Is eye care a part of preventive examinations at the pediatrician?
During an examination, a pediatrician will always assess the overall look and movement of the eyes and depending on the age, also distance visual acuity as well as color vision. However, it does not mean that if a child can read 100% of the items displayed on the optotypes that they have no refraction defect. Hyperopia (farsightedness) is an example of an eye defect that children can accommodate for when low diopter problems are present. These cases then refer to latent hyperopia which causes amblyopia (lazy eyes). The same applies to astigmatism where a child helps herself/himself by for example tilting the head or by squinting the eyes to correct the visual defect. However, when the diopter difference between the two eyes is greater (anisometropia) and is not addressed adequately, then the eye with a higher diopter value can develop the lazy eye syndrome.
When should parents arrive with their child for an eye examination and what problems should these include?
Parents should always book a visit for an eye examination at any moment when they feel that their child’s vision has worsened, when they notice cross eyes, squinting or when the children tilt their head. Often, the causes for a visit include redness and purulent eye secretions of children and infants. When relatives of the child suffer from eye problems and refractive defects (nearsightedness, farsightedness, astigmatism, strabismus, amblyopia etc.), the child should undergo an examination as early as between 6-12 months of age.
What are the most common eye defects and diseases found in children?
With infants and babies, we most commonly encounter chronic conjunctivitis connected with purulent secretion from one or both eyes at once. This problem is caused by a narrowing of the lacrimal ducts and its flawed development dating back from the prenatal age. Until the age of six months, infants can have their lacrimal ducts probed and flushed. This is then followed by local application of antibiotic drops which prevents further infection and any possible scarring. With toddlers, surgical procedures to recreate new ducts are sometimes required. An indispensable part of treatment involves localized massages of the lacrimal sack often avoiding any follow-up surgery.
With toddlers, we often encounter strabismus (cross eyes), i.e. often with the eyes pointing towards the nose – otherwise known as convergent strabismus. In such cases a thorough eye examination ensuring mydriasis (dilation of the pupil) and cycloplegia (a temporary paralysis of the ciliary muscle which disables the ability of the eye to accommodate to various conditions). During this examination, it is possible to accurately measure the diopter values of a child and recommend the best visual aid. Generally, with children up to five years old, farsightedness is 10 times more common than nearsightedness.
Untreated farsightedness, especially in cases with varied diopter values in each eye, leads to the lazy eye syndrome (amblyopia) which can only be corrected at childhood. After the age of 7, the chances of any improvement rapidly decline because children experience the end of visual development. Lazy eyes can be corrected with the help of eye occluders (patches) and glasses. With a part of the patients, this is connected with strabismus as well. However, this often disappears when glasses are prescribed. In some cases, surgery to treat strabismus is a possibility as well.
Once in their school years, we most commonly encounter children suffering from shortsightedness and astigmatism (i.e. irregular corneal curvature). Both of these defects can be treated by wearing appropriate glasses.
What threatens children’s eyes the most?
A major problem is posed by eye injuries. With smaller children who do not yet have good communication abilities, we need to rely on examinations which are often only possible under general anesthesia. The most common injuries include contusions of the eyeball, penetration or perforation or fractured orbits. All such injuries are very serious and some of them can eventually cause blindness. The history of a potential injury is often revealed by the child after they complain about pain in the eye or worsened vision. Parents tend to notice redness in the eyes, atypical coloration or strabismus the most.
Modern day children spend considerable amounts of time in front of screens (TVs, notebook, mobiles …). What impact does that have on their vision? Does it cause any specific complications?
Research from the last couple of years appears to indicate that long-term close-up work under artificial lighting can induce shortsightedness (myopia). It has been proven that longer-term stays outside under natural light (at least two hours) can lower the risk of shortsightedness developing in children. Additionally, long-term monitor exposure results in subconsciously blinking less which results in the eye film drying up quicker, often leading to difficulties associated with the dry eye syndrome. For the vision and the entire nervous system to develop properly, it is important that children are exposed to various stimuli in their environment. Ideally, working and playing with all electronic devices should be minimized whenever possible.
What does a child’s eye examination entail?
For small children, it is especially important to establish a good relationship between the patient and the doctor. The child has to trust the doctor completely. After such contact is established, whether through play or communication alone, the visual acuity is tested depending on the child’s age - always starting from the right eye to the left one. In children unable to speak yet, we use symbols (a cross, circle, triangle, square etc.), from the age of three, we use the letter “E” and schoolchildren are shown either letters or numbers.
Small children have their diopter measurements done on an automatic refractometer. We then observe the eye movement and the eye’s cooperation capability, then trying to identify the type of strabismus. Then, depending on the age and abilities of the child, a slit lamp examination follows to try and assess the state of the conjunctiva, cornea and the lens. The doctor then also attempts to identify any potential clouding of the eye. After this, special drops are then applied to both eyes. Children should be informed at this stage as all drops cause a momentary burning sensation which each child reacts to differently. Due to the effects of these drops, some children are afraid of further eye examinations. The drops take about 30-45 minutes to begin working and only then can the examination continue. Diopter measurements are taken without the burden of eye accommodation (deactivated temporarily by the drops). The last part of the examination involves checking the fundus (eye interior) where the doctor assesses the state of the retina and the optic nerve. The entire examination is finalized by a recommendation for the child and his/her parents with regards to corrective glasses. It is very important to respect the prescribed frequency and number of visits to ensure good eye and vision development.
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