General EYE ADVICE

Recommendations:

(i) Early assessment to detect any ocular or sight problems is strongly recommended, as these problems not only affect the development of the child's vision, but also the overall development of the child. Vision is important in the development of many skills that a child needs to acquire. Infants must "learn to see" and also "see to learn".

Videotapes are available that demonstrate the important developmental milestones in preschoolers. This information would help in giving the parent an idea as to how well their child is progressing and whether any special efforts should be made to help the child in their acquisition of particular skills. For a brief explanation of the visual skills that infants and preschoolers acquire see "Infants' vision: learning to see" and "Your baby's developing sight".

Provided there are no signs of eye problems necessitating an eye examination at an earlier age, all children should have an eye examination between six months and twelve months of age. However, if there is anyone in the family with a known turned eye or muscle imbalance, or significant amount of long-sightedness in one or both eyes, an eye examination within the first three months of life is strongly recommended.

An inherited long-sightedness may be the precipitating factor for esotropia in some infants. There may well be no sign of long-sightedness in a one year old infant with esotropia, only because the long-sightedness may be masked by the infant's strong accommodative system, or it may be eliminated by changes to the ocular structures that are brought on by the infant's need to achieve normal-sightedness.. The usual resort then is surgery, as there does not appear to be any long-sightedness that needs to be corrected.

In cases of astigmatism and short-sightedness, no action is usually required at the three month stage. However, follow-up examinations would be important if significant amounts of these errors are detected at this early stage. The eyes will continue to emmetropise (progress to normal vision), especially over the next two to three years. Intervention is usually required if there is no sign of improvement at the eighteen months stage.

Once the child has been examined by an eyecare practitioner, he or she can then determine how soon the next eye examination should be scheduled.

(ii) Seek professional advice on what now constitutes a healthy diet. Infants should be breast-fed for at least the first six months but preferably for longer periods of time. A supplement of breast milk is preferable to no breast milk. If breast-milk feeding is not at all possible, one should preferably use formula milk that contains n-3 and n-6 series polyunsaturated fatty acids (Infant Nutrition). After six months of age, one needs to place special emphasis on the infant's iron requirements. The infant's age is important when considering the types of foods and the quantities needed. Iron is especially important between the ages of six months and three years. At this time the ocular structures are more "plastic" and a strong neuro-muscular system will help to achieve normal-sightedness. A regular supply of iron is also important thereafter for strong and durable focusing ability.

(iii) Adequate visual experience is needed in order for the infant to test and "fine-tune" the ocular structures. This is not usually a problem for most infants. However, it is worth noting that checkered patterns on walls etc. tend to better stimulate the focussing mechanisms, enabling better "fine-tuning". They also encourage the phenomenon of fusion to develop, despite possible misalignment of the eyes.

Infants should be given the opportunity to see at all distances. Occasional outdoor viewing would help to practice seeing at long distances. Of course all necessary precautions, such as sun protection, should then be taken.

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Section B