The academic year is in full swing and children are deep into their curricula but let’s not forget one of the most important, yet often overlooked necessities for learning – eye health. Healthy vision is critical to a child’s physical development, success in school, and overall well-being.
In the womb
Promoting a child’s eye health should begin before birth, during pregnancy.
Supplements for eye health
Docosahexaenoic acid (DHA), an essential omega-3 fatty acid, is critical for vision and brain development. One of the highest concentrations of DHA within the body is found within the cell membranes of retinal cells called photoreceptors. (1)
Photoreceptors capture light signals and transduce them through the protein, rhodopsin, into electrical signals which are carried to the brain to produce an image. Photoreceptors have a high metabolic rate and turnover of their cell membranes, so DHA is a vital nutrient for vision.
Did you know? Since approximately 30% of our brain is devoted to the visual pathways, promoting brain health also promotes eye health.
Optimizing omega-3 nutritional status during pregnancy— in particular— DHA, is paramount. Recommended omega-3 intake during pregnancy is 200-300 mg/day and this may be achieved through dietary sources, as well as prenatal supplementation. (5) Plant-based options are also available.
Lifestyle tips for eye health during pregnancy
Avoidance of smoking, alcohol, and illicit drugs during pregnancy, as well as other toxins can cause multiple problems for a baby, including serious vision problems. Many of these issues are associated with low birth weight and/or prematurity, which in turn, may be associated with an increased risk of vision problems in infants.
Eye health in the first year of life
When babies are born, their eyes and visual pathways are poorly developed. A neonate can see only light and dark contrast with poor color discrimination. At this stage, vision is typically in the range of 20/400. However during the first few months of life, visual acuity develops at a rapid pace and by six months of age, babies can see resolution up to 20/25.
The maturation of the retina is believed to be responsible for this development of vision. It is therefore important to have adequate DHA in an infant’s diet, breastmilk being the best source. In infants who are formula-fed or have been weaned off breast milk, studies have shown that those receiving DHA supplementation have improved visual function. (6)(7)
Many infant formulas already contain DHA, though it may be best to use an infant DHA supplement. Recent evidence suggests that in addition to DHA, arachidonic acid may be critical as well for infant visual development, though prospective studies have not yet been performed. (7)
Lifestyle tips for eye health in infants
Eye or vision problems may delay a baby’s development, so detecting any issues as early as possible is important. Here are some important steps to ensure a baby’s vision develops properly:
- Watch for any signs of eye and vision problems, such as inward or outward turning eyes, or significant delays in tracking moving objects. Bring them to a pediatrician’s attention.
- Make sure to have eye screenings at birth and again between 6-12 months of age to catch any vision problems early. Screenings can be done by a pediatrician, family physician, or ophthalmologist (a medical doctor specializing in eye health).
- Stimulate a baby’s vision with age-appropriate games and high-contrast toys to help develop their vision.
- Avoid screen time in children under the age of 18 months, as recommended by The American Academy of Pediatrics. (8)
Eye health during early childhood (ages 3-10)
As children grow and change from year to year, so do their eyes and vision. The visual pathways in the brain responsible for tracking, depth perception, and convergence (focusing at near) continue to develop throughout early and middle childhood.
Did you know? It is not uncommon for refractive errors to begin in early childhood, such as hyperopia (farsightedness), (9) myopia (nearsightedness), (10) or astigmatism (an irregularly shaped cornea). (11)
Some problems like amblyopia, also known as “lazy eye,” can begin during early childhood. It is important to detect and treat amblyopia as early as possible before the condition becomes irreversible, preferably before the age of ten.
Because children at this age may not always be able to tell us that they are having vision issues, it is important to be aware of the following signs:
- Holding reading material very close to their face
- Complaining about things appearing blurry
- Losing their place when reading
- Avoiding reading and other near work
- Turning their head to the side
- Having a short attention span with visual tasks
If a vision issue is suspected in a child, a pediatric ophthalmologist may be best suited to evaluate the problem.
