Farsightedness in children

In this article:

• Methods of treatment for Farsightedness in Children
• Prescription lenses
• Surgical treatment
• How can you care for your child at home?
• Reduce eye strain
• Keep your child’s eyes healthy
• When should you call for help?
• References

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Methods of treatment for Farsightedness in Children

There is a lot of debates if farsightedness in children needs to be treated. Some believe that children will outgrow it, and that is why a child with this vision defect need to be left alone. Others think that untreated farsightedness can slow development and cause unneeded stress in a child who constantly use accommodation eye muscle to see better.

At least everyone agrees that vision screening should be performed at an early age and at regular intervals throughout childhood. The elements of vision screening vary depending on the age and level of cooperation of the child.

Eye doctors will give you best advise in your situation, as every child is different. And so are their eyes. It is really not important what your friend said, or how your neighbor treated her kids. What is really important is the actual eye defect your child has. The best reliable answer comes from an eye exam that is interpreted by an expert in refraction errors in pediatric ophthalmology.

While different opinions on hyperopia treatment can be discussed by experts at the scientific conferences, there are few real goals your decision should be based on:

• Always correct the vision if your child cannot see well and develop appropriately
• Prevent stress of amblyopia (lazy eye) and (eye strain)
• Prevention of development of strabismus (crossed eyes)
• Prevention of recurrent eyelid infection and conjunctivitis.

Prescription lenses

Basic principles of prescribing glasses are:

• The amount of total hyperopia should always be elicited by cycloplegic retinoscopy, especially in children.
• Symptomatic patients and young children should always be treated with proper refractive correction.
• Young children should be prescribed full hyperopic correction gradual tapering during school age.
• The maximum accepted plus power with a clear vision (20/20) should be prescribed.
• A gradual increase in hyperopic correction from the comfortably accepted power in school-aged children may be necessary as full correction may produce blurring at distant. A short course of cycloplegic agents may improve the acceptance of hyperopic correction.
• Accommodative convergence should be treated with full hyperopic correction. Developing/developed amblyopia should undergo a thorough evaluation, and full hyperopic correction with occlusion therapy should be prescribed.
• Hyperopic children should have a reevaluation every 3 to 6 months.

The Pediatric Ophthalmology/Strabismus Preferred Practice Pattern® Panel members wrote the Pediatric Eye Evaluations Preferred Practice Pattern® guideline (PPP). 

Contact lenses must be discussed with your eye doctor first. While it sounds very convenient, there is a lot of consideration based on your eye measurements and specifics of your vision/refraction. There are plenty of new materials and even colors available. Contacts are better precepted by children then glasses. They also are easier to wear in sports (and some sports actually do not allow glasses).

Most families decide to get both contact lenses and glasses for convenience. Lens may irritate eyes with long wear. So, a child might be wearing contacts at school, and changing into glasses at home. It is important to teach kids how to take care of the eye contacts to prevent eye problems and infections. It is strongly recommended not to wear contact lenses at night.

Surgical treatment

There are multiple types of ophthalmological surgeries, most with laser. You need to consult with pediatric eye surgeon if farsightedness is not compensated with accommodation, and the vision is poor. Surgeries in children are complex due to the small size of an eyeball. The addition problem is that eye is still growing, so the visual axis will change with time, and vision may worsen again. Most of the pediatric eye surgeons recommend a conservative approach, unless vision cannot be compensated with the glasses and contact lens for some reason.

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How can you care for your child at home?

It is important that you help your child to develop and learn if a farsightedness was diagnosed. As children use accommodative muscles inside the eye to adapt for refractive error, an amblyopia (eye strain) can become a problem in school years.

Reduce eye strain

You should provide the best study conditions if your child has hyperopia:

• Bright soft lighting of the study area. The light should be mounted so the shadow does not cover the book and study materials.
• Adjust the height of the chair and desk, to ensure the correct angle of the eye to the screen and books
• Spend money on expensive monitor that does not cause an eye strain
• Ensure the timed breaks during homework with exercise and fresh air. Sport breaks are the best, when the child can run or play a ball outdoors.

Keep your child’s eyes healthy

Correct diet and sport are extremely important for the body and eye development and growth. It was found that daylight and amount of exercise correlate to eye fatigue and vision. Sports, such as ping-pong, tennis and basketball will help to train and relax accommodative muscles. It is important to limit time your child spends on electronic devises – a computer eye fatigue is proven in research studies.

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When should you call for help?

No one but parents know their child best. There are no guidelines when you need to call a specialist for help. But an attentive parent will see the child struggling at school or with activities. While there might be an issue with a stubborn kid who just does not like certain subjects, you will easily see the problem if the child is dropping grades in favorites.

A school teacher may give you a hint by sending a concerned note that your child is not paying attention during a reading class or math. Not all inattentive children have ADHD, many just have vision or hearing deficit. A vision test is a good start to figure out what is going on. Frequent headaches is an alarming sign that there might be an eye strain developing.

You will be wise to discuss this issue first with your pediatrician. Then you will need to find the best pediatric eye specialist. Don’t leave your child in struggle – excellent eye doctors can be found in your area.

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References

Hyperopia. Majumdar S, Tripathy K.2021 Aug 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 32809551 Free Books & Documents. Review.

Visual Acuity. Daiber HF, Gnugnoli DM.2021 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 33085445 Free Books & Documents. Review.

Photorefractive Keratectomy. Somani SN, Moshirfar M, Patel BC.2021 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 31751077 Free Books & Documents. Review.

Harb EN, Wildsoet CF. Origins of Refractive Errors: Environmental and Genetic Factors. Annu Rev Vis Sci. 2019 Sep 15;5:47-72. [PubMed]

Jones SM, Weinstein JM, Cumberland P, Klein N, Nischal KK. Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis. Ophthalmology. 2007 Dec;114(12):2271-80. [PubMed]

Wallace DK, Morse CL, Melia M, Sprunger DT, Repka MX, Lee KA, Christiansen SP., American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel. Pediatric Eye Evaluations Preferred Practice Pattern®: I. Vision Screening in the Primary Care and Community Setting; II. Comprehensive Ophthalmic Examination. Ophthalmology. 2018 Jan;125(1):P184-P227. [PubMed]

Biscevic A, Pidro A, Pjano MA, Grisevic S, Ziga N, Bohac M. Lasik as a Solution for High Hypermetropia. Med Arch. 2019 Jun;73(3):191-194. [PMC free article] [PubMed]

Fashner J. Eye Conditions in Infants and Children: Myopia and Hyperopia. FP Essent. 2019 Sep;484:23-27. [PubMed]