My Child has just been told that he/she is longsighted and needs glasses! The Optician told me about it – but it was complicated! What does it all mean and where do we go from here? Longsightedness – or – HYPERMETROPIA – or – HYPEROPIA are all words describing a condition of the eye where the eye is out of focus and has to accommodate – or focus – in order to see clearly. Just like looking through a telescope – you have to turn the dial and focus the lenses in order to get a clear picture. I always find it easiest to explain longsightedness – in terms of comparing it to the normal eye.

The Normal Eye

This eye can see clearly at a distance – it is perfectly in focus – and does not have to focus or do anything to see clearly. Then, when the normal eye has to see up close, the muscles in the eye contract and the eye focuses up close – the closer you look at something – the more you can feel your eyes focus focusing / straining. But, as you look closer note that your eyes are turning in to your nose to see the object coming closer. – So, no focusing for distance and increasing amounts for near viewing. A young healthy eye can focus almost up to their nose ! but this ability to focus decreases throughout life. In terms of diopters – a young child can focus up to about 15 diopters in total – but will only use about 3 to 4 Diopters to read a book held at about 30cm.

The Longsighted Eye

This eye is physically too small – meaning that the image formed by the lenses of the eye is focused behind the retina – meaning that the image on the retina is out of focus, or blurred. The brain recognises this problem and fixes it by telling the eye muscles to contract and focusing the lens in the eye in order to create a clear image on the retina. In a child with a large range of focus this is quite easily done. Example; Say your child has a prescription of +3.00. This means he/she has to focus 3 Dioptres to see at a distance. When he/she reads he has to focus 3 Dioptres on top of that – so needs to focus 6 Dioptres in total when reading at 33cm.

The Problem With Longsighted Eye’s

As a child grows their visual needs change. We all know how their school work changes over time – the print gets smaller, maths gets more complicated, they start doing Irish or other languages. In playtime children use computers, playstations, smart phones and play sports to fast increasing levels of skill. All of these changes mean that the child is less and less able to predict what they will see or should see next. If their eye is out of focus, even briefly, they will make a spelling error, miscalculate or even miss-kick!.
Both Eyes Longsighted:

If both eyes are reasonably equally longsighted – both will tend to focus equally. BUT, if the child is tried or not concentrating (how often does that happen! ) they may loose focus and no longer see clearly. Depending on the amount of longsightedness, this will vary from Zero to +12.00 Dioptres. Even a child with +3.00 will have to focus their eyes twice as much as a child with normal eyes. This will tire out the eyes quite quickly and cause the child to loose concentration and interest in the text.

Significant Right / Left Difference

If one eye is significantly more longsighted than the other, the child’s brain will see clearly with one eye and blurred with the other. It will no longer be able to fuse these two pictures together and create a 3D image. In order to fix this, the brain will decide to simply ignore the eye with the most blurred image and so see clearly in one eye only. This will cause the child to develop the so called LAZY EYE. From Birth until age about 8 is an extremely critical period in the child’s visual development. Should a child have an undetected lazy eye after the age of 8 it is effectively impossible to reverse the damage and retrain the brain to use that eye. For this reason it is critical a child is corrected with spectacles and if needed the child may need to put a temporary patch on his/her good eye to force the brain to use the lazy eye. This patching needs to be monitored very carefully and in Ireland requires ophthalmological monitoring. An ophthalmologist is an eye surgeon / consultant.

Squint / Turn In One Eye

This vision problem in children is often first presented when a parent (usually Mom) notices a turn in the child’s eye. Most commonly this happens between birth until age 4-5, but usually earlier rather than later. This turn in the eye is usually due to the child being longsighted and as the child focus’s its eye, the eyes over focus and turn in towards the nose – (Just like the normal eye turns in when it is focusing on something up close). The child, with small out of focus eyes, needs to focus more all the time and the stimulus to turn in develops and presto – one eye turns in to the nose and the child is left using the other eye to look at the object of interest. This means that the brain is again only using one eye. The eye turning inwards is ignored by the brain as it is not looking in the correct direction. This eye will therefore be a LAZY EYE. Giving the child spectacles will mean that he/she no-longer needs to over focus, the eyes will both look in the same direction and so the child will see equally with both eyes at the same time.

