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Pediatric Care

Pediatric ophthalmology is a subspecialty of ophthalmology dealing with children's eye diseases. When a baby is born their eyes are not completely capable of seeing and vision can be limited to around 20/1500. (the ability to see shapes but not features) The main reason for this lack of vision is due to the fact that their brains have not learned how to process the visual images it receives. Over time children will begin to detect extremely fine details. Sometimes visual development can be hindered by a variety of eye diseases or conditions.

Common Vision Problems for Children

Amblyopia

Amblyopia refers to reduced vision in one or both eyes caused by visual deprivation in childhood. Even with appropriate eyeglasses, an eye with amblyopia does not see well. It is often reversible with the appropriate treatment protocol. Amblyopia results from actual atrophy of the visual pathways in the brain that allow an individual eye to "see." That is, because of improper stimulation of the involved eye, the portion of the brain serving that eye does not develop properly.

Amblyopia may be caused by any condition that affects normal visual development or use of the eyes. Amblyopia can be caused by strabismus, an imbalance in the positioning of the two eyes. Strabismus can cause the eyes to cross in (esotropia) or turn out (exotropia). Sometimes amblyopia is caused when one eye is more nearsighted, farsighted, or astigmatic than the other eye. Occasionally, amblyopia is caused by other eye conditions such as cataract.

Treatment for ambyopia consists of forcing use of the amblyopic eye, either by patching, or by instilling topical medication (atropine) in the eye with better vision. Glasses may be required to balance the refractive differences of the eyes. Early detection and compliance with the treatment protocol are key to the success in treating this condition. Although the best outcome is achieved if treatment is started before age 5, research has shown that children older than age 10 and some adults can show improvement in the affected eye. An opaque, adhesive patch is worn over the stronger eye for weeks to months. This therapy forces the child to use the eye with amblyopia. Patching stimulates vision in the weaker eye and helps the part of the brain that manages vision develop more completely.

Strabismus

Strabismus, also known as crossed eyes or lazy eye, is a visual problem in which a misalignment of the eyes prohibits both eyes from focusing on the same point at the same time. One eye may look straight ahead, while the other eye turns inward, outward, upward, or downward. One of the eyes often has a shortened or elongated muscle that controls eye movement. To prevent double vision, the brain ignores the visual input from the misaligned eye, which typically leads to amblyopia or "lazy eye" in that eye.

During strabismus surgery a small incision is made on the clear membrane covering the white part of one or both eyes. Through this incision,the surgeon will tighten, relax, or reposition eye muscles causing the misalignment. Modern strabismus surgical techniques involve "hidden" incisions, leaving virtually no visible scarring of the eye surface as a result of this surgery.

When strabismus surgery is recommended for a child, the earlier in life it is done the better the chance of the child achieving binocular vision, or "depth perception".
Despite having the appropriate surgery, some patients may require further eye muscle surgery in the months, years or decades following their initial operation to further refine their ocular alignment.


Children's Vision

Some experts estimate that approximately 5 to 10% of pre-school aged children and 25% of school-aged children have vision problems. According to the American Optometric Association (AOA), all children should have their eyes examined at 6 months of age, at age 3 and again at the start of school. Young children without vision problems or risk factors for eye or vision problems should then continue to have their eyes examined at least every two years throughout school.

Common risk factors for children's vision problems include:

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