Evaluation of Eye Development in Children
Hello Hermina Friends, Eye conditions in children are very different from adult eyes, namely there is a development of vision ability and the condition of the eye structure progressively since birth needs to be evaluated in integrity. The occipital region of the human brain is a special area of vision that will interpret images captured by the eye. The myelination process in the optic nerve and brain will develop and become more complex in the first 10 weeks of age, which is marked by significant vision development, fixation, and eye coordination. Anatomical structures such as central and peripheral retinal cell density will also develop until the age of 7 years, so that there is maturation of vision and vision functions, namely the quality of children's visual acuity can reach 100%. If this process is disturbed, it will affect the quality of human vision. Monitoring of children's vision function can be grouped according to the child's age
Age 0 months At this age, babies are very sensitive to light. When exposed to very bright light, babies will appear to close their eyes / glare. Studies report that at this age, peripheral vision is clearer than central vision which is still developing. In the first 4 weeks of life, retinal cells and optic nerves increase so that they can begin to detect shapes, bright colors and contrasts, and begin to focus on objects 20-30cm from the eye and follow light that moves slowly. A study reports that visual stimulation with contrasting colored objects (black, white, and primary colors) can increase the development of nerve cells in the brain.
Age 1-3 months At the age of over 1 month, the myelinization process is more mature, so that babies are more focused on lights and objects, start to stare and follow objects or faces nearby, and there is a possibility to follow the facial expressions of the person they are talking to. The ability to move the eyeballs is also increasingly developing. Babies also start to try to reach for objects in front of them.
Age 3-6 months The structure of nerve cells in the central vision brain is very developed so that they are already aware of the surrounding environment, fixation and eye coordination when there are stimuli, can distinguish colors, recognize faces or objects when in front of a mirror, recognize and follow distant objects from a distance of approximately 1.20 to 1.80 meters, and respond to smiles / expressions of people around them. In addition, binocular vision abilities begin to develop.
Age 1-3 years Children can control eyeball movements when focusing and fixing vision on objects at different distances, as well as on fast or slow movements. This allows children to make good eye contact when socializing. In addition, perception of differences in darkness, light, shape, color, size and type of objects is getting better. So, they can recognize and identify the names of people around them, animals and objects around them.
Age 3-6 years Binocular vision is perfect, and understanding of three-dimensional shapes and depth of space is better. Children can recognize colors in more detail, distinguish the shape of objects, symbols or more complex images, such as two- and three-dimensional objects. In addition, children can identify similarities and differences in objects. Children also have the ability to learn and remember everything they have seen. Perception and coordination of vision and motor skills are good. At this age, children's vision abilities are similar to those of adults. Therefore, an examination is needed to evaluate visual acuity and eyeball position (strabismus screening).
Visual stimulation that can be done by parents/caregivers - Age 0-3 months Bring the face/object closer and move slowly when communicating and playing - Play with objects/pictures that have contrasting patterns and colors (black, white, primary colors) at a distance of 20-40 cm - Place the object in the baby's hand, bring it closer to the face and move it slowly - Age 3-6 months Use toys according to the recommended age - Place the object/toy in one of the baby's hands and move the object. - Do the same on the other side of the hand Use both elbows of the baby's arms to join both hands in the middle of the baby's chest - Age 6-12 months - Place a favorite toy at a distance slightly out of reach to encourage the child to try to reach it - Use the same sentence phrases every time you greet the child - Ask for the location of parents (mom/dad), caregivers or certain objects and let the child find the location of the face/object being asked about - Interact often face to face - Play with a mirror - Play hide-and-seek/peek-a-boo - Tell stories with picture books
Things that need a complete examination if 1. Age 0 months = history of premature babies, there are abnormalities in the structure of the eyeball, there is a white pupil reflex, there is a family history of eye disease or disorders in children 2. At the age of 3 months = babies are not yet able to focus and follow objects near them, eyes squint in / out 3. At the age of 3-6 years = squinting, tilting or turning the head when looking at objects far or near, eyes squint in / out
References:
- Khan AO, Chang TCP, El-Dairi MA, Lee KA, Utz VM, Mireskandari K, et al. The pediatric eye evaluation. Basic and Clinical Science Course - Pediatric Ophthalmology and Strabismus. American Academy of Ophthalmology. 2022. Page 5-14.
- Gudgel D. Eye screening for children. American Academy of Ophthalmology. Reviewed on 2024. Available from: https://www.aao.org/eye-health/tips-prevention/children-eye-screening
- Mukamal R. Twenty things to know about children's eyes and vision. American Academy of Ophthalmology. Review on 2024. Available from: https://www.aao.org/eye-health/tips-prevention/tips-children-eyes-vision
- Baldonado K. Eighteen Vision Development Milestones From Birth to Baby’s First Birthday. Prevent Blindness. 2018. Available from: https://preventblindness.org/wp-content/uploads/2020/04/18_Key_vision_questions.pdf
- Zimmermann A, de Carvalho KMM, Atihe C, Zimmermann AMV, Ribeiro VLM. Visual development in children aged 0 to 6 years. Arq Bras Oftalmol. 2019 May-Jun;82(3):173-175. doi: 10.5935/0004-2749.20190034