Children’s eye diseases in our population still often go unnoticed, without adequate
reaction in time, and unfortunately, we have many 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.
The eye only grows 1.84 times in size during lifetime, making it one of the smallest
organs in our body. Intense development of vision in children lasts up to 4 years of age
and vision is fully developed by 8 years of age. 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.
EXAMINATION
Pediatric ophthalmologic examination is one of the most important examinations to be
performed by the age of four. As mentioned above, 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 ophthalmic 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 refractive
errors. 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 writing board at school. Also, children with
refractive errors often complain about headaches after long periods of reading or
playing video games. Aside from all refractive errors, among the most common eye
diseases that need to be treated in childhood are strabismus, amblyopia (lazy eye), and
congenital cataract.
AMBLYOPIA
Amblyopia, or lazy eye, 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.
Furthermore, 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 is not straight or
does not follow, and the previously mentioned visual impairment will develop. 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 the right position. 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 surgery. Therefore, it is necessary to operate on a congenital mature (white)
cataract as early as possible, even in infants. During the procedure, 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.
