Summer 2008

Seeing Eye-to-Eye

Children Benefit From Early Vision Screening

The Spence triplets—Eleanor, George, and Abigail—are the beneficiaries of early vision screening.

When Laurie Spence gave birth to her triplets in June 2004, she knew they could be susceptible to a number of health conditions.

“Fortunately, they all were fine,” Mrs. Spence said of the children, who were born at 31 weeks’ gestation. “The one thing that was wrong, well, it was the least of the things that could have happened to them.”

By age 2, all three children— George, Eleanor (Ella), and Abigail— were wearing glasses.

“Eye issues are more frequent in premature children,” said JOHN AVALLONE, M.D., a pediatric ophthalmologist on the medical staff at AAMC, known as “Dr. Nice” to the now 4-year-old Spence children. “In the case of George and Eleanor, their eyes turned inward, a condition called accommodative estropia. It’s caused by focusing efforts as they try to see clearly.” Abigail had a need for glasses for one eye more than the other.

Eleanor was diagnosed as farsighted in the NICU at the hospital where the triplets were born, and was wearing glasses by nine months of age. “When Ella was tired or looking at something close up, her eyes crossed,” said Mrs. Spence.

By age 2, Abigail and George were wearing glasses, too, with George in bifocals. By then, the Spence family had moved to Sunderland, in Calvert County, and had been referred by the military health plan TRICARE to Dr. Avallone.

“When you see a little child in glasses, people routinely stop and ask the parents, ‘Why is your child in glasses? How did you know?’” said Dr. Avallone. “The techniques used to figure out whether adults need glasses are subjective: is ‘this’ better or ‘that’ better? Children are incapable of answering those questions. There has to be a more objective way of quantifying the need for glasses.”

That objective way is an in-office procedure called a retinoscopy. The ophthalmologist shines a light into the eyes and watches the light reflected from inside the eye “back out to the world,” Dr. Avallone said. The physician watches the reflex and determines whether glasses are needed. About four percent of children need glasses to develop normal vision.

The Spence children currently wear glasses, as well as patches over their good eye to help strengthen the weaker eye. “It has been a dramatic change,” said Mrs. Spence. “If we had caught this at age 7, their improvement would not have been as drastic. But at age 2, their brain is still developing and their weak eyes can become stronger.”

Dr. Avallone recommends that children between ages 3 and 5 be screened by a pediatrician. “The state of Maryland screens children in the public school system, but doesn’t have money to screen all children. The Lions Club volunteers also screen children at various events in the area. They do this free screening because they understand early detection is critical,” he said.

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