struggling to see clearly, possibly due to their astigmatism. Squinting can temporarily improve focus by reducing the amount of light entering the eye and increasing depth of field. However, it is essential to ensure that your child is watching from an appropriate distance to minimize eye strain.

3. Clarity at Different Distances
Astigmatism can affect both near and distance vision, leading to difficulties in seeing clearly in various lighting conditions. If your child is having trouble with schoolwork, it could be due to their inability to see the board or their assignments clearly. The frustration with colors, such as not being able to see a white crayon on white paper, can also stem from visual clarity issues.

4. Learning Instruments like Piano
Playing an instrument such as the piano can be beneficial for children with astigmatism, provided they have the appropriate visual correction through glasses. Engaging in activities that require visual focus can help strengthen their visual skills. However, it is essential to monitor their comfort and ensure they are not straining their eyes.

5. Visual Acuity Expectations
With proper correction, many children can achieve significant improvements in visual acuity. While reaching a vision of 1.0 (20/20) is possible, it may not be guaranteed, especially if there are other underlying issues. Regular follow-ups with an eye care professional are crucial to monitor progress.

6. Long-term Glasses Use
Once your child reaches the age of 10 and if their vision stabilizes, they may not need to wear glasses all the time, especially if they can see clearly without them. However, if their astigmatism remains significant, they may still benefit from wearing glasses for specific tasks, such as reading or watching television.

7. Early Detection and Treatment
Early detection and intervention are vital in managing astigmatism and preventing complications like amblyopia (lazy eye). If astigmatism is identified and treated early, it can help mitigate the risk of developing more severe vision problems.

8. Observation and Treatment Options
In some cases, monitoring the condition or using eye drops may be appropriate before resorting to glasses. However, a comprehensive eye examination is necessary to rule out other conditions and confirm the diagnosis.

9. Screening for Younger Siblings
For younger children, there are various methods to assess vision, including specialized instruments that can detect refractive errors like astigmatism. While traditional vision charts may be challenging for very young children, pediatric eye care professionals often use alternative methods to evaluate visual acuity.

In conclusion, addressing your child's astigmatism with corrective lenses and regular eye examinations is essential for their visual development. Engaging with an eye care professional who specializes in pediatric vision will provide you with the best guidance tailored to your child's needs.

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