Refractive disorders: Astigmatism. (3) Different features

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Development

Astigmatism relatively changes a little throughout all life.

Astigmatism is not very frequent during school age and it has got few changes of frequency and degree. One study made in Orinda, California, showed that the frequency of increase in an astigmatism of 1 diopter or more, at 6 years old, rises gradually from 2% by 3%, at 14 years old.

Higher levels of astigmatism are associated with moderate to high hyperopia during infancy, but both tend to decrease by the age of 5 years.

If a child is going to have a high astigmatism, it should already exist before beginning school stage.

In adult age, astigmatism does not usually change; if it do it, it usually indicates tension-related one, as myopia (in both cases vision therapy is very useful in order to structure a correct vision).

The little astigmatism that appears during infancy can be due to the strength that the upper eyelid exerts on the cornea causing that the vertical meridian to be more curve than the horizontal one.
In a more mature age, this astigmatism may change its shape, turning the vertical axis flatter, because of the laxity of palpebral muscle that rests on the eyeball. That is the reason why the axis or degrees of our astigmatism change through the years.


Prevalence

According to an American study published in Archives of Ophthalmology, nearly 30% of children between the ages of 5 and 17 have astigmatism.
On the other hand, a recent Brazilian study found that 34% of the students in one city of the country were astigmatic.
The National Autonomous University of Mexico revealed that astigmatism is the visual problem with most prevalence among people younger than 23 years old, and even 23% of population younger than 14 years old, put up with it.
Regarding the prevalence in adults, a study in Bangladesh found that nearly 32.4% of those over the age of 30 had astigmatism.
Also, several studies have found that the prevalence of astigmatism increases with age.


Factors and Causes

FACTORS:
If a child is going to have a high astigmatism or hyperopia, these will appear from birth or in early age. This means the factors are hereditary.

CAUSES:

• High weight of the upper eyelid.
• Slightly fallen upper eyelid (Ptosis).
• Ocular contusions.
• Corneal scars or lacerations, due to hits, injuries and infections in the eye.
• Changes in corneal shape following eye surgery (refractive one, of catarata,…)
• KERATOCONUS (this disorder will have its own post later, but let me briefly explain that the cornea acquires a conical shape as time goes by, and each time it gets thinner).
• Metabolic changes, as for instance high sugar levels in the blood that changes the shape of the lens of the eye, and this causes astigmatism. When this sugar level is normalized, the lens usually gets back to its shape and said astigmatism disappears.

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Refractive disorders: Hyperopia.(2) Different features

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Appearance of hypermetropic eye


The farsighted eye, unlike the myopic eye, is smaller than usual, or its lenses have less power.
Consequently, the image is focused BEHIND the retina.







Development

Some authors “…concluded that the growth of the eye during infancy is extremely rapid, and its adult size is reached by the age of 3 years…” and that “…the process of emmetropization is evident during the first year of life…”.

“…by the ages of 6 to 8 years old emmetropization has taken place, the great majority of the children being in the emmetropic group, which has its peaks at 1.00 diopter of hyperopia…”

There is a high percentage of children who were born hyperopic, because our eyes, when we were born, are not completely developed, and are small. As time goes by, if this hypermetropia is low, it disappears when the eye grows, so that sometimes, it can even turn it into myopia in school years.

Hyperopia, unlike myopia, do not usually vary until getting into adult years. At that moment, the appearance of presbyopia or “old sight” causes that the hyperopia increases much more, either hyperopia can appear or the myopia can even decrease.


Prevalence

Around 10% of people in Spain suffer from hypermetropia. 22.4% of population in USA and Australia is hyperopic. Specifically, there is a prevalence of 12.8% in American children aged 5-17 years.

In school years, hyperopia is usually lesser worrying than myopia because the clinically significant values of hypermetropia (and astigmatism) are 2-4% of the children who begin the school years, and also, these values do not increase over time.

“Hypermetropia is influenced by ethnicity. Native Americans, African Americans, and Pacific Islanders are among the groups with the highest reported prevalence of hyperopia. A study of 1.880 Chinese schoolchildren in Malaysia showed that the prevalence of hyperopia greater than +1.25 diopter, was only 1.2%”. (pag 8)


Probability


Factors

If you remember, environmental factors are very important in myopia; however, although the majority of children are hypermetropic when they start the school years, the hyperopia does not usually increase, but it decreases if anything.
Therefore, its existence is usually thought to be caused by hereditary factors.

