Pediatric Ophthalmology


Vision accounts for 80 percent of all learning in the first 12 years of life; good vision is key to a child’s growth and development. Classroom performance and social development can be seriously upset by an untreated vision problem.

Although the eye tests given at school are welcome, they cannot detect all visual problems. It is very important to have your child examined by an ophthalmologist before the age of four and periodically thereafter. Strabismus, amblyopia and refractive errors are the most common visual problems in children. Early detection and treatment of these conditions is essential. Glasses, patching, and surgery, if necessary, are the mainstays of treatment.

Strabismus

Strabismus is a visual defect in which the eyes are misaligned and point in different directions. With normal vision, both eyes aim at the same spot and the brain fuses the two pictures into a single three-dimensional image. When one eye turns, two different pictures are sent to the brain, which learns to ignore the misaligned eye and sees only the image from the straigt, better-seeing eye. The child then loses depth perception.

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The exact cause of strabismus is not fully understood. To line up and focus both eyes on a single target, all of the muscles in each eye must be balanced and moving together. The brain controls the eye muscles. Strambismus is especially common amnon children with disorders that affect the brain, such as cerebral palsy, Down syndrome, hydrocephalus and brain tumors. A cataract or eye injury that affects vision can also cause strabismus.

Children should have an eye examination at or before their fourth birthday, or earlier if their is family history of strabismus or amblyopia.. If a child is diagnosed with strabismus, there are various appropriate treatments. In some cases, eyeglasses may be a solution, as well as exercises or prisms. However, surgery that repositions certain muscles in one or both eyes is often the best solution. Children require general anesthetic for this procedure and recovery time is rapid, usually within a few days. Glasses may still be required after the surgery. In some cases BOTOX, a drug used in certain circumstances to treat strabismus, can be injected into an eye muscle to relax its action temporarily. The opposite muscle then tends to straighten the eye and in some cases, permanently correct the misalignment. However, the injection may need to be repeated and is not as effective as surgery in some cases.

Pseudostrabismus

In some cases infants may appear to have strabismus as their eyes may drift in or out at times, a condition known as pseudostrabismus. This may be caused by an infant's facial configuration and improves with age as the bridge of the nose narrows, the folds of the eyelid skin disappear and the eyes open wider. By the age of about four months an infant's eyes shold be straight most of the time. To tell the difference between strabismus and pseudo strabismus, shine a flashlight on your child's eyes. When the child is looking at the light, a feflection can be seen on the front surface of the pupil. If the eyes are properly aligned, the light reflection will be at the same place in each eye. If the child has strabismus and the eyes are not aligned properly, the reflection will appear in a different location in each eye.

Amblyopia

Strabismus may also cause amblyopia, or reduced vision in the weaker eye. This can be treated by patching the "good" eye to strengthen and improve vision in the weaker eye. If amblyopia is detected in the first few years of life, treatment is usually successful. If treatment is delayed until later, amblyopia usually becomes permanent.

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Learning Disabilities

A learning disability is a disorder in understanding or using spoken or written language. People with learning disabilities gnerally have average or above average intelligence but have difficulties with reading, writing, listening, speaking, concentration or mathematical calculations. Dyslexia is a type of learning disability that involves difficulty in reading. The term learning disabilities does not apply to children who have learning problems caused by visual or hearing handicaps, mental retardation, emotional disturbance or environmental, economic or cultural disadvantage. Learning disabilities may be inherited, but research points to a brain's disability to interpret what is read or heard, not to poor vision.

Learning disabilities are complex problems; there are no quick fixes. Simple solutions, such as diet, megavitamins, sugar restriction, eye exercises, eyeglasses or vision training do not cure learning disabilities. Most of these treatments are costly, and your resources could be better spent on remedial education programs. With proper help, children with learning disabilities can become very successful. If you or your child's teachers suspect a learning disability, you should contact the school and if necessary to local or state Director of Special Education. Public law requires schools to evaluate any child who is thought to have a learning disability.

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