Are eye problems and other visual disturbances more prevalent in the internationally adopted child when compared to the general population?
Poor visual acuity is one of the most important medical factors that can contribute to poor behavioral, developmental and academic achievement in a child if left untreated. The actual country of birth of the child is irrelevant, but there has been a documented increased prevalence of eye problems such as Strabismus and ambyopia in the internationally adopted child, especially the ones adopted from Eastern European countries.
In infants and children, in order for visual development to proceed normally, visual experiences must occur with well aligned eyes that are free from eye pathology and other visual acuity errors. One of the consequences of not fulfilling theses visual requirements during the early years of life could lead to disorders like strabismus, ambyopia, and decreased visual acuity. In the general population, the aforementioned visual disturbances are reported to occur in 2%-3% of the general pediatric population. In the United States, physicians and school nurses are very good at screening for such problems. In the case of the institutionalized child, one would speculate that because of the lack of general medical care, conditions such as “Lazy Eye” or “Cross Eyed” would go undiagnosed and untreated for an extended period of time. Basic medical care is generally considered a luxury for those unfortunate enough to reside in an Institution. Routine vaccinations, correctable surgical conditions and basic medications such as antibiotics are often lacking, so why should we expect these children to have an annual vision screen. It therefore should not come as a surprise that many orphan children have amblyopia and strabismus.
Amblyopia is reduced vision in an eye that has not received adequate stimulation or usage during early childhood. It basically means “without sight." Amblyopia has many causes, among them being a "lazy" eye. Amblyopia most often results from this "lazy" or misalignment of the child's eyes. A "lazy" eye is seen by an observer as crossed eyes, or divergent eyes. Amblyopia also results from a difference in image quality between the two eyes (one focusing better than the other). In both cases, (misalignment and weaker focusing), one eye becomes stronger than the other. If this condition persists, the weaker eye may become useless. Visual acuity tests and newer technology such as the Visual evoked potentials are some of the best ways to screen for these visual disturbances. These screening tests are generally performed at the routine well child visits, vision screen performed by an ophthalmologist or by the school nurse. The test may pick up abnormalities if they are present at the time of the examination. A child may have normal vision on today’s examination, and over the course of the following year, visual disturbances occur and it is picked up at the next check-up examination. This is why annual vision screens are performed in children.
Strabismus is a misalignment of the visual axes of the two eyes. The eyes can turn inwards or outwards Children appear to be cross eyed. Strabismus may cause or may be due to amblyopia.
With early diagnosis and treatment, the vision in the "lazy eye" may be restored. The earlier the treatment, the better the opportunity to reverse the vision loss. Before treating Amblyoia, it may be necessary to first treat the underlying cause. Glasses are commonly prescribed to improve focusing or misalignment of the eyes. In extreme cases, surgery may be required to allow both eyes to work together.Eye exercises are a limited form of treatment. The correction may be followed by: Patching or covering one eye may be required for a period of time ranging from a few weeks to as long as a year. The better-seeing eye is patched, forcing the "lazy" one to work, thereby strengthening its vision. Medication - in the form or eye drops or ointment - may be used to blur the vision of the good eye in order to force the weaker one to work. This is generally a less successful approach.
I am not sure of the exact percentages of Strabismus or Amblyopia for children that resided in institutions. In my own personal experience I have found that there is an increased incidence of referrals that I make to the pediatric ophthalmologist in my International adoption cases, especially for those children from Eastern European countries.
The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.
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© George Rogu, M.D.
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