Eye health vitamins and nutrients
Though often overlooked for eye health in children, nutrition is a key factor to support visual development. The most important nutrients for eye health include:
- Vitamins C, A, and E
The Dietary Reference Intakes (DRIs) for each of these nutrients vary depending on the child’s stage of development. Specific recommendations based on age, sex, height, and weight may be found using the DRI calculator.
Vitamin A is critical both for healthy retinal function and also to maintain the health of the surface layers of the eye – the cornea and the conjunctiva. Vitamin A deficiency is the leading cause of preventable blindness in young children in developing nations. (12) Vitamin A deficiency may lead to night blindness as well as xerophthalmia, or severe dryness of the ocular surface. Vitamin A may be found in a variety of animal products (liver, fatty fish, eggs), vegetables (sweet potato, winter squash, kale, collards), and fruits (mango, cantaloupe).
Vitamin C is not only a powerful antioxidant but also helps with collagen synthesis. Collagen is an important building block for many structures of the eye, including the cornea, sclera, uvea, choroid, and vitreous. (13) Excellent dietary sources of vitamin C include fruits, such as kiwi, lemons, oranges, papaya, and strawberries, as well as vegetables such as kale, mustard spinach, Brussels sprouts, and broccoli.
Vitamin E is also a potent antioxidant for eye health. It helps to maintain the clarity of the lens and fight against oxidative damage in the retina. Dietary sources of vitamin E include a variety of nuts and seeds, such as almonds, pine nuts, sunflower seeds, and hazelnuts. Oils such as wheat germ, avocado, and hazelnut are wonderful sources of vitamin E. Fish such as Atlantic salmon and rainbow trout are also rich in vitamin E. Finally, avocados, sweet peppers, and mangoes are also good dietary sources.
Zinc is a crucial mineral necessary to maintain vision. Zinc is found in high concentrations in the macula. The macula is the center of the retina responsible for high-resolution vision. Zinc works along with vitamin A in the visual cycle in the retina. Dietary sources of zinc include oysters, beef, baked beans, and cashews.
Selenium is a trace mineral also necessary for eyesight. Selenium functions not only as an antioxidant, but also helps with the absorption of vitamin E. Plant-based sources of selenium include brazil nuts, frozen spinach, and baked beans. Animal sources include tuna, halibut, turkey, and beef.
Anthocyanins are in the class of flavonoid polyphenols, nutrients that come from plants and are powerful antioxidants. Anthocyanins give certain fruits and vegetables their bright colors and are commonly red, blue, or purple. Fruits such as berries, red grapes, pomegranate, cherries, and black plums are rich in anthocyanins. Vegetables high in anthocyanins include red cabbage, red onions, eggplant (within the peel), purple sweet potatoes, and purple carrots. Make sure children eat 1-2 servings per day of anthocyanin-rich foods.
Just as in infants, young children need an adequate intake of omega-3 fatty acids to support their vision health as well as cognition. The vision-promoting omega-3s, DHA and eicosapentaenoic acid (EPA), may be found in fish oil, and good sources for children include wild salmon, sardines, and anchovies. Plant-based sources of DHA and EPA include chia seeds, Brussel sprouts, algal oil, walnuts, and flax seeds.
Supplements for early childhood
Though it is always best to support eye health through proper nutrition, unfortunately, many children do not get sufficient nutrients through dietary intake alone. Therefore, it may be prudent to supplement with a children’s multivitamin which includes not only all of these essential nutrients for good vision but also the full range of B vitamins important for healthy eye and brain metabolism. In case dietary sources of omega-3 fatty acids are not sufficient, a DHA/EPA supplement may also be added.
