Eyesight problems: improving diagnosis in children

Published on 18 February 2010

What's the problem and who does it affect?

Gaps in vision

Some children have eyesight problems called visual field defects, which restrict their field of view. For example, when looking straight ahead, they may find it difficult to see what’s in front of their feet, meaning they trip over a lot.

Diagnosing visual field defects is important for several reasons. They can contribute to learning difficulties and hinder children’s physical development, affecting their hand-eye coordination and manual dexterity, for example, making them seem clumsy and accident-prone. They can also be a sign that a child has a potentially life-threatening brain tumour.

Children who have had a stroke, a head injury or meningitis are at risk of suffering visual field defects, as are children with cerebral palsy who were born prematurely, children with the eye disease glaucoma and children who are taking certain medications, including a treatment for epilepsy.

Unfortunately, it is very difficult to diagnose visual field defects in children. Tests used in adults are impossible for young children to follow. Even older children can find them difficult. The test presently used in children is inadequate – it typically detects only major defects, cannot give an accurate measure of them, and is limited by both children’s concentration levels and examiners’ abilities.

What is the project trying to achieve?

Watch this space

The researchers are developing a revolutionary new way of diagnosing visual field defects in children. The child sits in front of a computer screen for a few minutes, watching bright and interesting pictures as they flash up around the screen. Eye-tracking technology monitors how the child’s eyes move while they watch the screen.

Children don’t need to understand that their vision is being assessed. They can simply follow their natural instincts, as their eyes are drawn around the screen by whatever grabs their attention.

The computer maps children’s visual fields and measures the extent of any defects – any gaps in the children’s peripheral vision – using information on what children have seen, and what they have missed.

The researchers have already developed the equipment. Now they are validating its performance by using it to assess the eyesight of 40 young adults and at least 100 children, some with normal vision and some with visual field defects.

What are the researchers' credentials?

The highly experienced project team comprises a hospital consultant who treats children with eyesight problems and eye diseases, medical physicists and a specialist in the nervous system of children.

The researchers have been working together for over three years, developing their groundbreaking new way of diagnosing visual field defects in children. They have already published promising results on the feasibility of the system.

Experienced research nurses from Edinburgh’s Royal Hospital for Sick Children, who work in a specialist unit dedicated to conducting clinical research in children, are helping with the project.


 

Who stands to benefit from this research and how?

Transforming diagnosis

The researchers hope their new system will revolutionise the diagnosis of visual field defects in children and in some young adults, including those with learning disabilities. They believe the system could be suitable for widespread use – by specialist eye doctors, children’s doctors and opticians – and that children will enjoy the test.

The researchers believe the new system has the potential to provide an accurate measure of visual field defects in children. This is difficult, sometimes impossible, to do at the moment. The new system could improve diagnosis of certain illnesses, including life-threatening brain tumours, as eyesight problems can be the first sign of a tumour. The test could also help when monitoring the growth of a tumour and checking the effectiveness of treatments like chemotherapy.

An accurate diagnosis of a child’s visual field defects could bring many other benefits too. It could help parents, teachers and therapists to understand what sort of support the child needs at home and at school. This could be particularly helpful for children who are experiencing learning difficulties.