Waiting lists a big issue for children needing eye care

Most common eye conditions in childhood start when the child is four or under and are easily treated. The difficulty is spotting the problem and getting treatment as soon as possible afterwards.

“The big issue with eye problems in childhood is the waiting time between the problem being picked up at a school eye check and the child being seen at an outpatients’ clinic in hospital. Waiting lists are particularly long in parts of Dublin,” says Tony McAleer, orthoptist at the Royal Victoria Eye and Ear Hospital in Dublin.

A turn in the eye is one of the most common problems in childhood, and it usually develops between the ages of two and four. “This is usually picked up by parents and then referred on through a GP because the turn doesn’t usually appear until after the nine- and 18-month check- ups,” says McAleer.

A turn in the eye usually develops because a child has been squinting to focus their eyes. This creates strain and pulls the eye inwards.

“Two- to four-year-olds are at risk of developing a squint when they over-focus to see clearly. It is caused by long-sightedness and is correctable with glasses, but it is best treated before the child is eight,” says McAleer.

A possible knock-on effect of a squint or turn in the eye, according to McAleer, is that the sight in the turned eye stops developing and gets lazy. A patch on the good eye helps resolve this in about three months or so. Children will be asked to wear these at home for two to six hours a day.

So, do children comply easily to the prescribed treatment? “Generally, children are fine about wearing glasses if the glasses make life easier for them. If children have problems wearing an eye patch, we prescribe eye drops into the good eye; this prevents it focusing, so that the child has to use the other eye,” says McAleer. These eye drops work for two to three days.

Technological goggles adapted to reduce the focus in the good eye and encourage the use of the turned eye are a possible replacement for patches in the near future. The idea is that children would wear these goggles while playing screen-based games, so their eye exercises are done in a playful context.

A child’s eyesight usually settles into its normal range at the age of about five or six.

McAleer says that the school eye checks in senior infants are a reliable way of accessing as wide as possible a group of children. However, he says it would be better if they were carried out in junior infants to catch problems slightly earlier.

“Generally, we believe eye clinics should be community based rather than requiring children to attend a hospital-based clinic,” says McAleer. Some areas, such as north Dublin, already have community-based eye clinics, which are considered to be a good model of care.

McAleer is a member of the National Primary Care Eye Services Review Group, which is planning a comprehensive, high-quality paediatric eye service for the whole country.