At age 2, Stuart Terbeek would stand with his nose nearly up to the TV screen to see his favorite show.
He also bumped into things and would hold books up in the air to look at the pictures.
A pediatric ophthalmologist diagnosed the problem: Stuart was farsighted and among the 1 in 20 children with amblyopia, or lazy eye. After getting glasses, wearing a patch and later using eye drops, Stuart now sees the world in focus at age 4.
"From the moment he put his glasses on and could see, he was so pleased," said Leslie Terbeek, Stuart's mother. "We even let him sleep in his glasses because he likes to wake up with them on."
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But thousands of children aren't as fortunate as Stuart, who is the "little ambassador" for the Children's Eye Foundation, a nonprofit organization founded by the American Association for Pediatric Ophthalmology and Strabismus.
A screening program to begin in January in Tarrant County is designed to help children like Stuart get treatment before a vision disorder leads to blindness.
Through the Children's Eye Foundation's See by Three program, more than 26,000 youngsters in Tarrant County will be screened for vision disorders over four years. The program, which is funded by a $345,000 grant from Fort Worth-based Alcon, will train pediatricians to screen all their young patients and refer those who need treatment to ophthalmologists.
The goal is to eliminate preventable blindness in children by reaching out to their families, who might otherwise overlook the importance of vision screening by age 3, said Thomas Rogers, the Children's Eye Foundation executive director.
Getting an early start
Starting vision screenings at an early age is so important because amblyopia is the leading cause of vision loss in children, and the sooner it is treated the better.
If it's not found in the first seven to eight years of life, the vision loss can become permanent, said Dr. George Beauchamp, Children's Eye Foundation chairman.
"It should be found between the ages of 3 and 5," he said. "If we wait until 7, it's a much harder job to treat and by 9 it may be impossible."
Amblyopia, which is commonly called lazy eye, occurs when the vision in one eye is reduced because the eye and brain are not working together properly, according to the National Eye Institute. The eye looks normal but is not being used normally because the brain favors the other eye.
It affects a child in every classroom, or about 1 in 20 children. It is most often caused by an imbalance in the positioning of the two eyes, which leads them to cross in or turn out. The disorder is occasionally caused by cataracts or scar tissue.
Amblyopia is treated by patching the stronger eye, which forces the weaker eye to work harder. Depending on the severity of the problem, children wear a patch for three months to five years.
Treatment is tricky
But getting a toddler to wear a patch can be challenging, as the Terbeeks discovered.
"He was often cheating and trying to peek," Terbeek said. "But we needed a way to kick-start his brain and get the other eye to take over."
Drops to make the stronger eye blurry several hours a day did the trick for Stuart.
In one family, the dad wore a patch whenever the son did as a way to encourage him, Beauchamp said.
Although amblyopia can lead to blindness in the affected eye, parents often underestimate the importance of early vision screening.
Only 1 in 3 children receives a vision screening before kindergarten, leaving many children with unidentified eyesight problems, according to the World Health Organization. By the time vision screenings are done in the public schools, the disorder is more difficult to treat.
When the same program was implemented by the foundation in West Virginia and Florida, half of parents who were told their child had a vision problem did not follow up with a pediatric ophthalmologist as recommended, Rogers said.
When fully implemented, See by Three, will train more than 300 medical professionals to perform vision screenings.
"In theory, the program makes it possible to eliminate blindness from amblyopia in children throughout Tarrant County," Beauchamp said. "But it will require screening and convincing parents that they need to have their children's' eye examined."
Terbeek, who lives in Illinois and has relatives in North Texas, said the family was fortunate to spot the symptoms of an eye disorder so early in Stuart's life.
"It was a wake-up call," she said. "If I hadn't brought him in he would have been crossed-eyed within a year and eventually the lazy eye would have shut down."