Astigmatism is a refractive error that occurs when the cornea or lens of the eye has an irregular shape, causing light to focus unevenly on the retina. Instead of one sharp focal point, the eye forms several, so images look blurred, stretched or shadowed at every distance.
Astigmatism is common in childhood and frequently occurs together with myopia or hyperopia. Small amounts may not disturb vision at all. Above a certain degree, however, the developing visual system never receives a sharp image, and amblyopia (lazy eye) may follow. For this reason I treat childhood astigmatism as a visual development issue rather than simply a spectacle prescription.
A certain amount of astigmatism is common in newborns and infants. As the eye grows, corneal curvature changes and much of this early astigmatism decreases on its own during the first years of life. What matters is not the number alone, but its meaning for the child's age, the difference between the two eyes and the direction visual development is taking.
Children rarely report blurred vision, since they have no sharper experience to compare it with. Symptoms therefore usually appear as behaviour.
My main concern in astigmatism is not comfort but amblyopia. When only one eye is affected, the child copes with the better eye and the problem may surface only at a screening examination. The schedule I recommend is:
Astigmatism often coexists with other refractive errors. If distance vision is the main complaint, read myopia in children; if near work and inward deviation are prominent, see hyperopia in children. Other topics are listed under pediatric eye diseases.
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
Much of the low astigmatism detected in infancy decreases on its own as the eye grows. In a school-age child it is usually more stable, though the degree may shift during growth. Glasses do not remove astigmatism, but by placing a sharp image on the retina they protect visual development and prevent amblyopia.
A degree of astigmatism is common in newborns and infants, and most of it decreases during the first years. What matters is not the figure alone but the difference between the two eyes and the course of visual development. Marked astigmatism in one eye may require glasses even before any complaint appears.
Children do not report blurred vision. Squinting, tilting the head, sitting close to the television or board, skipping lines while reading, tiring quickly and headaches are the usual warning signs. None of them proves astigmatism on its own, but any of them is reason enough for an examination.
How much the glasses are worn depends on the degree of astigmatism, the difference between the eyes and whether amblyopia is present. When glasses are meant to support visual development, they only work if worn throughout the day. A frame that slips is as important as the prescription, because the child then looks over the lens.
The visual system develops with a sharp image. If significant astigmatism is left uncorrected, particularly when one eye is more affected, the brain favours the clearer eye and the other falls behind; this is amblyopia. Because the visual pathways are most adaptable in the preschool years, early diagnosis directly changes the outcome.
A red reflex check is performed in the newborn period. If there is a family history of refractive error, strabismus or amblyopia, or a history of premature birth, I recommend a first examination between 6 and 12 months. For every child without complaints, a screening examination around age three and again before starting school is appropriate.
Permanent laser correction is an adult procedure performed once the prescription is stable. It is not used in growing children, because the eye and cornea are still changing. In childhood, treatment relies on glasses, contact lenses in suitable cases, and patching when amblyopia is present.
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