Spectacles For Longsightedness

These spectacles lenses are convex – thick in the middle and thin at the edge – like a magnifying glass. Children’s faces are small so they need to be fitted with small frames. Adult frames need larger lenses. Larger diameter lenses are in their nature thicker in the middle and in turn are also heavier. It is therefore important to supply a child with the best fitting frame and then decide on the best matching lens size, material and design to suit the frame. There are numerous options available – small diameter lenses, aspheric lenses with flatter curves, high index lenses made from denser thinner lighter materials and custom made lenses which can incorporate all of the above into the lens that best suites the frame shape, size and usage needs of the child. These choices are best made by your optometrist / dispensing optician.

Nolke Opticians and Children’s Eye Testing:

Optometrists Kjell Nolke and Mary Counihan have many years experience in examining children’s eyes. In fact we thoroughly enjoy the experience and challenges children present during the tests. Typically children can be a bit nervous or frightened in an opticians room. Parents / guardians are always brought in to the room to both reassure the child and give relevant information on health and both child and family history. Nolke Opticians have a full range to vision charts including picture charts allowing non reading children ease of recognising the familiar shapes at a distance. All children leave much assured that they had nothing to worry about and more often than not enjoy the return visits.

Nolke Opticians carries an extensive range of children’s frames in both practices. These range from young baby frames to trendy teens wear. Fitting of frames is often a battle between fashion and function. This is where expert advise comes in to provide parents reassurance that all of our frames will meet the needs of the child but at the end of the day – it is the function of correcting the visual defect that is paramount and there will be plenty of time for fashion in the years to come.

South East Health Board And Children’s eye Testing

Children in the South East are entitled to a FREE eye examination by an ophthalmologist (eye Doctor) and if needed will receive a prescription to go to their local optician to get spectacles. This will entitle the child to a free pair of spectacles or an allowance towards a more expensive pair. Higher prescriptions requiring slimed down lenses are also covered by the prescription – meaning that the child will receive slimmed down lenses at no extra cost.

At time of writing – Feb 2016 – there are significant waiting times in the health board system – quotes of over 6-12months. Should a parent be concerned they should contact the health board offices on the Cork road and enquire about appointment availability.

IMPORTANT – NOLKE OPTICIANS WOULD STRONGLY ADVISE PARENTS WHO ARE WAITING FOR THEIR CHILDS FIRST EYE TEST THROUGH THE HEALTH BOARD SYSTEM, TO HAVE THEIR CHILDS EYES EXAMINED BY AN OPTICIAN. THIS WILL FIND OUT IF THE SCHOOL NURSE / HEALTH VISITOR WAS CORRECT IN THEIR REFERRAL. THE CHILD IS SIMPLY REFERRED TO THE HEALTH CLINIC WITHOUT ANY INDICATION OF THE URGENCY OR REASON FOR THE REFERRAL. IN OUR OPINION THIS IS ENTIRELY UNACCEPTABLE AS THE WAITING TIMES MAY BE TOO LONG TO CORRECT SPECIFIC EYE PROBLEMS.

The Advantages Of Going To Your Optician Are

1. Opticians appointments are available on a daily basis with easy access and little waiting in queue. 2. If the child needs urgent assessment this can be arranged and / or spectacles can be purchased same day at the optician. 3. If there is a medical need to have urgent assessment this will be appropriately referred by the optician. 4. If the child’s eyes are fine – then the optician can advise the parents & health board and save them the unnecessary appointment. 5. Nolke Opticians charge €30 for a student eye test – a small price to pay for your child”s health. We even provide a €15 quick screening test which will determine the need for a full test if needed.

In Summary:

Whilst the health board system is a valuable resource – I would not rely on it alone for my child’s eyecare. Take your child to an optician – any optician – and ensure that their eyesight is as it should be.

Kjell Nolke F.A.O.I. Optometrist.