In the other hand, a visual disorder derived from hyperopia is the presbyopia or “old sight”, that is typical of old people. In this case, this disorder is product of the time as it goes by. The ciliary muscle, as the rest of body muscles, loses elasticity and strength, and as well the capacity of being contracted; this way, the lens can not be more convex, and that prevents the accommodation to happen. That is why hyperopic people begin to suffer presbyopia earlier than emmetropic people; and these ones, earlier than myopic people.

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What is VISION? Its importance.

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As many people know, VISION is one of the five traditional senses. Nowadays, some people include in this group the balance and the proprioception too; I will calmly explain these terms later on.


Vision is the most important sense because up to 80 percent of the information that we receive, gets in across the eyes; not only the images but all the feelings that come with them too. That is why, it is very important that the visual system is effective, because it affects the learning and even the behaviour. In the reading case, up to 100 percent of the information that gets in, is purely visual.


People usually technically define VISION as “Action, effect and ability to see”. But personally, this definition does not satisfy me.


Vision does not occur only in the eyes. The eyes are just the most external part of a “complex mechanism”. They are the entrance. They are just responsible for receiving the object’s image; it is a very important function, but we do not see just because of them. Later on this image and all the information about it, follow a process until the brain is reached, and there we process, identify, understand, memorize, remember, learn and answer all the information that we receive. All that is VISION. Thereby, it is not only important that the image gets in but also knowing what to do with it. And that is what separates us from the animals; they receive an image that goes to the primitive brain but they do not learn from, memorize, understand, interpret it... The thinking part is what makes us different. And this is achieved by the NEOCORTEX (the “wrinkled dough of the brain”).


Thereby, in order for vision to be perfect, it is required for the COMPLETE visual path (not only the eyes) to be in perfect condition.

Vision is not efficient if:
- any of the eye’s layers prevent the light from getting in, that is, they lose their transparency;
- the light is not transmitted from neuron to neuron from the first layer of nervous cells which is inside the eye (which is known as the retina, the layer that receives the luminous stimulus), as far as the last neuron of the brain (in many areas of it, not only in the purely visual one);
- or there is some injury in any part of the visual path.

In another post I will explain the steps that occur in the Visual Process and that the vision does not just mean seeing 20/20.


It is crucial to have a good vision for the general development of a person’s life, and it is the most important tool for a child to have success at school. If the vision fails, the child’s school performance or the adult’s work performance fails too. Take one moment to think how many visual activities we do every day: at school or at work: reading, writing, drawing, painting, building, calculating, having contact with other people, fixing some things, cutting hair, putting bricks,… And during the rest of the day: when we take the right bus, drive, walk the street, eat, cook,…
Constantly, we are receiving visual information from which experiences are created. They can be better or worse depending on the quality of the information that we receive.

Nowadays, in Spain, the Optics-Optometrist National Association (Colegio Nacional de Ópticos-Optometristas –CNOO-) and in USA, the College of Optometrists in Vision Development (COVD) estimate that:
- up to 25 percent of the schoolchildren may have visual problems not diagnosed, that can affect their ability to learn (COVD) (CNOO)
- up to 70 percent of schoolchildren who have a learning disability in reading have some sort of visual problem; (COVD)
- and around 30 percent of school failure is related to visual upsets. (CNOO)


One child thinks everybody sees the same way as him; so, if he sees wrong, he will say nothing because he will think that it is usual. Therefore, the parents and teachers are the ones who have to suspect or recognize whether a child has some visual problem. The discovery and early treatment, before or during school-age, can avoid some future academic, emotional and social problems in the child. In future posts I will give a list of some signs and symptoms of visual problems that may indicate the need for a comprehensive vision exam, that I hope it serves you as an orientation.


When we are born, the vision is not a sense totally developed; so, everybody has to “learn to see”, just like we learn to walk. We have to learn to interpret the visual information that we receive. And just as the child’s motor development happens step by step while growing, the same happens with the vision. Both developments happen in parallel. So, if the child skips any motor development phase, it can affect the visual development, thus causing lazy eye, strabismus, or learning disabilities.


“We do not see with the eyes, but through the eyes” (Larry McDonald O.D.)