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So Kids Can See Clearly

American Forces Press Service

WASHINGTON, Sept. 21, 1999 – What are some indicators that a child might be having vision problems? Are eye care benefits available to family members under TRICARE? How can parents make sure their children's eyes are protected from safety hazards?

American Forces Press Service sought answers to these and other questions about kids' eyes from Air Force Dr. (Lt. Col.) James Williamson, who shared with reporter Doug Gillert not only his experience as an Air Force optometrist for 14 years but his perspective as a parent of two young sons. The deputy director of clinical quality for the TRICARE Management Activity, Williamson said kids' eyes are different from adults' and need special attention. More from Dr. Williamson:

AFPS: What are some indicators that a child might be having vision problems?

Dr. Williamson: If you notice something wrong with your child's vision such as difficulty seeing at distance, or sense there's something wrong, you should bring them in for an examination. For instance, if you notice an eye is turning in or out, or if they have hand-eye coordination problems or they're having trouble seeing the blackboard, it would be wise to bring them in for an eye examination.

AFPS: Is there an age when this might become most discernible?

Dr. Williamson: It's best to bring kids in between the ages of 3 and 4 for their first eye exam. That way we can check on the health of their eyes and see if there's any disease, alignment problems or refractive error -- farsightedness, nearsightedness or astigmatism.

AFPS: When are children's sight problems most likely to be discovered?

Dr. Williamson: As children grow, their eyes grow. The optics of their eyes may not match up with the length of the eyes, resulting in refractive error. You're most likely to see refractive errors start developing when they're in the third or fourth grade. That's why it's best to bring school-age children in annually for an eye exam.

Kids may also have problems coordinating their eyes and focusing. When children read, their eyes have to turn in, or converge, to track the words on the page. They also have to focus on the words to keep them clear. It is not uncommon to see children with convergence, focusing and tracking problems, though most children don't have them.

AFPS: So you recommend children get eye exams every year?

Dr. Williamson: I think it's a good idea. The American Optometric Association and the American Academy of Ophthalmology recommend the first exam should be at the age of three. After that every one to two years is usually sufficient. The doctor will suggest the interval for the next exam based on the examination findings. I like to examine my kids every year before school starts because we have a family history of nearsightedness.

AFPS: Are parents' eye conditions passed on to their children?

Dr. Williamson: Absolutely. It's genetic, but you can't always predict what's going to happen. I've had parents come in who were both significantly nearsighted, yet their child was farsighted. But most of the time, the children come out somewhere in between the parents. I am actually slightly farsighted. My two boys may tend to follow my gene trait, but it's quite possible they may become nearsighted like their mother as they get older.

AFPS: Do children need the same type of exam as adults?

Dr. Williamson: The exams are similar, but we don't normally start testing for things like glaucoma until they're older, usually in their late teens. If, during an examination, the optic nerve looks suspicious or they have large or cloudy corneas, for example, then we would also perform additional testing for glaucoma.

AFPS: Does TRICARE provide full eye care coverage for family members?

Dr. Williamson: Active duty family members are entitled to an annual eye exam. If they can't get in to the military treatment facility, they can go off base to the managed care support contractor for a small co-pay of $6 to $12 depending on rank.

AFPS: If children need eyeglasses, how can parents help them cope with the need and possible embarrassment of wearing glasses around other children?

Dr. Williamson: One of the best things you can do is allow children to participate in picking out their glasses. You can help them pick out glasses they like and want to wear. If one or both parents wear glasses, the child may be a little more accepting of them, but parents need to explain how the glasses will help the child see more clearly and comfortably.

AFPS: What safety considerations should parents take into account in purchasing children's eyeglasses?

Dr. Williamson: I always recommend plastic lenses. I never recommend -- I don't believe any optometrist should recommend -- glass lenses, because they can shatter. You're always better off to get plastic lenses for kids for safety reasons. And if they participate in sports, polycarbonate resin lenses in a safety or sport frame would be best.

AFPS: Parents might be a little bit hesitant about getting their kids plastic lenses, because they scratch so easily.

Dr. Williamson: That's true, but you can always get anti-scratch coatings on them. They don't totally eliminate scratches, but you must keep the safety factor in mind. They may get scratched, but that's better than having a glass lens shatter and cause serious eye damage.

AFPS: Are contact lenses a viable option for some children?

Dr. Williamson: Contact lenses can be somewhat high risk. If you don't take care of the lenses, they get dirty, bacteria will grow on them and you can end up with corneal ulcers and eye infections. I don't generally recommend contact lenses until they are in their teens and they show a level of responsibility.

You may, though, have children with very high refractive errors that would require thick and cosmetically unappealing lenses. For these children, contact lenses might be a consideration if the parents are willing to take on the responsibility of helping them take care of the lenses. There are times, too, when only one eye requires major correction. A single contact lens may be more appropriate than having a very thin lens for one eye and very thick lens for the other, which again is cosmetically unappealing and uncomfortable to wear.

For instance, I've prescribed contact lenses for newborn babies after they've had a congenital cataract removed. If they have a cataract, they'll develop a lazy eye, so the cataract must be removed for them to have any chance of useful vision in that eye. A contact lens will make up for the focusing power they have lost and equalize the visual acuity between the eyes. Of course, the parents bear the responsibility of insertion and removal of the lens and hygiene.

AFPS: Even if their children don't need glasses, shouldn't parents be concerned about their kids' eye safety?

Dr. Williamson: Unfortunately, people don't always think in terms of safety. Whenever your kids are involved in any activity or task, you've got to be thinking not only about eye safety but safety, period.

During sports or when they're mowing the lawn or using power tools, anything can happen. Just last night, Scotty, my 7-year- old, and I were playing pool on his little pool table and he almost poked me in the eye with his cue stick.

So, in any situation, you have to anticipate what the potential problems are.

AFPS: Do you recommend that children wear safety glasses, for example, when they're doing yard work?

Dr. Williamson: It doesn't hurt to have something on, and in particular, when they're using a lawn trimmer. You've got to protect the eyes. I can't tell you how many times I've had to remove foreign bodies from people's eyes -- a piece of metal or dirt embedded in their cornea.

AFPS: Parents used to tell their children not to sit too close to the television or it would ruin their eyes. Is that true?

Dr. Williamson: Not really. A child's world is up close. Everything they play with, such as toys, dolls or video games, are close tasks. Their world is a near-point world, and that's why they tend to pull things up close. They're actually more comfortable that way.

AFPS: Do they need ultraviolet coatings on their glasses if they're going to use a computer a lot?

Dr. Williamson: That's not really necessary. Again, computer work is close work. Whenever you bring anything close, the lenses in your eyes have to focus and your eyes have to converge on the target. So there's some work involved.

If children complain about their eyes getting tired or things getting out of focus -- whether it's a computer screen or any other close-up activity -- get them to take a break. Lack of lighting or ergonomically related issues may need to be addressed. However, if there continues to be a problem, an eye examination would be in order.

AFPS: Any final insights?

Dr. Williamson: Children often have a limited degree of self- awareness. They may not realize they're having vision difficulties or may ignore them, thinking it's normal. The best way for parents to stay on top of their kids' vision needs is through careful observation and regular exams.

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