Eye screening is a critical part of the early well-child examination. In this report by SADE OGUNTOLA, experts say that early detection of vision-threatening eye conditions in babies provides a tremendous opportunity to prevent significant disability and, even blindness.
F OR Iveren, after a very long wait to conceive, gave birth prematurely to baby Precious. Unfortunately, because she refused to have Precious examined soon during the critical four weeks after birth, owing to ignorance, Precious subsequently became blind from Retinopathy of Prematurity (ROP).
A 40-year-old woman, Iveren, had waited five long years after marriage for the fruit of the womb. She and her 45-year old husband, Adamu, had prayed and fasted, yet no baby. The doctors could not explain why they were unable to conceive.
Iveren woke up one morning, about a year ago, feeling unwell. At first, she thought it was an unusual upset which would go away in a day or two but when the headaches, fatigue and queasiness continued into the second week after a visit to the family’s physician, tests were conducted and she was found to be pregnant.
Unfortunately, Iveren gave birth prematurely to baby Precious. Unfortunately, she refused to have Precious examined during the critical four weeks after birth, owing to ignorance. Precious subsequently became blind from Retinopathy of Prematurity (ROP).
Retinopathy of prematurity (ROP) is a potentially blinding disease caused by abnormal development of retinal blood vessels in premature infants. The retina is the inner layer of the eye that receives light and turns it into visual messages that are sent to the brain.
Precious is one of the many Nigerian children either blind or living with poor ability to see because during the critical four weeks after birth, proper eye examination was not done to rule out congenital eye problems.
Dr Boluwatife Olusanya, a child eye specialist at the University College Hospital (UCH,) Ibadan, said eye check at birth and again during infancy is recommended to detect and treat early eye conditions a baby might be born with.
Dr Olusanya said like adults, some babies were born with or develop eye conditions such as cataract, glaucoma, drooping of the upper eyelid, cornea opacity, eye cancers and neonatal conjunctivitis which needs to be detected and treated early to ensure the child’s vision is properly developed.
The outcome of the eye problems could range from less severe ones such as squinting and amblyopia or “lazy eye” to severe one’s cancers that if not properly treated, could lead to death.
Amblyopia develops when an impairment such as strabismus, refractive error, or cataract interferes with the brain’s ability to process visual information from one eye, causing it to favour the other eye. Once a child is visually mature, vision loss from amblyopia cannot be corrected with glasses or contact lenses.
Children with amblyopia can suffer from poor school performance and impairments in-depth perception and fine motor skills such as handwriting and other hand-eye coordinated activities. Some studies show that amblyopia negatively affects self-esteem. People with amblyopia are at increased risk of visual disability, should they lose vision in their good eye.
“All these conditions can occur in babies and infants less than one year. A baby cannot complain. It is by checking for them that they can be detected,” he declared.
The vision system is not fully formed in babies and young children, and equal input from both eyes is necessary for the brain’s vision centres to develop normally.
According to Dr Olusanya “The eye also learns the act of seeing, so when it is not allowed to see clearly, for any reason, it does not render its function properly. It could result in a condition medically called amblyopia, or “lazy eye,” a situation where the vision may become limited in ways that cannot be corrected later in life.
“There is a time limit within which the eye needs to learn to see, the most critical period is the first three months of life. The eye does not get to its full potential until the age of 7 or 8 years. It is like the mouth, it is there but the child does not start to talk until maybe a year.
“If there is a cataract at one week or one month and it is now addressed at the age of 3, the vision will not be as good as it would have been if it was addressed much earlier because the eye did not have the opportunity of learning to see properly.”
Dr Olusanya, however, said only a few babies eyes are examined at birth. “The test is called the red reflex test. It is a basic indicator that the eyes are normal. The quality of the reflection seen using an ophthalmoscope to check the eye can help to know if there is a problem or not.”
This test does not have to be done by an ophthalmologist. It can be done by any doctor using an ophthalmoscope. In United Kingdom, it is the midwife that does the examination at birth.
He added, “even with a penlight, obvious problems like cornea opacity or a squint can be detected. You don’t need to wait for the newborn to open the eyes; you can just lift the eyelids and see if there is a problem.”
Unfortunately, eye screening for newborn is only available in hospitals with specialists like paediatricians. However, Dr Olusanya, stated that building eye examination into congenital anomaly checks in new babies would go a long way in reducing the incidence of poor sight and blindness in children in general.
”It is true that not every child will have that problem. But in those children that may end up with some eye problem, if there is no early intervention, some visual impairment that is not reversible will occur. One case of a child that cannot see is a big issue. It is 100 per cent for that family,” he stated.
Dr Olusanya, however, stated that children with amblyopia, or “lazy eye”, have structurally intact eyes that may appear normal. But one eye isn’t used, generally because of a subtle misalignment. Unless someone notices this early enough, the “lazy” eye can slowly go blind, simply because the brain hasn’t received proper stimulation from it. It’s learned to ignore input from that eye.
Howbeit, Dr Temiye Edamisan, a paediatrician at the Lagos University Teaching Hospital (LUTH), said eye testing is part of what children doctor monitor at their visit to the clinic.
According to him, “We check everything to determine whether the child is growing normally, and that includes the eye. Does the eye follow objects correctly and look into the eye to see if there is any abnormality. And cases requiring specialist attention are referred to the eye doctor.”
Dr Edamisan added that other milestones are also considered. “Does he react when you talk to him; is he fearful or looking playful? And then give the mothers basic information as to what to do when they notice things like catarrh or body temperature in their babies.”
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