Why eye screening at birth is critical for your child’s well being

REBECCA Obajimi, 13, cannot remember when her eyesight started getting blurry. All she knows is that she had to squint to see the whiteboard at school. It wasn’t until last year when a free medical eye screening diagnosed Rebecca’s extreme nearsightedness and amblyopia, or lazy eye.

She has made great improvement after going through intense treatment at the hospital but her lazy eye, which causes depth perception problems, may never go away. The chances of it being completely corrected would have been much higher if her condition had been caught earlier.

Rebecca is one of the countless students falling through the cracks of the nation’s fractured efforts to catch and treat vision problems among children.

Thousands of children and teens are blind or have a vision disorder and a large majority of those vision impairments could be treated or cured if caught early.

Professor BoluwatifeOlusanya, a child eye specialist at the University College Hospital (UCH,) Ibadan said eye checks at birth and again during infancy is recommended to detect and treat early eye conditions a baby might be born with.

Prof Olusanya said some babies are born with or develop eye conditions such as cataract, glaucoma, drooping of the upper eyelid, cornea opacity, eye cancers and neonatal conjunctivitis which need to be detected and treated early to ensure the child’s vision is properly developed.

The outcomes of these eye problems could range from less severe ones such as squinting and amblyopia or “lazy eye” to severe ones like cancers that if not properly treated can lead to death.

Amblyopia develops when 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 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 of not seeing well. It is by checking for them that this can be detected,” he declared.

The vision 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 Prof 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 can 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 3 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 the age of one week or one month and it is now addressed at the age of three years, 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.”

Prof Olusanya, however, said only a few babies’ eyes are examined at birth in Nigeria. “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 the 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 newborns is only available in hospitals with specialists like paediatricians. However, DrOlusanya, stated that building eye examination into congenital anomaly checks in new babies will 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 problems, if there is no early intervention, a 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.

DrOlusanya, 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 (look crossed, turn out or don’t focus together).

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.

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