The Pediatric Ophthalmology service at Mehta eye clinic has slowly grown to be a referral centre for pediatric eye problems.
At present, this service involves not only diagnosis and management of various facets of pediatric eye disorders like refractive error, childhood cataract, glaucoma, amblyopia, squint, retinal disorders, congenital anomalies, pediatric eye cancer etc. but also adult patients with squint/double vision problems. The department provides appropriate therapeutic intervention for all stages of retinopathy of prematurity, a blinding disease of the premature newborn.
Common Pediatric Eye Problems
1. Strabismus
Strabismus is a general term that indicates any misalignment of the eyes.
Most children do not complain of or experience double vision. They may have double vision, or may close one eye, or someone may see an eye misalignment. Most often, there are no symptoms of strabismus in children. Adults more often have double vision.
The only way to diagnose strabismus reliably is with a complete eye exam that includes measurements of the eye alignment.
Strabismus is often treated with glasses, prisms in glasses, or surgery to move eye muscles and bring the eyes back into alignment. Sometimes a combination of all of these treatments is required.
2. Amblyopia
Amblyopia is a term for poor vision development in the brain that stems from some underlying problem in the eye getting a clear, focused image sent to the brain.
There are, generally, no symptoms associated with amblyopia. Children, especially, are unaware that they don’t see well out of one eye.
Vision screenings in children are aimed at detecting amblyopia at a young age while treatment is effective. Pediatricians and public schools screen vision regularly. Any suspicion of poor vision in a child should be investigated with a comprehensive eye exam by someone who has extra training in pediatric ophthalmology. Any child with a family history of amblyopia in a close relative (parent or sibling) should also be examined thoroughly at least once.
Treatment of amblyopia depends on the underlying cause. Glasses may be given or surgery may be recommended for some special cases. Generally, drops to blur the good eye are given, or the good eye can be patched to help the worse-seeing eye improve. Treatment takes months to years, and involves the brain learning better vision from the eye with amblyopia. Because it is a disorder of brain development, there is a period after which detection and treatment of amblyopia is not helpful. This age may be different for different people. Treatment is most effective at a young age, so early detection is critical.
3. Pediatric Glaucoma
Glaucoma is a disease of high eye pressure, which damages the optic nerve. Glaucoma in children is rare. It can be congenital or result from injury or surgery on the eyes. There are also some diseases associated with the development of glaucoma in children.
There are no symptoms of glaucoma, generally. In some serious cases of infant glaucoma, the baby may be very light sensitive, tear quite often, and the eye actually enlarges. Generally, glaucoma is without symptoms.
Pediatricians look at the eyes during well-child check ups. If they see anything abnormal, they refer for further evaluation. Any excessive tearing or possible eye pain/light sensitivity in a young child should be brought to the pediatrician’s attention. Diagnosis can only be made by an ophthalmologist trained in glaucoma or pediatric eye care.
Treating glaucoma in children is performed with drops or surgery, depending on the situation. Sometimes multiple medications and multiple surgeries may be required to control the eye pressure.
4. Pediatric Cataract
Cataracts are rare in children. They can be congenital or develop as an effect of an eye injury or disease. A cataract is a clouding of the normally clear lens in the eye.
Pediatricians check for the red reflex on infant and toddler well-child check ups. This is one way of detecting a lens that isn’t clear. Vision screenings by pediatricians and school systems also help detect eye problems such as cataracts. A diagnosis of a cataract can be made during a comprehensive eye examination by a qualified ophthalmologist.
Treatment is often surgery, and can take place in infants as young as a few weeks old in some cases. Some cataracts in children are mild and don’t require surgery. Very mild cataracts can be followed without surgery to be sure good vision development takes place. If surgery is needed, there may be an artificial lens used, as in adults, or there may be no artificial lens placed at the time of surgery. Glasses or contact lenses are generally needed in all children who have cataract surgery. A cataract in a child requires close follow up to help ensure good vision development, regardless of whether surgery has been performed.
5. Should All Childern Should Be Screened?
All children should be seen by an eye doctor for the first time at 3-4 years of age. However if any of the following are present then the child should be brought to the eye doctor at the earliest:
- One on both parents wearing glasses
- History of Consanguinity (marriage among cousins) in family
- Premature delivery
- Birth weight less than 1.5 Kgs
- History of any congenital defects like heart, kidney etc
- History of febrile fits or any convulsion
- History of admission in the ICU- incubation/ ventilation given to child
- Behavioral disorders or any developmental delay in the child
- History of colour blindness and retinal disease in family
6. Why Should An Eye Doctor See A Child?
Early detection of eye sight problem gives rise to better vision development. Good vision correction causes good performance at school and home. Squinting of eye if diagnosed early can be treated with exercises and glasses in some cases.
It is possible to give the child good binocular (coordinated) development of eyes. Other behavioral, social problems if present in the child will also benefit in their treatment.
7. When Is The Best Time To Bring The Child?
If the child has a problem then anytime is a good time to visit the eye doctor however specific visits can be planned as follows:
- A preterm infant/low birth at infant at 4 weeks after birth
- A normal baby at 3 to 3½ years of age for a preschool eye check