Your Child's Vision: Addressing Nearsightedness and Astigmatism

A child who is about to turn three years old has a visual acuity of 0.7 in both eyes?

My child will turn three in four days.
A month ago, we visited an ophthalmologist because since birth, the lower eyelashes have been rubbing against the eyeball, causing excessive tearing and discharge.
During that visit, the right eye was found to have a refractive error of -4.00 diopters (myopia) and -1.50 diopters (astigmatism).
The doctor advised us to teach our child to recognize the vision chart.
Today, we returned for a follow-up, and the refractive error in the right eye remains -4.00 diopters, with both eyes showing -1.50 diopters of astigmatism.
The vision chart results for both eyes are 0.7.
The doctor mentioned that a three-year-old child should still be hyperopic (farsighted), and a vision of 0.6 indicates amblyopia (lazy eye), while our child is currently at 0.7.
The doctor prescribed a long-acting cycloplegic agent and instructed us to start administering it at bedtime one week before the next appointment to determine whether it is pseudomyopia or true myopia.
We were also advised to reduce the opportunities for our child to engage in near work.
The result of both eyes being 0.7 has left us feeling frustrated, sad, and guilty, as our nearly three-year-old child is facing such a serious eye issue.
What can we do to make this condition reversible? Are there any dietary adjustments we can make to help improve the situation? Our child loves reading and watches cartoons on weekends; could this be contributing to the severity? When I was a child, I spent all day watching TV with my grandmother, yet I only developed myopia in middle school, and it has remained stable at around -1.00 to -2.00 diopters for over twenty years.

Min Xin, 30~39 year old female. Ask Date: 2013/12/10

Dr. Zhuang Yamin reply Ophthalmology

Dear Min-Hsin,
Hello! The visual development of a three-year-old child is not yet complete, and a visual acuity of 0.7 is not considered abnormal.
In simple terms, his current visual development status is normal (no amblyopia).
However, due to the presence of significant refractive errors (myopia and astigmatism), it is important to be cautious about the potential for developing amblyopia before the age of six, when visual development is still stabilizing.
Please try not to worry too much; children's ciliary muscle accommodation abilities are very strong, and sometimes the refractive error can vary significantly after instilling dilating eye drops.
Based on your description, the physician you consulted has conducted the examination, management, and explanation very appropriately.
Additionally, since the issue was identified early, as long as you continue to cooperate with follow-up examinations and monitoring, the chances of developing amblyopia will be greatly reduced.

I would like to remind you that in pediatric vision issues, the important aspect is "how well can visual acuity develop and what is the best corrected vision achievable," rather than "whether or not to wear glasses." I have seen some parents mistakenly believe that "once glasses are worn, the condition will worsen," and thus hesitate to allow their children to wear corrective lenses early on, which can lead to tragic outcomes of amblyopia due to missed treatment opportunities.
Wishing your precious child good health! Keep it up!
Best regards,
Ophthalmology Department, Changhua Hospital
Caring for you~

Reply Date: 2013/12/10

More Info

When it comes to addressing your child's vision issues, particularly concerning nearsightedness (myopia) and astigmatism, it's essential to understand the complexities involved in pediatric eye care. Your child's recent diagnosis of 400 degrees of nearsightedness and 150 degrees of astigmatism at the tender age of three is indeed concerning, but there are steps you can take to manage and potentially improve their visual health.

Firstly, it is important to recognize that children’s eyes are still developing, and their visual system is quite adaptable. The fact that your child has been diagnosed with myopia and astigmatism at such a young age does not mean that these conditions are set in stone. The eye care professional's recommendation to use a long-acting cycloplegic agent (dilating drops) is a standard procedure to determine whether your child's nearsightedness is "true" or "pseudo" myopia. Pseudo myopia can occur when the eye is temporarily focusing too much on near objects, leading to blurred distance vision. This can often be improved with proper management, including reducing near work and encouraging outdoor activities.

In terms of managing your child's vision, here are several strategies you can consider:
1. Limit Near Work: As advised by your child's doctor, reducing the time spent on near activities such as reading, drawing, or screen time is crucial. The American Academy of Ophthalmology recommends the 20-20-20 rule: every 20 minutes of near work, take a 20-second break to look at something 20 feet away. This helps reduce eye strain and allows the eyes to relax.

2. Encourage Outdoor Play: Studies have shown that spending time outdoors can help slow the progression of myopia in children. Natural light exposure and the opportunity to focus on distant objects can be beneficial for eye health.

3. Regular Eye Exams: Frequent check-ups with an eye care professional are vital. This allows for monitoring of your child's vision and timely adjustments to their treatment plan as necessary.

4. Vision Therapy: Depending on the specific needs of your child, vision therapy may be recommended. This is a structured program of visual activities designed to improve visual skills and processing.

5. Diet and Nutrition: While there is no definitive diet that can reverse myopia, a balanced diet rich in vitamins A, C, and E, as well as omega-3 fatty acids, can support overall eye health. Foods like leafy greens, carrots, fish, and nuts are beneficial.

6. Corrective Lenses: If prescribed, ensure your child wears their glasses consistently. Corrective lenses can help improve their vision and reduce eye strain.

7. Parental Support and Education: Educate yourself about your child's condition and stay informed about the latest research and treatment options. Your support and understanding can significantly impact your child's attitude towards their vision care.

It's understandable to feel overwhelmed and concerned about your child's eye health, especially when comparing your experiences with their current situation. However, every child's eyes develop differently, and early intervention can make a significant difference. By following your eye care provider's recommendations and implementing these strategies, you can help create a supportive environment for your child's visual development. Remember, the goal is to monitor and manage their condition effectively, allowing for the best possible outcomes as they grow.

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