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What is Pediatric Ophthalmology?

Pediatric ophthalmology is a subspecialty of ophthalmology that focuses on the diagnosis and treatment of eye problems in infants, children, and adolescents. Pediatric ophthalmologists are trained to diagnose and treat a wide range of eye conditions that are specific to children, including congenital cataracts, strabismus (crossed eyes), amblyopia (lazy eye), and retinopathy of prematurity (ROP). They also have expertise in managing the unique visual and developmental needs of children, such as ensuring that children have proper vision for learning and performing daily activities.Pediatric ophthalmologists work in collaboration with other pediatric specialists, such as pediatricians and neurologists, to provide comprehensive care for children with eye problems.

Pediatric Ophthalmology and Squint services

Most common eye problems seen in children:

  • Squinting/deviation of eyes
  • Refractive error
  • Lazy eye disease (Amblyopia)
  • Watering from the eye
  • Developmental or Congenital Cataract
  • Eye allergies
  • Eye injuries
  • Retinopathy of Prematurity (ROP)
  • Tumors

What is Squint?

A squint (strabismus) is the term used to describe eyes that are not pointing in the same direction.

Squinting of eyes may occur occasionally or may be present throughout the day. It may appear in only one eye or may alternate between the two eyes.

Squint can become obvious after chronic illness and it can also run in families.

In order to focus both eyes on an object all the eye muscles of each eye must be balanced and coordinated.

When one eye is squinting, it may not receive a focused image. This can lead to a deterioration of vision in the squinting eye (Lazy eye/Amblyopia).

It is necessary to diagnose squint as soon as possible and to treat it appropriately to prevent development of Amblyopia/Lazy eye.

How is squint treated ?

If your child has been diagnosed with a squint, it will be managed or treated by one of the modalities of treatment:

  • Opticals (Spectacles)
  • Occlusion (Patching)
  • Orthoptics (Eye Exercises)
  • Operation (Surgical correction)

What is Amblyopia (lazy eye) ?

Amblyopia is one of the most common causes of visual impairment which can be completely reversed if diagnosed early and treatment initiated on time. Unless it is successfully treated during early childhood, it usually persists into adulthood.

  • Amblyopia, commonly known as lazy eye, is an eye condition defined by an unexplained reduction of vision in one eye, unrelated to any obvious eye disease.
  • The vision is not usually correctable by glasses or contact lenses.
  • Amblyopia occurs when the vision in one eye does not develop properly during early childhood.
  • If not treated on time; it can lead to a permanent visual impairment.
  • Although it mostly affects one eye, both eyes can also have decreased vision due to amblyopia.

Why does amblyopia occur ?

Our visual development occurs up to the age of 9 years, the most critical phase lasting from birth to 6 years of age.

Both eyes must receive clear images during this critical period.

If the image is not clear, the brain shuts off the image which is out of focus and the child depends only on the better eye to see.

Thus, anything that interferes with a normal image formation on retina in either eye during the crucial period of visual development, leads to amblyopia.

The good eye and brain will inhibit (block, suppress, ignore) the eye with the blur.

The inhibition process (suppression) can result in a permanent decrease in the vision in that eye that cannot be corrected with glasses, lenses or Lasik surgery.

The most common causes of amblyopia are:

  • Strabismus (an imbalance in the positioning of the two eyes)
  • Anisometropia (when one eye has a high plus or minus number)
  • An eye disease like cataract or ptosis (drooping of eyelid) that prevents a clear image from being focused onto the retina.

How to know if your child has Amblyopia ?

You may not be able to tell that your child has lazy eye.

Amblyopia is usually difficult to diagnose, as many children with this condition look absolutely normal and carry out all their activities with the normal eye.

Only an eye doctor can confirm the diagnosis.

That is why early infant and preschool eye examinations are so necessary.

Still there are some signs which can help you in detecting if your child has amblyopia:

  • If your child’s eye is turned in,out or upwards
  • If he/she closes one eye (especially in bright light)
  • If a small child/infant resists covering of a particular eye

These are warning signs enough to raise a suspicion of amblyopia.

What is a Doctor’s Role ?

Amblyopia is best treated by an ophthalmologist

Treatment may involve use of

  • Spectacles
  • Eye drops
  • Eye patches
  • Surgery

Treatment of Amblyopia

Amblyopia can be treated up to the age of 17(in selected cases), but it is most effective when done early in child’s life usually before the age of 7 years.

What is a Parent’s Role ?

Parents play a vital role in making sure that their child does not have this disability.

First, it is important to recognize any signs of a problem. Secondly, Once suspicion is raised, contact an ophthalmologist as soon as possible. You play an important role in making sure that your child has a lifetime of good eyesight.

Far too many parents fail to take their infants and toddlers for an early comprehensive vision examination and many children go undiagnosed until they have their eyes examined at a much older age.

Amblyopia is best treated at an early age and becomes less amenable to treatment as the child grows up.

Good vision in both eyes is essential to allow good depth perception and for fine, near activities.

Congenital Cataract

Cataract is opacification of the clear lens

Cataract occurs in old age so how it happens in kids ?

Cataract can occur in children as

  • Congenital- by birth
  • Due to infections in the mother which are passed to the baby before birth
  • Due to injury to lens or injury during birth
  • Due to metabolic problems in the child
  • Associated with other familial syndromes
  • Pediatric cataracts can be present just after birth or can develop in childhood

The cataract can be caused in one eye or both, can range from being a small dot over the lens to total white opacity of the lens.

How can I know if my child has cataract ?

  • Mild cases can be without symptoms and go unnoticed for years.
  • A routine check up can help the Ophthalmologist to identify any such problem, it helps to identify unnoticed or very mild problems
  • Blinking of eyes in light
  • Whitish reflex in the eye
  • Not seeing face/toys clearly
  • Inward or outward turning of the eye (Squint)
  • Constant movement of eye (Nystagmus)
  • Delay in development

What is the risk if treatment not done ?

There are chances of developing Amblyopia/lazy eye in childhood. This can be irreversible if critical stage has passed, and treatment is postponed.

How is treatment done ?

Treatment can vary according to severity and involvement of one/both eyes

  • Surgery
  • Eye drops
  • Occlusion of eye
  • Spectacles

How successful is cataract surgery for children ?

Early visual rehabilitation is critical to prevent irreversible amblyopia (lazy eyes) in children.

Earlier onset and the longer duration worsens the prognosis.

The surgery is quite successful but the success also depends on multiple factors including post surgical follow up, use of glasses/patching of eyes. There can be associated problems in such eyes which need to be taken care of.

Dedicated parents play a pivotal role in the visual rehabilitation of these children.