Lifestyle tips for eye health in early childhood
Lifestyle choices are just as important to promote healthy vision in this early stage of childhood. The amount of time school-aged children spend outdoors in natural light may have some impact on whether they develop myopia. (10) Recent research suggests that spending time outdoors may lower the risk of nearsightedness in children. (14) It is not yet clear if this benefit in children is due to exposure of developing eyes to natural light or exercising distance over near vision while outdoors.
While outdoors, however, just as in adults, it is important to protect children’s eyes from potentially damaging UV rays. Sunglasses with 100% UV-A and UV-B blocking filters as well as hats are best while outdoors, especially on bright, sunny days.
Finally, it’s crucial to protect children’s eyes from injury. Follow these simple, safe practices to avoid eye injuries in children:
- Care when using sharp objects such as a pencil or scissors
- Eye protection while playing high-risk sports or using sharp tools
- Limiting exposure to chemicals, fumes, flames, and fireworks
Eye health for later childhood (ages 11-18)
During later childhood, school demands increase and require intense visual involvement for reading, writing, computer, and chalkboard/smartboard work. Even physical education and sports require strong vision. If eye health is not well supported, a child may feel tired, have trouble concentrating, and have problems in school. If an issue is suspected, an eye screening with an ophthalmologist or another professional who is properly trained to assess vision in school-aged children is best.
Eye health nutrients
At this stage of childhood, proper nutrition remains vital to vision health. Foods rich in Vitamins A, C, and E, zinc, selenium, and anthocyanins, as well as the omega-3 fatty acids, DHA and EPA, should be an essential part of an older child’s diet.
However, there is an additional factor to consider and protect against— digital technology and blue light exposure.
Lutein and zeaxanthin are two pigmented molecules within the carotenoid family which are essential for retinal health. These antioxidant molecules are found in high concentrations in the center of the retina, the macula. They absorb high-energy blue light and ultraviolet light, acting as natural blue-light filters and warding against oxidative damage in the retina.
Did you know? Lutein and zeaxanthin have been shown to provide both structural and functional benefits for retinal health. These nutrients increase optical pigment density in the macula, (15) as well as reduce headaches, eye fatigue, and strain.
Though a DRI has not yet been established for lutein or zeaxanthin in children, one study suggests that a daily intake of 6.5 mg of lutein and 2 mg of zeaxanthin is required in adults. (16) These nutrients are best found in green leafy vegetables, egg yolk, and corn, though they are present only in small amounts.
Supplements for eye health in older kids
If dietary intake is not sufficient, supplementation for eye health may be considered in older children to provide the essential nutrients for healthy vision. The ideal multivitamin should contain vitamins A, B complex, C, and E, zinc, selenium. A DHA and EPA supplement may be added. A supplement containing lutein and zeaxanthin may also potentially protect children’s eyes against the blue light emitted by digital screens.
Short-wavelength, high-energy blue light is emitted from many sources including sunlight, light-emitting diodes (LEDs), as well as fluorescent and compact fluorescent bulbs. LED screens are found in most digital devices, including smartphones, tablets, computers, and televisions.
Just as in adults, there has been a significant rise in the use of digital technology by children, both in school and for recreational use.
Did you know? According to the U.S. National Library of Medicine, children spend on average between 5-7 hours daily on a screen. (17) This screen time increases their level of blue light exposure.
The long-term consequences of blue light exposure in children and adults are not well understood. According to the American Academy of Ophthalmology, fortunately, there is no clinical evidence to date to suggest that blue light from devices directly damages the human retina. (18) However, children living in a digital world who are continually being exposed to increasing amounts of screen time may be at higher risk of short-term consequences from blue light exposure. According to one study, a child’s lens absorbs less blue light than the adult lens. (19) This may allow more blue light to reach a child’s retina.
Blue-blocking glasses have been shown to protect teenagers against the negative effects of blue light, especially in the setting of prolonged use in the hours before bedtime. (23) Screen filter apps that block out blue light as well as reduce the flicker rate from screens may also be useful to mitigate digital eyestrain and sleep disruption.
