Avoiding visual impairment

Avoiding Visual Impairment and Blindness [1] [2]

An estimated 23.7 million adults and 19 million children in America are visually impaired or blind.  Of the children, 12 million are visually impaired due to refractive errors, a condition that could be easily corrected, but 1.4 million children are irreversibly blind and need visual rehabilitation interventions to help attain full psychological and personal development. 

According to the American Academy of Ophthalmology, babies, children and teenagers have different eye health needs than adults. [3]  Some problems, like amblyopia, that can be treated in babies and young children, become irreversible once a child is older.Amblyopia––sometimes called “lazy eye”––means poor vision in an eye that has not developed normal sight, usually during early childhood.  Amblyopia is common and affects two or three of every 100 people in the U.S.  Convergence, the ability of both eyes to focus on an object simultaneously, becomes more fully developed by about age seven; this is one reason any problems a child has with focusing or eye alignment should be treated before that age.  It is crucial to protect the sight of babies, children and teenagers from injury, and other risks like smoking and it is important to detect eye problems as early as possible do avoid developmental delays.

Guidelines for parents of babies:

  • Watch for signs of eye and vision problems such as inward or outward turning eyes or significant delays in tracking moving objects.
  • Have recommended infant/child eye screenings.
  • Most children are naturally somewhat farsighted (hyperopic) that causes nearby objects to be blurry but they can see well at other distances. More pronounced myopia (nearsightedness) that causes distant objects to be blurry and astigmatism (distorted vision), are thought to be inherited. There is some evidence from recent studies in the United States and Australia that the amount of time school-aged children spend outdoors, in natural light, may have some impact on whether they develop mild myopia.

Preschool vision screening is important for at least the following reasons:[4][5]

  • A child may have refractive errors, such as hyperopia , myopia, astigmatism and anismetropia (unequal refractive power).  One of 10 to 20 young children will have vision disorders that if not detected and treated early, preferably before a child reaches age 5, can lead to permanent vision impairments.  They include amblyopia (lazy eye), strabismus (lazy eye, misaligned eyes), and If a baby or child has strabismus (one eye may turns in, out, up or down), signals from the misaligned eye are “turned off” by the brain to avoid double vision, so the child uses only the better-seeing eye and sight in the unused eye may be permanently lost.
  • Parents are often unaware that their children have difficulty seeing clearly so many vision problems are undetected by parents.
  • Young children are unaware of how they should see and have no symptoms of discomfort or pain so they don’t tell parents they have eye problems.
  • Children do not “outgrow” amblyopia (affecting 2%-3% of children) and strabismus (affecting 4% of children).

Refractive errors are just one potential cause of blurred vision, so it is important for your child to have an examination right away if they are experiencing symptoms.
The most common refractive errors in children are:

  • Myopia (nearsightedness) causes distant objects to be blurry.
  • Hyperopia (farsightedness) causes nearby objects to be blurry.
  • Astigmatism (distorted vision)

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Other eye conditions and diseases that can affect a child’s vision are:

  • Ptosis––a drooping upper eyelid that covers the eye either somewhat or entirely, and so blocks vision.
  • "Cloudy" eyes––if the cornea, which is normally clear, appears cloudy, the child may have a cataract or other eye disorder that needs treatment
  • Conjunctivitis (pink eye)––can be a viral or bacterial infection (both are very contagious), or an allergic reaction (not contagious).  The eye many be uncomfortable, red or pink and have tears or discharge.  If the problem is a contagious pink eye, the child needs to stay home from school or return home to avoid infecting others. Contagious pink eye usually resolves in three to seven days.
  • Chalazion––is a small lump on the eyelid, and may occur when a meibomian gland (an oil-secreting gland in the eyelid) becomes clogged. It is not caused by infection.
  • Stye––is a red, sore lump near the edge of the eyelid; it is caused by an infected eyelash follicle.
  • Preseptal or Orbital Cellulitis­­––is an infection with tissues around the eye that makes the eye red and painfully swollen.  It may be related to trauma, an upper respiratory infection or an eyelid infection. The condition usually occurs in one eye, which may be swollen shut. This is a serious condition that requires urgent medical attention.
  • Blocked Tear Duct––causing a watery, irritated or chronically infected eye.

 Accident Prevention

Each year thousands of children sustain eye damage or even blindness from accidents. However more than 90% of all eye injuries from participation in sports, recreation, crafts or home projects can be prevented through use of suitable protective eyewear.  It is important to choose protective eyewear with "ANSI Z87.1" marked on the lens or frame so they meet the American National Standards Institute (ANSI) Z87.1 safety standard. ANSI-approved protective eyewear is available from most hardware stores.

Sports-related eye injuries are common in children and young adult athletes.  Between the ages of five and 14, the most frequent cause is from playing baseball.  Fishing is another common cause of eye injuries.

