Jewish World Review Jan. 8, 2003 / 5 Shevat, 5763

Focusing on farsighted children



Experts don't agree on when treatment is needed.


By Kathleen Doheny

http://www.NewsAndOpinion.com | If the school vision exam shows a child is farsighted, many eye doctors often tell parents not to worry, that their child will outgrow the condition and that it doesn't need correction.That's especially true if farsightedness is the only vision problem.

But an Ohio researcher and optometrist disagrees and urges parents and eye doctors to at least consider correction if a child is even moderately nearsighted, even if that child does not have other vision problems, such as lazy or crossed eyes.

The recommendation is based partly on a study in which Karla Zadnik, a professor of optometry at Ohio State University in Columbus, and her colleagues followed 33 children, ages 6-14, with moderate to high farsightedness. The researchers tracked the youngsters from first grade one to eighth grade, noting that the farsightedness increased a small amount each year but did not decrease or resolve without correction, Zadnik told colleagues at a recent Research to Prevention Blindness seminar in Washington, D.C.

``This result argues for early correction of moderate to high hyperopia, even in the absence of an eye turn or marked symptoms on the part of the child,'' Zadnik said.

When the farsightedness is accompanied by crossed eyes or other symptoms, eye specialists will typically prescribe glasses. But Zadnik is suggesting that the farsightedness by itself should be a reason to recommend eyeglasses.

When a child has farsightedness, or hyperopia, he or she sees distant objects but can have trouble focusing on close objects. The condition occurs if the eyeball is too short or the cornea has too little curvature, so light rays focus behind the retina, instead of on the retina. Routine vision screening, such as those done in school, may not detect farsightedness. A pediatrician's eye exam may not pick it up either, Zadnik says.

Farsightedness is treated with eyeglasses or contact lenses that correct it by altering the way light enters the eye.

One big reason for her recommendation to correct farsightedness, Zadnik says, is her worry that the vision problem will affect learning. There are not good studies that say a child with uncorrected farsightedness will do poorly in school, she says. But you can make the logical conclusion, she adds, that any problem that affects vision can impede learning.

To properly diagnose farsightedness, the eyes should be dilated, Zadnik says.

At the Research to Prevent Blindness meeting, her colleagues did not all agree with her recommendation.

And another expert, Dr. Michael Redmond, a pediatric ophthalmologist in Pensacola, Fla., says the decision to correct farsightedness depends on a number of variables.

``As you get up to 4 or 5 diopters in farsightedness, in children, most everyone would agree that these kids should be corrected with lenses,'' says Redmond, who chairs the Children's Eye Care Program of the Foundation of the American Academy of Ophthalmology.

And if the farsightedness is accompanied by problems such as eye turn, correction should be prescribed, Redmond agrees.

But in other cases, it's not easy to decide whether eyeglasses are really necessary. There is no harm, physically, in correcting farsightedness, Redmond says. But he worries about wasting resources and taking up much parent time from work for mild cases, in which the eye can sometimes compensate even without corrective lenses.

Even so, Zadnik recommends that parents at least be aware that farsightedness could be a problem. ``The concept of farsightedness in children is something many parents don't even know about,'' Zadnik says. ``They hear a lot about nearsightedness.''

She suggests they be on the lookout for problems.

``The symptoms might be kind of subtle,'' she says. ``They just don't like to read,'' in some cases. ``Maybe they get a headache.''

Once farsightedness is detected, parents can have a struggle convincing children to wear eyeglasses to correct it, Zadnik acknowledges. The glasses prescribed to correct for farsightedness make the eyes look big, she says, and kids are reluctant to wear them.

Still, when children have trouble focusing on near objects or suddenly don't want to read, checking in with the eye specialist is advised, Zadnik says.

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