Óptica Carreras Children's eye care
Sight is the ability to distinguish objects and details — what we commonly call visual acuity. Vision, however, is a far more complex process: it is the brain's ability to receive, interpret and make sense of the information coming in through the eyes.
It is estimated that 85 % of the information the brain receives is visual, so efficient vision is key to learning, development and quality of life.
Children's vision
Vision is not innate: it is learned and develops progressively during childhood, following specific stages and in constant interaction with the environment, the neurological system and motor development.
The first years of life are decisive for proper visual development.
The better and richer the visual stimulation, the better skills such as visual acuity, spatial perception and depth perception will develop.
There are congenital, developmental and environmental factors that can disrupt this process and lead to problems such as:
- Amblyopia (lazy eye).
- Strabismus (eye turn).
- Refractive errors: myopia, hyperopia and astigmatism.
In addition, children are especially vulnerable to ultraviolet radiation and blue light from screens, digital devices and LED lighting. Its effect is cumulative and can affect eye health in adulthood.
0 to 3 months — Newborns are sensitive to light. From the fourth week, visual fixation, eye coordination and the ability to follow moving objects appear. This is a monocular stage, so it is important to stimulate both eyes equally (for example, by changing the position of the cot).
3 months to 1 year — Object handling and locomotion (crawling on the tummy, then on all fours) begin — fundamental for neurological, motor and visuomotor coordination. The child learns to coordinate both sides of the body and both eyes.
Around 6 months — Binocular vision begins: the two eyes align and work together. The child starts judging distances and improves control of eye movements thanks to crawling.
1 to 3 years — Vision matures in parallel with neuronal organisation. The contralateral pattern and the balance between right–left, front–back become consolidated.
3 to 6 years — Vision develops fully:
- Spatial perception.
- Body schema.
- Laterality.
- Directionality.
Motor coordination between the two eyes, three-dimensional spatial perception, focusing ability and the remaining skills have been acquired — the foundation for starting reading and writing.
From age 6 — The development of visual abilities is completed. The child must be ready to face school demands, which are overwhelmingly visual.
From 6 to 12 years, the maturity of the visual system consolidates, directly related to school performance.
For this reason we recommend:
- A first eye examination at age 3–4.
- Another examination at age 6.
- Annual check-ups thereafter.
Binocular vision problems
Binocular vision is the coordination between both eyes.
These problems are increasingly common today due to prolonged screen use.
The most frequent are:
- Convergence insufficiency (the most common).
- Convergence or divergence excess.
- Divergence insufficiency.
Reading effectively requires coordinating both eyes and focusing correctly skills that develop in childhood but can break down at any age.
Frequent symptoms
- Eye discomfort or tiredness
- Double vision (constant or intermittent)
- Covering one eye when reading
- Abnormal head postures
- Headache
- Difficulty concentrating, especially in children
Treatment
The most effective treatment is usually vision therapy, sometimes combined with specific glasses depending on the type of problem.
Accommodative problems
Accommodation is the ability to shift focus from far to near quickly and automatically.
It also means sustaining focus for long periods (reading, writing, screens).
When this function fails we speak of accommodative dysfunctions, which can appear in children and in young adults.
Frequent symptoms
- Blurred vision when changing distance.
- Blurred near vision.
- Eye strain.
- Itchy or stinging eyes.
- Headaches.
- Difficulty concentrating.
Treatment
It may include: specific glasses, lenses with near-vision support and/or vision therapy when glasses alone are not enough.
Amblyopia (lazy eye)
Amblyopia is diagnosed when vision is below 100 %, or when there is a difference of two lines or more of visual acuity between the two eyes.
Amblyopia is not just reduced visual acuity, but a set of sensory and oculomotor alterations.
It can involve:
- Reduced vision.
- Lower contrast sensitivity.
- Focusing difficulties.
- Abnormal eye movements.
- Binocular vision problems.
Types of amblyopia
- Due to a difference in prescription between the eyes.
- Associated with strabismus.
- Bilateral, due to high uncorrected prescriptions.
- Due to visual deprivation.
Today, backed by numerous evidence-based studies, the most effective treatment is patching combined with vision therapy, because it not only improves the lazy eye but teaches both eyes to work together.
At Óptica Carreras we use new technologies, such as digital tools and therapeutic video games, which can be done in the practice or at home.
The Visionary programme with Gabor patches
In our practice we use the Visionary programme, a vision therapy tool based on advanced visual stimulation with Gabor patches, designed specifically for the treatment of amblyopia.
Gabor stimuli selectively train the visual neurons responsible for:
- Visual acuity,
- Contrast sensitivity,
- Central visual processing.
This type of stimulation acts directly on brain plasticity, promoting visual recovery even at ages when it was previously thought impossible.
Benefits of the Visionary programme
- Improved visual acuity in the amblyopic eye.
- Increased contrast sensitivity.
- Less traditional patching time.
- Greater motivation and adherence to treatment.
- Treatment possible across a wider age range.
A modern, personalised approach
By combining patching + vision therapy + Visionary with Gabor patches, we treat amblyopia in a way that is more complete, more effective and kinder to the visual system.
The goal is not only for the lazy eye to see better, but for both eyes to learn to work together, improving functional vision and the patient's quality of life.
Strabismus
Strabismus appears when one eye turns. In children, the brain may suppress the image from the turned eye, causing amblyopia (lazy eye).
In adults, it usually causes double vision.
Strabismus can be constant or intermittent. Both can affect school performance and visual quality.
Treatment
It may include:
- Glasses.
- Vision therapy.
- Surgery.
Vision therapy is key to improving the functionality of the visual system and, in many cases, improves the surgical prognosis by eliminating cerebral suppression.
