The time from birth to starting primary school is the most significant period for rapid development in our lives. During this period our nervous systems develop to transform us from helpless babies to completely mobile individuals. Along with movement and coordination, the nervous system also has to develop its ability to gather information about our surroundings and make sense of them. Vision develops as part of this process and it is estimated that about 80% of our brains are involved in some way with sight itself or some aspect of analysing what we see. By the age of five our visual systems are nearly completely developed although some development probably continues slowly up to the age of eight or thereabouts.

The whole process of vision development is extremely complex and even now only partially understood. There is a large number of well recognised disorders of the eyes and visual system that show up in the pre-school years most of which are very rare but are important to detect early on. The majority of early detection or screening is carried out at the local health centre reviews up to and including the pre-school review. Screening is carried out earlier shortly after birth where a newborn child is considered to be at risk from an eye disorder (for instance babies with low birth weight or born prematurely), this eye examination is carried out in the maternity hospital. The commonest eye disorders picked up at the pre-school visits are squints (where the eyes are not aligned correctly). Any child whose General Practitioner feels may have an eye problem requiring specialist attention will be referred onto an Ophthalmologist (an Ophthalmologist is a medically qualified doctor who specialises in diagnosing and treating diseases of the eyes).

Aside from this formal visit, parents may be anxious about their child's eyes or eyesight for a number of reasons. One of the commonest concerns is whether or not their child has a squint. This is where the eyes are not in alignment, giving a "cross-eyed" appearance if they deviate towards each other, or a "vacant" appearance if they deviate away from each other. The concern may be raised because another family member has been affected or that the eyes may seem to squint when the child is tired. Quite often, folds of skin are present either side of the nose which span the inner corner of the gap between the eyelids. These can give rise to the appearance of a squint when in fact the eyes are perfectly aligned. The only sure way to distinguish between this false or "pseudo-squint" from a genuine squint is a thorough examination by an ophthalmologist.

The causes of squint are many and although the majority of affected children only need careful observation and prescription of the appropriate glasses, some may require referral to an orthoptist if the angle of squint (i.e. the amount of non-alignment) is large or it appears that one eye is developing defective vision. Orthoptists work within hospital eye departments and are specifically trained to deal with the problems of defective coordination between the two eyes. Sometimes surgery is necessary to correct the squint. It should also be added that squint can sometimes indicate more serious eye disease requiring urgent attention, this is another reason for examination by an ophthalmologist. Whatever your concerns, always make a note of the points you want to raise about your child's eyes before any consultation and don't be afraid to ask awkward questions - they are usually the most important ones.

Dr Jonathan Whittle is an Associate Specialist in Ophthalmology, at the Princess Alexandra Eye Pavilion, Edinburgh and is Medical Director of Optical Solutions, Medical Eyecare, where appointments are taken every Tuesday and Thursday 2:30 - 7:00 pm.

Optical Solutions

Telephone 0845 519 1226
or e-mail info@optical-solutions.co.uk

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