Pediatric ophthalmology represents a special part of modern ophthalmology. Children’s eye diseases in our population still often go unnoticed, without adequate reaction in time, and unfortunately, we have a large number of visually impaired individuals whose eye diseases were not detected and treated during childhood. At birth, the child’s eye is still undeveloped, like many other organs and organic systems.
Did you know? The eye only grows 1.84 times in size compared to its size at birth, making it one of the smallest organs. Intense development of vision in children lasts up to 4 years of age and vision is fully developed by the age of 8. While vision is developing, disorders can be treated to enable normal development of the child’s eye. Therefore, if visual disturbances or decreased visual acuity are not detected in time, treatment results in later stages are significantly worse, and the child remains partially or completely visually impaired for life.
CHILD EXAMINATION
Pediatric ophthalmologic examination is one of the most important examinations to be performed by the age of 4. Intense vision development lasts until the end of the eighth year of life. Therefore, it’s important to know that a child is never too young for an ophthalmologic examination, even when they still don’t know letters and numbers, or when it can be expected that the child will cooperate less during the examination. The child should be prepared to perceive the examination as a game.
METHODS OF DETERMINING VISUAL ACUITY VARY DEPENDING ON AGE:
For babies, special cards with a pattern are used, determining which size of the pattern attracts the baby’s attention, and the result is compared with tables prescribed for the age. For preschool-age children, pictures (Lea symbols) are used, which are made according to the same rules as letters for adults. For a better insight into the state of visual acuity, it is necessary to examine the child’s ability to recognize pictures at close and long ranges.
EVERY CHILD’S OPHTHALMOLOGICAL EXAMINATION INCLUDES:
Subjective determination of visual acuity (if possible due to the child’s age) Determination of the child’s orthoptic status (strabismus tests) with binocularity and stereovision tests Dilation of the pupils and determination of the child’s objective refraction (diopters) A complete examination of the anterior and posterior segment of the eye
REFRACTIVE ERRORS (DIOPTERS)
The most common reason why children come for an eye examination is diopters. Usually, parents of small children notice that the child doesn’t see well because they bring books and toys closer, watch TV at a short distance, or squint and blink frequently when trying to fixate on distant objects. In older children, vision problems are discovered when they can’t see the board at school. Also, children with diopters often complain about headaches after long periods of reading or playing video games. Among the most common eye diseases that need to be treated in childhood are strabismus, amblyopia (lazy eye), congenital cataracts, and nystagmus (eye twitching).
AMBLYOPIA
Amblyopia, or lazy eye, actually represents insufficient development of the optic nerve, the optic pathway, or the vision center in the brain, that is, the inability to achieve maximum visual acuity in one or both eyes, even with full correction of refractive anomalies. The problem of amblyopia is especially pronounced if it is present only in one eye. Then the vision problem in the worse eye is “masked” by the vision of the better eye, the child doesn’t complain or show any symptoms, and the problem often goes unnoticed. The vision center in the cerebral cortex takes the image only from the better, healthier eye, and the weaker eye is “suppressed” by the better eye, leading to strabismus. Although a hereditary component has never been officially proven, amblyopia is more common in children whose parents are also visually impaired.
STRABISMUS
Strabismus is a disorder of the position or mobility of the eyes. In healthy eyes, both eyes are in the right position, i.e. they are positioned straight in front of the object being looked at, and the movements of displacement are coordinated. Each eye is moved by 6 muscles, while the impulse for movement comes from the brain. With coordinated eye movements, perfect cooperation of both eyes is achieved, which enables the development of binocular vision, i.e. cooperation when looking with both eyes at the same time, where two slightly different images merge in the brain into one image with three dimensions (stereo vision). If both eyes do not stand straight, or there is limited mobility in one of the directions, the brain will exclude the eye that does not stand straight or does not follow, and the previously mentioned visual impairment will develop, and neither binocularity nor stereo vision can develop. In some cases, when vision development is already completed and binocular vision can no longer be established, strabismus surgery can be performed for cosmetic reasons, to reduce the deviation and bring the eye to a position straight forward. This would give the patient a better aesthetic appearance. After facial and head injuries, paralysis of some of the muscles that move the eye can often occur, and in addition to impaired appearance, a patient whose previous vision mechanisms worked well can develop double vision. In such cases, even though the function of the muscle or the nerve that drives it cannot be returned, surgery can bring the eye into a position that more closely matches the normal natural way of looking and thus facilitate daily functioning.
CONGENITAL CATARACT
Sometimes a child can be born with a cataract in one or both eyes. Such congenital cataracts usually occur due to developmental disorders or some infections while the child is still in the mother’s womb. Given that a clouded lens prevents light from entering the eye, even if the rest of the eye is completely healthy, the child’s vision will not be able to develop and will remain highly visually impaired even after a later successful operation. Therefore, it is necessary to operate on a congenital mature (ripe) cataract as early as possible, even in infants. During the operation, as in adult patients with cataracts, the cloudy eye lens is removed, and an artificial lens is implanted in its place, allowing the eye to develop visual function.