In adult strabismus, a prior medical assessment is essential, as it may be linked to neurological disease or trauma. But once the cause of the palsy is known, the earlier rehabilitation begins, the higher the success rate.
Vision therapy and new technology
Vision therapy plays a fundamental role in treating strabismus, as it works directly on binocular coordination, eliminating suppression and integrating both eyes.
In addition, a few months ago we incorporated the Visionary virtual reality headset, advanced technology that allows us to treat strabismus in a more precise, immersive and personalised way.
Thanks to virtual reality we can:
- Train binocular vision progressively.
- Reduce suppression of the turned eye.
- Improve functional alignment.
- Work on eye–brain coordination in a motivating, controlled environment.
Adult strabismus and oculomotor palsies
One of the great advances of this technology is that it also delivers very positive results in adults, even in complex cases such as:
- Acquired strabismus
- Post-traumatic strabismus
- Oculomotor palsies
Although it was traditionally thought that treatment options were limited in adulthood, we now know the brain retains plasticity, allowing significant functional improvements, reduced double vision and a better quality of life.
A comprehensive, personalised approach
Virtual reality therapy is part of an individualised treatment plan, which can be combined with:
- Virtual reality sessions in the practice.
- Glasses or prisms.
- Conventional vision therapy.
- Medical or surgical treatment where indicated.
In many cases, prior vision therapy improves the surgical prognosis, and in others it allows surgery to be avoided or postponed, whenever the case allows.
Our goal is always the same: to teach the brain to use both eyes in a coordinated way, whatever the patient's age.
Vision and learning difficulties
Seeing is not enough: the brain must interpret, remember and reproduce what it sees.
Difficulties with visual skills can directly affect learning, reading, writing and school performance.
Eye movement (ocular motility)
Ocular motility refers to the eyes' ability to move precisely, in coordination and efficiently, both voluntarily and automatically. These movements are essential for everyday activities such as reading, writing, copying from the board, following a moving object or playing sport.
Good ocular motility allows the eyes to move accurately, without unnecessary jumps or excessive effort, keeping vision clear and stable.
Which eye movements do we assess?
Within ocular motility we mainly assess:
- Saccadic movements
The fast movements we make when jumping from one word to the next while reading, or from one point in space to another. - Pursuit movements
They allow us to follow a moving object smoothly and continuously, such as a ball or a car. - Fixation stability
The ability to keep the gaze steady on a point without losing it or drifting away.
The proper functioning of these movements is key to fluent reading, good comprehension and effective visuomotor coordination.
What happens when there is an eye movement problem?
When eye movements are inefficient, the brain has to make an extra effort, which can cause symptoms such as:
- Slow or choppy reading.
- Losing your place when reading.
- Skipping or repeating words.
- Difficulty copying from the board.
- Eye strain.
- Headaches.
- Poor concentration.
- Poor school performance.
In many cases these problems go undetected in conventional eye tests, because visual acuity can be normal.
Treatment with vision therapy
Vision therapy is the most effective treatment for eye movement problems.
It consists of a programme of personalised exercises designed to:
- Improve the precision of eye movements.
- Increase reading speed and fluency.
- Reduce visual effort.
- Optimise eye–brain coordination.
Therapy can be carried out in the practice and at home, always under professional supervision and with regular follow-up.
Eye movement therapy with an eye tracker
To treat eye movement problems we use vision therapy supported by eye-tracking technology, which allows us to record and analyse eye movements precisely, in real time.
Thanks to the eye tracker we can:
- Detect inefficient eye movement patterns.
- Design specific exercises tailored to each patient.
- Give the brain immediate feedback during therapy.
This technology allows more objective, personalised and effective training, speeding up the learning of more precise, automatic eye movements.
Visuospatial skills
These allow the visual organisation and manipulation of space; they are based on body schema and orientation.
For a child to learn, they need a clear perception of where their body is in space. That depends on the visual information they have about that space. Problems in this area can cause:
- Clumsiness.
- Poor balance.
- Reversal of letters and numbers.
- Difficulty finding their way around.
When difficulties with visuospatial skills are detected, vision therapy becomes a fundamental tool to help the brain organise, interpret and correctly use visual information in space.
Therapy is based on a programme of personalised exercises, adapted to each patient's age and needs, worked on progressively.
Exercises are done both in the practice and at home, using specific materials, movement activities and visual tools designed to stimulate the visual and neurological systems in an integrated way.
Proper intervention in visuospatial skills not only improves academic performance, but also promotes the child's confidence, coordination and independence in daily life.
Visual analysis skills
These include: visual discrimination, visual memory, figure-ground perception, form constancy.
A deficiency can cause:
- Reading difficulties.
- Errors when copying.
- Confusing letters and numbers.
- Difficulty remembering what has been read.
- Slowness in schoolwork.
Vision therapy for visual analysis skills
When there are difficulties with visual analysis skills, vision therapy trains the brain to process, organise and correctly understand the information coming in through the eyes.
These skills are fundamental for reading, writing, arithmetic and learning in general, because seeing well is not enough: you have to understand what you see.
Therapy is based on a programme of personalised exercises, adapted to each patient's age and needs, working progressively on:
- Visual discrimination (telling apart letters, numbers, shapes and details).
- Visual memory (remembering what has been seen).
- Form constancy (recognising a figure even when its size, position or context changes).
- Figure–ground perception (picking out a relevant stimulus among others).
- Visual closure (recognising an object even when it is incomplete).
Proper intervention in visual analysis skills allows the child to work more efficiently, reducing the slowness, errors and frustration associated with learning difficulties.
