Here to Serve is passionate about helping children who are battling cancer. August is National Child Eye Health and Safety Awareness Month and it reminds us to be mindful of the vision of a child. Unfortunately, Children do get eye cancer. Retinoblastoma happens to children under the age of five and is the most common childhood eye cancer diagnosed. It originates in the retina. The retina is a thin layer of nerve tissue that coats the back of the eye (unilateral), but in some children, both eyes may be involved (bilateral).  About 300 children in the U.S. are diagnosed with retinoblastoma every year.

Prevention Starts with Early Eye Examinations

Prevention starts with early eye examinations and vision screenings, which are crucial to the overall vision and health of the eye. “Children are susceptible to a host of vision and eye problems such as injury, infection and increased nearsightedness. Cancer is not the only reason to give eye care a high priority with children. In support of Children’s Eye Health and Safety Month in August, the American Academy of Ophthalmology provides information to the public that can help protect and preserve a child’s eye health for life.”

Did you know? Newborns cannot see at birth. Vision develops slowly over time. If an infant cannot see because of a congenital cataract or other eye problem, their brain development will suffer. Early visual experience is essential to brain development.

According to Kenneth Wright, M.D., a renowned pediatric ophthalmologist in Beverly Hills CA, “The critical period for early visual experience is the first 8 weeks of life.”

For more about Dr. Wright and to view his educational videos, click here or here more related videos.

The Role of the Pediatrician in Eye Care

Your pediatrician has the primary role, as your child’s physician, to provide basic eye screenings during routine visits. However, these screenings often fail to detect eye problems. This is because they lack the right equipment and often staff training to detect subtle findings the ophthalmologist and his staff are trained to detect. It is very common for a child to “trick” the system when having their vision checked by peeking or turning their head. They are just trying to see; they don’t realize they are fooling the test. Astute ophthalmic personnel are trained to catch even the most subtle test miscalculations brought on by a child sneaking a peek.

Eye Screening for Children

It may surprise you that the first eye examination should be at birth. If the child is premature, they should be monitored very closely for ROP, (Retina of Prematurity). In the case of prematurity, it is best to have your child seen by a pediatric ophthalmologist early.

The recommended schedule for eye screenings is: 

• Birth
• 6-12 months
• 12-36 months
• 3-5 years
• 5 years

Amblyopia

What is amblyopia? This is sometimes called “lazy eye”, one eye is often misaligned, but not always. If you see that your infant has an eye that tends to wander off, turn in or out, be sure to have a thorough exam by a pediatric ophthalmologist who specializes in treating eye conditions in children. Detecting amblyopia early is critical to preserving vision.

Often there is no obvious sign, at first, that one eye is not seeing well. If a child has a high refractive error (need for glasses to see) in one eye, the brain will begin to ignore any blurred images in that eye and favor the eye that sees well.

In effect, the brain turns off the images of the blurred eye. The only way to preserve vision in the affected eye is to encourage the brain to use it. This is accomplished by covering the good seeing eye. The sooner this is started, the greater the chance the vision can be saved. The success rate declines the older the child is when treatment begins.

What Can a Parent Do to Check Their Child’s Vision?

Parents can do a quick check on their infants. Hold up an object such as a toy, completely cover one eye at a time. Check to see if their child can fixate and follow the toy. If an infant has a hard time seeing out of one eye, they typically show signs of distress when the good eye is covered. When the poor seeing eye is uncovered, they will feel better and be able to fixate on the object you show them.

Early on, it may appear your infant’s eyes are crossing, but this can be a normal phenomenon. If you suspect something is not right, have your child examined by a pediatric ophthalmologist.

Pediatric Eye Cancer

Although rare, pediatric eye cancer can be devastating if not detected early. As previously mentioned retinoblastoma is cancer of the eye. It happens when nerve cells in the retina change, growing in size and number. The cells eventually form a tumor. The cells usually spread in and around the eye. They can also spread to other parts of the body, including the brain and spine.

Retinoblastoma usually affects young children under five, though it can sometimes occur in adults. Children with retinoblastoma may have inherited a gene from their parents that causes this disease. These children tend to get retinoblastoma at an earlier age, and in both eyes.

Meet Cooper

 “Never underestimate a mother’s intuition. Lisa Morris’s son, Cooper, was just 6 months old when she noticed his left eye looked unusual in photographs. There was a glint that gave him a slightly cat-eyed appearance. A week later, at his well-baby appointment she asked her family physician to take a closer look. He didn’t see anything concerning. Maybe it was nothing, but her intuition told her to remain on guard.

“Two months later, she knew what she saw in his photographs was real. The glint now appeared as a white spot. Again, the well-baby exam turned up nothing. This time, she made an appointment with a cancer specialist, who quickly confirmed her worst fears. Cooper had a tumor, called a retinoblastoma, growing at the back of his eye. She was told to go home and pack a bag. He was to be treated with chemotherapy immediately. Again, mother’s intuition told her to put on the brakes. She wanted 24 hours to consider treatment options. Ultimately, Lisa decided to take Cooper to an ophthalmologist who would offer a better treatment; one that saved Cooper’s life and his vision.” Learn more about Cooper and his story here.

What Your Eyes Do in Photos Can Be Telltale

A red reflex is produced when the flash of a camera lights up the blood-rich retina.  If the eyes are looking directly at the camera lens and the color of the reflex is both eyes are red, in most cases that is a good indication that the retinas of both eyes are unobstructed and healthy.

Leukocoria means ‘white pupil’ or ‘cat’s eye pupil. ‘ Leukocoria is an ab-normal pupillary reflex seen in children with retinoblastoma. When a camera flash turns eyes white, yellow or black in photos, this can be a warning sign for an eye abnormality or eye condition that needs to be seen by a pediatric ophthalmologist. Before you react, be sure the child was looking directly at the camera gens, the camera flash was on and the background was dimly lit, and the red-eye reduction is turned off. Often, a white reflex may not actually signal anything abnormal. Instead, the child is probably looking to the right of the camera, and the white reflection occurs in the left eye.

What About Screen Time? 

 There are many eye conditions that contribute the loss of early visual experience some of which can be life threatening if not caught early. School age children are using their screens more during the Covid-19 Pandemic. With that in mind, it is important to continue with regular eye health check-ups for your children. Ophthalmologists are some of the first physicians that diagnose very serious conditions during a routine eye exam. Lessor conditions, like nearsightedness, is the most common visual problem detected in
pre-school and elementary school children.

If you notice your child squinting, rubbing their eyes, putting their chin down, or turning or tilting their head when looking at things, these can be signs they are having trouble seeing. If they do not seem interested in the book you are reading them and look away or fuss, this may indicate they cannot see well up close. 

The sooner you have your child evaluated by an ophthalmologist, the greater the likelihood the child will achieve proper brain development, developmental milestones, and thrive in the educational environment. In fact, it may save their life!

Get Help If Your Child Has Cancer

We hope this information will help save the precious sight and life of children. If you know a child who has recently been diagnosed with cancer, ask them to contact us. Here to Serve provides support, guidance and assistance for families and their children as they work though the challenge of cancer. If you wish to donate your time or resources, please contact us at Here to Serve.

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