Pediatric

Pediatric ophthalmologists are medical and surgical doctors who specialize in the eye problems of children. In particular, vision develops in the brain until about age 9 years and can be adversely affected when the eyes are not straight or do not focus correctly. A child can grow up with good vision if these problems are detected and treated at a young age. All ophthalmologists have some training in children’s eye problems, but the pediatric ophthalmologist has had additional training and practice in examining children and caring for their eyes. If your primary care doctor suggests that your child have his or her eyes checked, a pediatric ophthalmologist will have the greatest knowledge of the possible conditions and the greatest experience in examining children effectively.

Children may need glasses for several reasons—some of which are different from adults. Because a child’s visual system is growing and developing, especially during the first 5-6 years of life, glasses may play an important role in ensuring normal vision development. The main reasons a child may need glasses are:

• To provide better vision, so that a child may function well in his/her environment
• To help straighten the eyes when they are crossed or misaligned (strabismus)
• To help strengthen the vision of a weak eye (amblyopia or “lazy eye”). This may occur when there is a difference in prescription between the two eyes (anisometropia). For example, one eye may be normal, while the other eye may have a significant need for glasses caused by near-sightedness, far-sightedness or astigmatism.
• To provide protection for one eye if the other eye has poor vision.

The American Academy of Ophthalmology and Piedmont Eye Center suggest that all children have their eyes examined by the age of 3. Of course, some conditions present even in newborns. If a problem is suspected, an eye exam should be performed.

A baby’s eyes can be tested even before they can give a verbal response. The ophthalmologist can test for vision fixation and motility. A dilated exam allows for measurement of refractive error with an instrument called a retinoscope. The doctor can determine the correct power of lens by holding lenses of varying power in front of the eye.

If a child’s eyes appear to be misaligned (crossed in or more rarely deviated outward), it is possible a condition known as ‘strabismus’ is present. Only an eye specialist can determine if this is present and prescribe treatment. In some cases, glasses may correct the condition whereas others may require surgery.

A common vision problem in children is amblyopia, or “lazy eye.” It is so common that it is the reason for more vision loss in children than all other causes combined. Amblyopia is a decrease in the child’s vision that can happen even when there is no structure problem with the eye. The decrease in vision results when one or both eyes send a blurry image to the brain. The brain then “learns” to only see blurry with that eye, even when glasses are used. Only children can get amblyopia. If it is not treated, it can cause permanent loss of vision.

Maybe, but they may not correct it all the way to 20/20. With amblyopia, the brain is “used to” seeing a blurry image and it cannot interpret the clear image that the glasses produce. With time, however, the brain may “relearn” how to see and the vision may increase.

One of the most important treatments of amblyopia is correcting the refractive error with consistent use of glasses. Penalization of the dominant eye by wearing an eyepatch or dilating eyedrops is frequently required.

Strabismus is a medical term for any misalignment of the eyes.

It is estimated that 4% of the United States population has strabismus.

Yes, there are different types of strabismus. Strabismus is most commonly described by the direction of the eye misalignment; esotropia, exotropia, hypotropia, and hypertropia.

Exotropia is the outward turning of one or both eyes. A commonly used term for exotropia is “wall-eyed.”

Hypertropia is one eye higher than the other.

Most strabismus is caused by an abnormality of the poorly understood neuromuscular (including brain) control of the eye movements. Less commonly, a problem with the eye muscles themselves causes strabismus.

Eye misalignment can cause amblyopia in children. When the eyes are looking in different directions, the brain receives 2 different visual images. The brain ignores the image from the misaligned eye to avoid double vision, resulting in poor vision development (amblyopia).

Any child can have strabismus. However, premature children and those with syndromes or brain disorders have an increased risk of strabismus.

The goal of strabismus treatment is to straighten the eyes and allow the eyes to be used together (binocular vision). Treatment may involve eyeglasses (glasses for children), eye exercises, or eye muscle surgery (strabismus surgery). Other problems present along with the strabismus (including amblyopia, ptosis, and cataract) are usually treated prior to eye muscle surgery.

Conjunctivitis or “pink eye” is a condition where the eyes look pink or red and may have discharge. Symptoms may include burning, irritation, discharge, or crusting of the lashes.

Conjunctivitis may be caused by bacteria, viruses, other infectious agents, chemicals, or allergies.

If the conjunctivitis is caused by bacteria, treatment with antibiotic drops or ointment may be indicated. Viral conjunctivitis does not respond to antibiotics but resolves without treatment.