Impaired Vision

The eye itself and the parts of the brain involved in vision still are developing during infancy and early childhood. Interaction among all the parts of the visual system, including structures of the eye that receive sensory input, cells that respond to light, and the area in the brain that converts messages from the eyes into visual images make vision possible. Disruption of any part of the system, especially in the first year, can lead to vision loss.

HOW DOES IMPAIRED VISION DEVELOP?
Loss of vision can happen at any time before or after birth. Certain infections in pregnant women, such as rubella (German measles), can cause blindness in the newborn. Congenital herpes or gonorrhea infections may damage vision, as may eye infections picked up from other sources.

			• Signs of childhood vision problems

A condition called retinopathy of prematurity frequently causes vision loss in premature infants. This disorder develops when a premature baby's retina is damaged by adminstration of high concentrations of oxygen—a necessary measure for saving many babies who are born too early.

Some infants are born with congenital forms of eye diseases that generally occur in adulthood, such as cataracts and glaucoma. Untreated strabismus (lazy eye), a result of the brain's natural tendency to block out images from the weaker eye if one eye is stronger than the other, also can lead to serious vision deficits. In rare cases, vision loss may be a result of a cancer. Blindness may also occur as a late complication of diabetes.

Eye injuries, which are commonly caused by balls, fists and sticks, often lead to visual impairment or loss of vision. Most of these injuries should be preventable. (For more information, see eye injuries.)

WHEN SHOULD I SUSPECT THAT MY CHILD HAS IMPAIRED VISION?
The signs of failing vision are subtle, particularly in infants. If a baby does not respond to a change in a parent's facial expression or is not distracted by a mobile or toy, it may be a sign that his sight is impaired. In babies over three months old, a cross-eyed appearance may be an indication of strabismus.

Older children with vision problems may avoid activities requiring coordination of sight and movement, such as playing catch or walking on a balance beam.

IS MEDICAL ATTENTION NECESSARY?
Yes. If you suspect that your child is not seeing well, a medical assessment is needed. If impaired vision is a result of a correctable problem such as strabismus, treatment should begin as soon as possible. If a child has a permanent vision loss, he should receive rehabilitation so that impaired vision does not interfere with normal development.

WHAT TREATMENTS ARE AVAILABLE?
The treatment depends on the cause and degree of visual impairment. If possible, treatment is aimed first at the underlying cause. Thus, antibiotics are given for eye infections, while eye patching, exercises and (in some cases) surgery are employed to correct strabismus.

Children with severe and irreversible vision losses generally attend special programs for the visually impaired starting at about age two. Before that, they may receive in-home therapy aimed at providing the types of stimulation necessary for normal development. The therapist can show parents how to play with the baby in ways that depend more on the senses of touch, hearing and movement than on sight. Parents also may learn how to choose appropriate toys and arrange the home in a way that permits the child maximum independence.

CARING FOR A CHILD WITH IMPAIRED VISION
Infants with normal sight interact with their parents mainly by focusing on their faces and maintaining eye contact. This type of interaction is not possible with a visually impaired baby, so parents need to learn other ways to foster attachment. Such babies can recognize parents' voices, smells and movement patterns, and then respond with changes in body language, such as becoming still and turning the head. Parents may need some instruction to interpret their babies responses.

GETTING HELP
Call your doctor if your child:

• Has a yellowish-white mass in the pupil

• Has an inward turning or wandering eye

• Has a partially closed eyelid

• Does not focus his eyes evenly by the third month of life

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.