Pediatric Ophthalmology

Childrens Eye Exams MiamiPediatric ophthalmology is a subspecialty officially named "Pediatric Ophthalmology and Strabismus." The title reflects what is most commonly seen in this patient population; visual disorders and diseases in childhood, as well as strabismus (misaligned eyes). Children are not just "little people," and some disorders are unique to children. That unique quality is based on the developing brain and the developing visual system.

Children can have any of the disorders that the adult population has, such as infection, accidental injuries, infection, cataract, glaucoma, retinal disease, blindness, and others. However in childhood, things are more complex due to the developing visual system. If a young child does not use the visual system fully during the developmental years, the vision can be permanently lost, the concept of "use it or lose it." Making things even more complex is the fact that children, especially very young children, frequently say nothing and have no frame of reference to even offer an observation, assuming they were old enough to talk. Loss of vision due to disuse is called amblyopia, and can occur until children are about 8 years old. It can be reversible if caught early, but if the underlying problem (such as poor focusing ability or structural abnormality) is not detected at a young enough age, it can become a permanent incurable problem.

Since children rarely volunteer comments about their eyes, it is up to the schools, doctors, and families to look out for them. Early screenings have become commonplace, but are often overlooked. Pediatricians generally do a good job of screening, but frequently screening begins with older, more verbal children, and sometimes it is jut too late. Therapy for reversing visual loss encompasses are variety of techniques, involving glasses, patching therapy, and sometimes surgery to correct problems as early as possible..

Strabismus (misaligned eyes) occurs in childhood as well as later in life, and occurs for a variety of reasons. It causes functional deficits, as well as a significant cosmetic abnormality. Patients with crossed eyes (or eyes that go out) are usually embarrassed and self-conscious about their appearance. People around them frequently say nothing, but they too notice the problem. Strabismus can be made better and it is rare that people have to live with this condition. Sometimes glasses will take care of it, sometimes prisms are used, and in a large percentage of patients, surgery is the best means of treatment. Surgery is highly successful, can be done as an outpatient, and the results can be dramatic. Surgery is done for the young and old alike, and each case is unique, so there is no "one size fits all" approach.

Regardless of the cause or outcome, preventable visual loss is a primary goal for any ophthalmologist that sees children. Strabismus should never be ignored and misalignment of an eye should always prompt a referral.. With better understanding of these disorders and earlier intervention, we can fix things now that were unimaginable a generation ago.

Richard B. Simon, MD

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