Pediatric ophthalmology represents maybe the most important part of modern ophthalmology. Child’s ophthalmic diseases in our population are still rarely recognized on time, or they are treated poorly. The result is a high level of amblyopia among general population in our region.
Did you know? After birth, child’s eye is still undeveloped, as many other organs and organ systems. The fact is that the eye grows no more than 1.84 times during life, which makes it one of the smallest organs of the human body.
Intensive visual development of the child lasts up to 4 years of age, and fully develops at the age of 8. Even being in a process of development, children’s vision can be properly corrected and treated in order to have a full visual acuity at the end of the eye’s growth. That is why it is important to be known that the child is never too small or too young for a regular ophthalmology examination, even when it cannot read or white. It is useful and advisable to prepare a child for the examination as if it is going to be a game.
Prof. dr Nikica Gabrić, dr med.
Mr sc.Bojan Kozomara dr med.
Ernesta Potkonjak, dr med.
Nebojša Đogatović, dr med.
Sanja Savičić, dr med.
Ana Aničić, dr med.
Miloš Milićević, dr med.
Vladimir Račić, dr med.
Borjana Solomun, dr med.
Dajana Abdulaj, dr med.
Tamara Bojanić Barić, dr med
There are various methods for a visual acuity assessment in children. For babies, we have special visual cards that are used to attract their attention, and as a result they are compared to the special charts for each card. When it comes to the preschool children, Lea symbols are used to assess visual acuity. For a thorough eye examination of a child, it is good to assess both near and far vision.
Procedure for the objective visual acuity assessment includes pupil dilation and it lasts for about an hour. It is advisable to prepare the child at home for the examination, particularly when it comes to the eye drops instillation. After the pupils are fully dilated, sciascopy is done in order to have a full status of the refractive error. At the end, appropriate glasses are prescribed. Even though the child’s cooperation is important, sciascopy is a great method for situations where the cooperation is not good, or it is totally missed.
Orhooptic status is the next step in the pediatric ophthalmology examination. It is also used in adults with strabismus, and it shows us motility of the eyes, as well as the “communication” of both eyes. By evaluating orthooptic status, strabismus can be detected, binocular vision disorders found, and potential amblyopia and nystagmus (flickering of the eye) are diagnosed. Stereo vision is also assessed and checked using special tests (Titmus, Lang). In those who have nystagmus, special additional measurements are done.
Binocular vision disorders and amblyopia are often caused by strabismus (eye squint). If present, strabismus can be assessed, and underlying amblyopia detected.
Anterior and posterior segment examination is used to detect other eye abnormalities and diseases, including inflammations, allergies, trauma, foreign bodies, congenital cataracts, etc. This part of the examination is the same as for the adults.
Refractive error is the most common cause of pediatric ophthalmology examination. Usually in small children parents notice that the child does not see well when it brings the book or toys close to their eyes, sits very close in front of the television, squeezes their eyes when it tries to see far objects, etc. In older children, problems are usually detected in school.
Furthermore, children with refractive errors sometimes complain of headaches after reading or playing video games.
Given all these facts, it is mandatory to treat each and every refractive error in children with diligence and thoroughness.
Amblyopia, or the “lazy eye” represents insufficient development of the optic nerve on one or both eyes, or impossibility of achieving the best visual acuity on one or both eyes, even when the full refraction is obtained.
Problem of amblyopia is specifically expressed if it is present in only one eye. In these cases the “lazy eye” is masked by the vision of the better eye, child does not complain, nor shows any symptoms whatsoever. This way, the amblyopia stays undetected for a long time. Furthermore, visual cortex then takes only the picture sent from the better, healthier eye, while the weaker eye is being suppressed. Strabismus can often be seen on the “lazy eye”.
Strabismus presents abnormal position and motility of the eyes.
In healthy individuals, both eyes have straight position when they fixate far objects. Every eye is moved by 6 muscles, while the impulse of muscle activation comes from the brain. By adjusted eye movements binocular vision development is achieved, while pictures from both eyes are blend in one in the visual cortex of the brain. If one or both eyes are not positioned properly, or there is a limitation of movement, the brain will shut down the eye which is not well positioned and take picture only from the eye which has good position and clear picture. This way, amblyopia and no binocularity will occur.
In some cases, when the development of vision is finished and there is no possibility to restore binocular vision, strabismus surgery can only be done due to cosmetic reasons, so the “lazy eye” would be brought to the proper straight position.
After facial or head injuries, paralysis of certain eye muscles can occur. Furthermore, these patients, due to inappropriate eye position can sometimes develop double vision (diplopia). In these cases, although there is no possibility of returning the function to the nerve or the muscle, the surgery can bring the eye into more natural position and reduce diplopia.
Sometimes, at birth, child can develop congenital cataract on one or both eyes. These cataracts are often seen in some infection during fetal period, or rarely in some development disorders.
Considering the fact that the clouded lens prevents light entrance into eye and optic nerve development, proper treatment is of utmost importance.
Mature cataract needs to be removed as soon as possible, most often at 2-3 months. During surgery, the cataract is removed the same way as if it was an adult patient and often the proper intraocular lens is implanted. If the cataract does not affect visual axis, it can be followed and controlled, while the vision is developing.