It is so important to identify children with vision problems, such as high refractive errors, as early as possible. Children with high refractive errors need glasses in order to see clearly. It is easy to understand how their development might be impacted if the world is blurry! Undetected refractive errors can also cause amblyopia, or lazy eye. Although amblyopia can be treated at any age, there is no denying that the earlier these children are identified, the earlier treatment can be initiated and the better the outcomes. But many children, especially preschoolers, have undetected vision problems because they don’t understand that what they see is abnormal! Many of these preschoolers function quite well, especially if the vision problem only affects one eye…….. Or do they?
A recently published study has shown that parental concerns about a child’s development is associated with refractive error. In children between the ages of 36 and 71 months, parents were more likely to report developmental concerns if the children needed glasses to correct for hyperopia (farsightedness), astigmatism (greater refractive error measured in one direction compared to another), or anisometropia (difference in refractive error between the two eyes).
The research design required parents to complete a short questionnaire which simply asked parents, “do you have any concerns about how your child talks and makes speech sounds; uses his/her hands and fingers to do things; gets along with others, etc. The children were then classified as either high or low risk for developmental problems based on the scoring protocol for this Parent Evaluation of Developmental Status. Then the children were given comprehensive eye examinations to evaluate (among other things) refractive status and whether the child needed glasses.
In addition to the risk for amblyopia, uncorrected refractive errors in young children are also associated with abnormal development. The authors cite several studies that have found reduced cognitive ability and visual-motor skills, especially in children with uncorrected hyperopia greater than 3.00 diopters. These deficits and the resultant difficulties in daily activities could be perceived as developmental problems by parents.
When there is parental concern about development in a preschool child, that child should have a comprehensive eye examination to determine if uncorrected refractive error (or any other vision problem) is contributory. Certainly other referrals will be indicated for proper diagnosis and management. If early intervention is initiated, maximizing the child’s visual capabilities will ensure that he/she is able to take full advantage of all therapeutic modalities, and put that child on the path to success!
Mindsight 
“There are important limitations of the study. This study cannot prove a causal relationship between refractive error and parental concerns about developmental delay. The PEDS questions were included late in the interview and parent responses could have been influenced by earlier demographic and health questions. Because of the cross-sectional design, parental concerns were not re-evaluated after correction of refractive error, to determine if these changed. Only one developmental screening tool was used; no other tools or examinations were used to confirm the presence or absence of developmental problems. The response rate to examination was relatively low, at 64% of those eligible. It is not known how those who did not present for the eye examination might have been categorized by the PEDS nor is it known whether the association between developmental risk and ocular outcomes would have been stronger or weaker in this group.”