A child’s eyes are the most important sense organ through which he sees the outside world and imbibes inputs for development and so, taking care of them is of utmost importance. A child’s eyes are not just a miniature of the adult eye. The way they function, the problems they can have and the treatment they require are all different. In this article we will discuss a few aspects of pediatric ophthalmology.
The ideal age for the first check up is at birth. The second check up should be at 1 year, then 2.5 years and then yearly there after. In premature babies, eye examination is done in the NICU itself.
In today’s age of technology, we see more and more children with glasses, more commonly myopia or near sightedness. The root cause of this is our changed life style, with children spending more time indoors in front of gadgets, increased scholastic pressure and less time for outdoor sports. High degrees of Myopia is associated with problems in the retina. Once a child is myopic his power increases to some extent till the age of 18 years. To control that, we need to encourage one hour of outdoor activity everyday, reduce screen exposure and take adequate breaks. There are eyedrops which can be started by advice of a pediatric ophthalmologist and special glasses which can slow down the increase in glass power.
Lazy eye or amblyopia is a cause of decreased vision which occurs only in children. This happens when children have high power or squint or other problems like corneal opacity or cataract in one eye. Vision in the eye with the problem does not develop well and even if the problem is treated, the eye still does not see well because it is lazy. In that case, we need to force the lazy eye to work by occluding the good eye for some hours in the day. There are modern software therapies too like Bynocs which train the lazy eye to work. However this treatment has to be done in the first 10-12 years of life.
Another eye disease common in children is squint. Squint can be present since birth or can come later in life secondary to other eye problems or untreated glass power. It can also be a manifestation of something as serious as retinoblastoma or eye cancer. Squint does not get corrected on its own and needs to be treated. It is not only a cosmetic problem. If left alone it causes lazy eye and permanent loss of vision in the squinting eye and loss of depth perception. A detailed eye check up is essential if the child is noted to have a squint. If any cause is found, it is treated. The associated lazy eye is also treated. Some squints need surgery. Squint surgery can be done at any age, the earlier the better. It is a safe surgery done on muscles outside the eye, has a good outcome and has no side effects. It can be repeated in case of any recurrent or residual squint.
Cataracts can also occur in children by birth or later, either due to birth issues or metabolic problems or sometimes in marriages within relation secondary to genetic defects. Cataracts need to be operated at the earliest. Intraocular lenses can be inserted after 1 year of age. The technique of operating cataracts in children is different from adults. They do not regain
full vision immediately after surgery. They need to use glasses, do occlusion therapy to treat the lazy eye component and keep a life long follow up.
Similarly glaucoma (increased eye pressure causing damage to optic nerve) can also occur in children and needs surgery.
Due to advances in IVF and neonatal care, the number of surviving premature and low birth weight children is more. These children have a risk of a retinal problem called retinopathy of prematurity, which can be blinding if not treated on time. A retina or pediatric specialist needs to screen their eyes at birth and treat the retinopathy, if present, with laser or injections. These premature children also have a chance of developing squint or needing glasses and so need a yearly eye check up.
One common problem that children have is ocular allergy, which causes itching and watering and redness. If severe, it can cause problems in the cornea and thereby the vision. It is generally secondary to environmental factors. It needs intermittent courses of eye drops for control, to be prescribed only by an ophthalmologist. Over the counter medicines such as steroids can cause serious side effects like cataracts and glaucoma, damaging vision. Protective glasses should be given. Children generally grow out of it before adulthood.
Watering at birth can also be secondary to blockage of tear ducts and in 90% cases resolves by massage over the duct. The remaining 10% require surgery at one year of age.
These are only some of the common eye problems that can occur in children. There are several more, but most of them are preventable or treatable by timely care. Regular visits to a pediatric ophthalmologist are of utmost importance. A dedicated pediatric eye clinic has the expertise and special handheld equipments like tonopen, retinoscope which are required to examine small children, and also facilities for safe general anaesthesia in children. Parents and pediatric ophthalmologists together can ensure that children see a brighter tomorrow.
Dr. Bapaye hospital has a dedicated pediatric ophthalmology department headed by Dr. Charuta Bapaye who is trained under Orbis International at the prestigious Sankara Nethralaya, Chennai and has almost 20 years of experience in pediatric eye care. We also have an Orbis fellowship trained nurse, anaesthetist and optometrist in the team. We are committed towards state of the art pediatric eye care.