Some guidelines for preventing eye injuries among children:

  • Children participating in sports should wear eye protectors made with polycarbonate lenses for baseball, basketball, football, racquet sports, soccer, hockey, lacrosse, and paintball.
  • All chemicals and sprays must be kept out of reach of small children.
  • Supervise and teach safe use of common items that can cause serious eye injury, such as paper clips, pencils, scissors, bungee cords, wire coat hangers and rubber bands.
  • Teach your children to be EyeSmart by safeguarding your own sight.
  • Only purchase age-appropriate toys.
  • Avoid projectile toys such as darts, bows and arrows, and missile-firing toys.
  • Look for toys marked with "ASTM", which means the product meets the national safety standards set by the American Society for Testing and Materials.
  • Use safety gates at the top and bottom of stairs. Pad or cushion sharp corners. Put locks on all cabinets and drawers that kids can reach.
  • Do not allow your children to play with non-powder rifles, pellet guns or BB guns. They are extremely dangerous and have been reclassified as firearms and removed from toy departments.
  • Do not allow children anywhere near fireworks, especially bottle rockets. These fireworks pose a serious risk of eye injury and have been banned in several states.
  • When very small children (age 4 and younger) are bitten by dogs, eye injuries occur about 15 percent of the time. The dog is usually one the child is familiar with, and second attacks by the same dog are likely. It is recommended that any dog that bites a child be removed from the household.
  • In the car, make sure children are properly secured in baby carriers and child safety seats and that the seat and shoulder belts fit well. Children age 12 and younger should never ride in the front seat. Store loose items in the trunk or secured on the floor, as any loose object can become a dangerous projectile in a crash.

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Nearly half of all eye injuries each year occur in and around the home so use care when:

  • Using hazardous products and chemicals such as oven cleaner and bleach for cleaning and other chores (accidents involving common household products cause 125,000 eye injuries each year).
  • Cooking foods that can splatter hot grease or oil.
  • Opening champagne bottles during a celebration.
  • Drilling or hammering screws or nails into walls or hard surfaces like brick or cement; the screws or nails can become projectiles, or fragments can come off the surface.
  • Using hot objects such as curling irons around the face; inadvertent contact with the user’s eyes can cause serious injury.
  • Loose rugs and railings or other hazards that could cause falls or slips.

Injury Risks in the Yard

  • Mowing the lawn.
  • Using a power trimmer or edger.
  • Clipping hedges and bushes.

Eye Injury Risks in the Garage or Workshop

  • Using tools (power or hand).
  • Working with solvents or other chemicals.
  • Any task that can produce fragments, dust particles or other eye irritants.
  • Securing equipment or loads with bungee cords.

For all of these activities, it’s important to remember that bystanders also face significant risk and should take precautions against eye injuries too. This is particularly important for children who watch their parents perform routine chores in and around the home. Bystanders should wear eye protection too or leave the area where the chore is being done.

First Aid

An ophthalmologist, primary care doctor, school nurse or children’s health service should examine the eye as soon as possible, even if the injury seems minor at first, as a serious injury is not always immediately obvious. Delaying medical attention can cause the damaged areas to worsen and could result in permanent vision loss or blindness.
While seeking medical help:

  • DO NOT touch, rub or apply pressure to the eye.
  • DO NOT try to remove any object stuck in the eye. For small debris, lift eye lid and ask child to blink rapidly to see if tears will flush out the particle. If not, close the eye and seek treatment.
  • Do not apply ointment or medication to the eye.
  • A cut or puncture wound should be gently covered.
  • Only in the event of chemical exposure, flush with plenty of water.

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The following is a modified version of the National Eye Institute’s advice for preserving eye health that is appropriate for teens and adults:[6]

  • Have a comprehensive dilated eye exam at least every two years. Many people think that their vision is fine but don’t realize that they could see better with glasses or contact lenses. In addition, many common eye diseases such as glaucoma, diabetic eye disease and age-related macular degeneration often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages when they are the most treatable.
  • Know your family’s eye health history. It’s important to know if anyone in your family has been diagnosed with an eye disease or condition because many are hereditary.

  • Healthy eating helps protect sight. A heart healthy diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens will help keep eyes healthy, as will fish such as salmon, tuna, and halibut that are high in omega-3 fatty acids. [7]
  • Maintain a healthy weight. Being overweight or obese increases the risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma.
  • Wear protective eyewear. Wear protective eyewear when playing sports or engaged in activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.
  • Quit smoking or never start. Smoking is as bad for eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness, [8] [9]

  • Wear sunglasses. Sunglasses help to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.   However, exposure to the UV-B in sunlight in childhood may help prevent the growing epidemic of nearsightedness.[10]
  • Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.
  • Clean your hands and your contact lenses properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.
  • Practice workplace eye safety. Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times and encourage your coworkers to do the same.

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Endnotes and Links

[1]Visual impairment and blindness. World Health Organization. Fact Sheet N°282
Updated August 2014. http://www.who.int/mediacentre/factsheets/fs282/en/
[2]Brody JE. The Worst That Could Happen? Going Blind. New York Times, February 21, 2017.
[3]Eye Health for Babies, Children & Teenagers. American Academy of Ophthalmology
[4]Importance of Preschool Vision Screening: 6 Reasons. Good-Lite
[5]Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force. Screening for visual impairment in children younger than age 5 years. May 2004. http://www.ahrq.gov/clinic/3rduspstf/visionscr/vischrs.pdf
[6]Simple tips for healthy eyes. National Eye Institute. https://nei.nih.gov/healthyeyes/eyehealthtips
[7]Age-Related Eye Disease Study Research Group. The relationship of dietary carotenoid with vitamin A, E, and C intake with age-related macular degeneration in a case-control study. Archives of Ophthalmology; 2007; 125(9): 12251232.
[8]Age-Related Eye Disease Study Research Group. Risk factors associated with age-related nuclear and cortical cataract. Ophthalmology; 2001; 108(8): 14001408.
[9]U.S. Department of Health and Human Services, Office of the Surgeon General. The Health Consequences of Smoking: A Report of the Surgeon General. Washington, D.C., 2004.
[10]Reynolds G. Let There Be Light. New York Times Magazine, January 22, 2017.

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