People are often confused about the importance of glasses for children. Some believe that if children wear glasses when they are young, they won't need them later. Others think wearing glasses as a child makes one dependent on them later. Neither is true. Children need glasses because they are genetically nearsighted, farsighted, or astigmatic. These conditions do not go away nor do they get worse because they are not corrected. Glasses or contacts are necessary throughout life for good vision.

Nearsightedness (distant objects appear blurry) typically begins between the ages of eight and fifteen but can start earlier. Farsightedness is actually normal in young children and not a problem as long as it is mild. If a child is too farsighted, vision is blurry or the eyes cross when looking closely at things. This is usually apparent around the age of two. Almost everyone has some amount of astigmatism (oval instead of round cornea). Glasses are required only if the astigmatism is strong.

Unlike adults, children who need glasses may develop a second problem, called amblyopia or lazy eye. Amblyopia means even with the right prescription, one eye (or sometimes both eyes) does not see normally. Amblyopia is more likely to occur if the prescription needed to correct one eye is stronger than the other. Wearing glasses can prevent amblyopia from developing in the more out-of-focus eye.

Children (and adults) who do not see well with one eye because of amblyopia, or because of any other medical problem that cannot be corrected, should wear safety glasses to protect the normal eye.

When children have difficulty reading, parents often think poor vision is the problem. If a visit to an ophthalmologist rules out any medical or vision problems, it may be a learning disability.

A learning disability is a disparity between a person's ability and performance in a certain area. It has nothing to do with intelligence or IQ. A learning disability can make it difficult to succeed in school and, if untreated, gets worse, causing a child to lose self-confidence and interest in school.

Identifying the learning disability is the first step in treating it. Dyslexia, a reading disability that may involve reversing letters and words, is one of the many learning disorders that can affect reading.

Exercises have been used to improve the coordination or focusing of the eyes. Since poor reading is not usually an eye problem, these exercises rarely prove helpful. Colored lenses, special diets or vitamins, jumping on trampolines, or walking on balance beams have also been prescribed without much success. Over time, these methods have tended to fall out of favor.

Children with learning disabilities benefit from various educational programs, in or out of school. Parents also play a vital role. They can support their children by reading with them at home. Children with learning disabilities need to be encouraged to develop strengths and interests so they can fully develop their unique talents and abilities.

Cataract in Children

A cataract is a clouding of the eye's normally clear lens. The lens of the eye plays an important role in focusing images on the retina, the light-sensitive nerve cells lining the back of the eye. If the lens loses its clarity, light rays do not focus clearly and vision is blurry. Just as it is hard to see through a dirty window, it is hard to see through a cataract. Although most cataracts occur in older adults, they can appear in children, in one or both eyes, often at birth. They look like a white or gray spot in the pupil.

Cataracts in children may be inherited or develop because of an infection or a disease acquired before birth, or as a result of an injury. In most cases, no specific cause is found.

Children may lose vision permanently because of amblyopia (lazy eye) if a severe cataract is not removed quickly. The better eye may also need to be patched. Mild cataracts may not need treatment.

The focusing power of the original lens, removed during cataract surgery, must be replaced to restore vision. Intraocular lenses (IOLs), permanent plastic lenses placed inside the eye, are implanted in older children much as they are in adults. In infants, IOLs are controversial because the eyes grow and change their prescriptions during the first few years of life. Many surgeons prefer contact lenses or even glasses for younger children.

Regardless of the type of correction, children need follow-up exams to avoid possible complications, including glaucoma, scar tissue forming in the pupil, and amblyopia. Often, children will need eye muscle surgery because the eye turns or crosses.

Despite these problems, cataracts are the single most treatable cause of childhood blindness. After surgery, most children can see the blackboard in school (20/60-20/100). While some do not do as well, with appropriate correction, many children see almost normally.

Eyeglasses for Infants and Children

Prescriptions for glasses can be measured in even the youngest and most uncooperative children by using a special instrument called a retinoscope to analyze light reflected through the pupil from the back of the eye.

Most lenses today, especially for children, are made of plastic, which is stronger and lighter than glass. It is a good idea to get a scratch-resistant coating on plastic lenses. Children can be rough with glasses and plastic lenses scratch easily.

Color tints or tints that respond to changes in light can be incorporated into lenses. For children, the tint should not be so dark that the child has trouble seeing indoors.

Frames come in all shapes and sizes. Choose one that fits comfortably but securely. There are devices available to keep glasses in place, a good idea for active children and young children with flat nasal bridges. Cable temples, which wrap around the back of the ears, are good for toddlers. Infants may require a strap across the top and back of the head instead of earpieces. Flexible hinges hold glasses in position, allow the glasses to "grow" with the child, and prevent the side arms from being broken.

Children often do not like their glasses although the prescription is correct. Distraction, positive reinforcement, and bribery help children get in the habit of wearing glasses. If all else fails, your ophthalmologist can prescribe an eye drop that blurs vision when the glasses are not in place. This often overcomes the child's initial resistance to wearing glasses.