|“My child is having trouble seeing.”|
|Needs glasses: Trouble seeing board at school, squinting|
|Learning disability: Trouble reading, normal visual acuity|
|Wants glasses: Peer at school recently got “cool” glasses|
|Dry eyes: Trouble after reading for several minutes, eye
|Physiological: No other complaints|
|Migraine: Associated headache|
|Check vision on eye chart|
|Check for papilledema|
Refer to an ophthalmologist.
Learning disorders should not be missed.
Practically speaking, most parents will not bring their older
children to their primary care provider specifically because of
complaints of decreased or abnormal vision. Vision problems will
usually come to attention either by your specific questions about
vision during your regular well-child history, or if the child fails
a vision screening test in the office.
There are several reasons older children may complain of decreased
or abnormal vision:
- 1. Need for glasses. The most
common reason children and young adults need glasses is myopia (nearsightedness). Patients
with myopia can see things at near, but have difficulty seeing clearly
in the distance. Myopia usually begins during grade school and typically
worsens gradually. It is not uncommon for children with myopia to
be unaware that they have a vision problem until it is specifically brought
to their attention. This may occur either during a vision screening
test or if the child is with someone who notes a distant object
that the child cannot see (Table 4–1).
- 2. Learning disorders. Children
with learning disabilities frequently complain that they are having
trouble seeing. However, the problem for the vast majority of children
with reading problems is not the eyes, but the processing of written
information in the brain. It is important that these children be
evaluated to verify that they do not have an underlying visual problem.
If the eyes are fine, these children are best served with additional
educational assistance (Table 4–2).
- 3. The child wants glasses. Some
children, typically in early elementary school, may feign vision
problems due to a desire to wear glasses. Most commonly, this occurs
after someone in their class has received glasses that bring them
positive attention (such as glasses with a cartoon character theme).
Such children are often visibly disappointed when told they do not
need to wear glasses.
- 4. Dry eyes. Problems with the
tear film in children are not uncommon, and they are a frequently
overlooked cause of blurred vision. A stable tear film is necessary
to form crisp visual images. Children with dry eyes usually complain
that things become blurry after they have been reading for a while. They
may also complain of eye irritation (Table 4–3).
- 5. Colored spots. There ...