As children grow into teenagers and young adults, there are a few additional important lifestyle recommendations to help older children maintain eye health:
Use contact lenses safely – Avoid swimming or showering in contact lenses to prevent a serious parasitic infection which can affect the cornea and lead to blindness. The use of sterile contact lens disinfecting solutions and a clean contact lens case also protects against eye infections.
- Go outside – Time spent outdoors can decrease the risk of nearsightedness, or myopia.
- Wash your hands – Conjunctivitis, a bacterial or viral infection, can spread quickly in schools. Avoid rubbing the eyes and wash hands with soap to avoid catching and spreading pink eye, not to mention other infections.
- Give your eyes a break – Avoid eye strain from prolonged reading or computer use by using the 20/20 rule—every 20 minutes, take a 20-second break by closing the eyes.
- Don’t share makeup – Sharing makeup is a surefire way to spread viral infections such as herpes keratitis.
- Protect your eyes when playing sports – Avoid sports eye injuries by wearing polycarbonate protective lenses, especially while playing high-risk sports such as baseball, basketball, and lacrosse.
The bottom line
In summary, children’s eyes and visual pathways within the brain undergo different stages of development and eye health needs your attention at each stage along the way. Age-appropriate nutritional, supplement, and lifestyle interventions, combined with ophthalmologic care when appropriate, allow children to reach their full visual potential of 20/20 and beyond.
- Querques G, Forte R, Souied EH. Retina and omega-3. J Nutr Metab. 2011;2011:748361. doi: 10.1155/2011/748361. Epub 2011 Oct 31. PMID: 22175009
- Malcolm CA, Hamilton R, McCulloch DL, Montgomery C, Weaver LT. Scotopic electroretinogram in term infants born of mothers supplemented with docosahexaenoic acid during pregnancy. Invest Ophthalmol Vis Sci. 2003 Aug;44(8):3685-91. PMID:12882824
- Malcolm CA, McCulloch DL, Montgomery C, Shepherd A, Weaver LT. Maternal docosahexaenoic acid supplementation during pregnancy and visual evoked potential development in term infants: a double blind, prospective, randomised trial. Arch Dis Child Fetal Neonatal Ed. 2003 Sep;88(5):F383-90.PMID:12937042
- Innis SM, Friesen RW. Essential n-3 fatty acids in pregnant women and early visual acuity maturation in term infants. Am J Clin Nutr. 2008 Mar;87(3):548-57.
- Guesnet P, Alessandri JM. Docosahexaenoic acid (DHA) and the developing central nervous system (CNS) – Implications for dietary recommendations. Biochimie. 2011 Jan;93(1):7-12. doi: 10.1016/j.biochi.2010.05.005. Epub 2010 May 15.
- Innis SM. Dietary omega 3 fatty acids and the developing brain. Brain Res. 2008 Oct 27;1237:35-43. doi: 10.1016/j.brainres.2008.08.078. Epub 2008 Sep 9.
- Lien EL, Richard C, Hoffman DR. DHA and ARA addition to infant formula: Current status and future research directions. Prostaglandins Leukot Essent Fatty Acids. 2018 Jan;128:26-40. doi: 10.1016/j.plefa.2017.09.005. Epub 2017 Sep 15. Review. PMID:29413359
- Council on communications and media. Media and young minds. Pediatrics. 2016 nov;138(5). Pii: e20162591.
- Wiseman EM, Bar-El Dadon S, Reifen R. The vicious cycle of vitamin a deficiency: A review. Crit Rev Food Sci Nutr. 2017 Nov 22;57(17):3703-3714. doi: 10.1080/10408398.2016.1160362.
- Schmut O. The organization of tissues of the eye by different collagen types. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1978 Aug 16;207(3):189-99.
- Cao K, Wan Y, Yusufu M, Wang N. Significance of Outdoor Time for Myopia Prevention: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials. Ophthalmic Res. 2019 Aug 20:1-9. doi: 10.1159/000501937.