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Paul R. King |
Hello all! I hope
the summer is treating you well. Going with the kid's
theme this month, I thought I would touch on some of
the more common childhood eye disorders. Understanding
these disorders could go a long way to building a
relationship of trust with the child's parents. This
in turn will help grow your practice and your standing
in the optical community. |
There are many common childhood eye
problems such as infection, injury, amblyopia, or "Lazy
Eye." There are also vision problems like
nearsightedness, farsightedness or astigmatism. Observing a
child's eyes and paying attention to how a child behaves is
very important. Unusual behavior such as closing one eye or
tilting the head to see things can be a warning sign.
School-age children may complain of things looking blurry or
not being able to see the chalkboard.
Fortunately, most childhood eye problems
can be corrected if detected early. To help protect a
child's sight, watch for warning signs and suggest that your
patients take their child to a doctor at the first sign of a
problem.
Common Childhood Eye Disorders
Amblyopia
Amblyopia, also know as lazy eye, is
reduced vision in an eye that has not received adequate use
during early childhood. It is estimated that 4% of children
suffer from this form of visual impairment. If not treated
early enough, an amblyopic eye may never develop good vision
and may even become functionally blind. Amblyopia has many
causes. Most often it results from either a misalignment of
a child's eyes, such as crossed eyes, or a difference in
image quality between the two eyes, meaning one eye focuses
better than the other. With early diagnosis and treatment,
the sight in the "lazy" eye can be restored.
Glasses are commonly prescribed to improve focusing or
misalignment of the eyes. Patching or covering the
better-seeing eye may be required for a period of time. This
forces the "lazy" eye to work harder, thereby
strengthening its vision. Medication may also be used to
blur the vision of the good eye in order to force the weaker
one to work. Surgery may be performed on the eye muscles to
straighten the eyes if non-surgical means are unsuccessful.
Eye exercises may be recommended before or after surgery as
well.
Strabismus
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Strabismus, commonly known as crossed
eye, is a misalignment of the eye due to muscle imbalance.
This misalignment substantially reduces depth perception.
Strabismus occurs in approximately 4% of children and young
adults. Strabismus has an inherited pattern and is much more
common in children who have one or more parents that were
affected. Treatment of strabismus may include patching of
one eye or corrective lenses. However, the majority of
children with strabismus will eventually require surgery to
better align the eyes. Strabismus surgery commonly entails
recession or resection of eye muscles to different sections
of the eye to either weaken or strengthen them depending on
the case. Strabismus surgery is generally successful in
realigning the eyes as close to normal as possible. |
Pediatric Cataract
The diagnosis of a congenital cataract,
or a clouding of the eye's natural lens, can be made on the
first day of life by a pediatrician in the newborn nursery.
Early diagnosis and referral are important. Irreversible
damage will occur if a congenital cataract is not treated in
the first few months of life. If the cataract is determined
to be visually significant, surgery is indicated to remove
the lens.
Congenital Ptosis
Congenital Ptosis refers to a drooping of
the eyelids that is present at birth. The drooping is due to
improper development of the levator muscle, a major muscle
responsible for elevating the upper eyelid. The lid may
partially or fully cover the eye, and it may occur in one or
both eyes. Children affected by congenital ptosis may need
to tilt their head back, lift their eyelid with a finger, or
raise their eyebrows to see from under their drooping lid.
Congenital Ptosis is treated surgically and is generally
performed during a child's preschool years.
Things that parents should expect to
be included in a pediatric eye exam:
1. Visual Acuity Testing
a. Visual acuity will be checked. This
is possible even in children who are not old enough to
speak. For older children, picture charts, letter games
and letter recognition can be used.
2. Eye Alignment (Muscle Balance)
Testing
a. Various methods are used to test the
alignment of the eyes and to make sure the muscles that
move the eye are functioning normally. This may be done
using light reflexes or alternately covering each eye to
make sure that they do not move from the straight-ahead
position.
3. Binocular Vision Testing
a. These tests are used to make sure
that the eyes are not only aligned correctly, but that the
brain is using them together as well.
4. Refraction Testing
a. Refraction is used to measure the
"power" of the eye. It determines if your child
is nearsighted, farsighted or has astigmatism. This can
even be performed in infants when they cannot cooperate to
tell us how well they are seeing. In young children, the
focusing power of the eye must be eliminated to allow an
accurate measurement. Therefore, drops are placed into the
eye to dilate the pupil and eliminate their focus
mechanism. These drops often take 30–60 minutes to work
and do not wear off for 8–12 hours.
5. Fundus Examination
a. During a fundus examination, the
examiner uses a special light, often worn on his or her
head, to look into the back of your child's eye. The
retinal blood vessels and the optic nerve, an extension of
the brain, can be seen. Because this is an area where
blood vessels and portions of the brain can be seen, it is
very valuable in helping to diagnose many disorders that
can affect the entire body. Once the examination is
complete, your child may be prescribed glasses. Treatment
for other problems may also be addressed.
Thankfully, most of the pediatric
patients you will see in the course of a week will have far
less dramatic situations for you to deal with than those
listed above. But remember, getting that first pair of
glasses can be a very harrowing experience for a child. So
don't forget to reassure them that they look great! Have a
great month gang and remember, take care of your patients
and send the customers to the other guys!
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Paul R. King, ABOC/NCLEC LDO
is an independent consultant specializing retail optical
laboratory
and sales training and also works as an optician for
Tri-State Vision in Cincinnati, Ohio
asktheking@ECPmag.com |
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