CHILDREN'S EYE PROBLEMS:

The most common of the problems seen in the eyes of children, other than nearsightedness, are those related to lazy eye difficulties, muscle weakness and turns of the eye. Some of these are present at birth while others become evident only later on. Proper diagnosis and management are critical to the development of clear vision which must be established during the first few years of life.

Crossing of the eyes is a very common problem in childhood. In many cases this is an illusion caused by the wide and flat bridge of the nose which has not yet developed. True crossing, however, may be present at birth or develop during the first year or two of life. The illusionary "crossing" will always disappear as the child grows since it is not a real crossing in the first place. True crossing is not outgrown. If you think your child has crossed eyes, it is important to have your child examined promptly.

With an eye persistently crossing, the vision may decrease in that eye, a condition known as amblyopia or lazy eye. A child may also have a lazy eye without it being crossed.  If one eye sees well and the other does not, and if there is no crossing of the eye, you may have no clue that there is even a problem in the first place.  By the time it is discovered during the vision screening tests given when your child is 5 years old and in kindergarten, it becomes significantly more difficult to treat.  For this reason, even if you have no suspicion of any problem, we suggest you have an initial comprehensive examination your child's eyes by the end of the first year of life.  Early amblyopia (lazy eye) can be detected and treated. If you suspect that there might be some problem, let us examine your child at that time, no matter how young.  We routinely examine even newborn infants where there may be a suspected problem.  Being old enough to read an eye chart in not necessary.

READING and LEARNING DISORDERS

There are many children who have difficulty reading, reverse their letters or are generally slow at learning. We often receive referrals from pediatricians for complete evaluation of these children's eyes. Certainly this is recommended, for if a child cannot see well, learning may be impaired.  However, true learning disabilities such as dyslexia are virtually never based on eye disease.  Furthermore, they are NOT improved by the so-called eye muscle exercises that have become popular in recent years. Eye muscle problems do not create learning difficulties. Children do not reverse letters (such as b and d) because of eye problems. Both the American Academy of Pediatrics and the American Academy of Ophthalmology want you to know that these eye exercises are of no value.  If your child has learning difficulties, the problem should be left to the learning disabilities specialists and the educators, NOT eye care providers who prescribe eye exercises.  Please don't hesitate to talk to our specialists about this important subject.

REFRACTIVE PROBLEMS:

Far in excess of any other childhood eye problem is simple nearsightedness, technically called myopia.  This is not really a disease but rather a continued growth of the eyeball's length. In other words, the eyeball is too long from the front to the back so that the image which is projected onto the retina is out of focus.  See the two photographs below.  The left hand picture shows the "normal" eye in which the image is focused exactly on the retina.  The right hand picture shows the myopic eye in which the image comes to a focus before it reaches the retina.  Then, as the light rays continue back until they reach the retina,  they are out of focus again.   All this happens because the eye is too long, and the retina is too far back from the lens.  

                   
             The "normal" eye (emmetropic eye)                The nearsighted eye ("myopic" eye)

Nearsightedness can be present during the first few years of life but more commonly starts during the school years. Children often do not complain about blurry vision. It is not until a parent or teacher notes that the child is squinting to see the board in school that the problem becomes evident. Glasses are generally the solution. These days, many children, even younger ones, are being fit with contact lenses as well. Our office can perform the necessary examination of your child to make certain that the appropriate prescription for glasses is available. In fact, our optical shop can even make up the glasses for you, often within the same day. If contact lenses are desired as an option, we can perform the fitting and take care of the follow-up as well.  

Farsightedness, or hyperopia, occurs when the eyeball is too short, and the image strikes the retina before it has had a chance to become in focus.  In other words, the retina is too close to the lens.  The focal point of the light rays is further back than the retina.  

 
The farsighted or "hyperopic" eye

OTHER PROBLEMS:

In addition to the simple refractive errors noted above, there are many other types of problems that may be seen.  Congenital eye disorders including cataract, incomplete development or anatomic irregularities are problems seen by pediatric ophthalmologists.  Some of these conditions may be associated with other developmental disorders, and it is not uncommon that the ophthalmologist (who is an M.D.) may be the one to diagnose certain systemic conditions.  

Prematurity,  with the need for supplemental oxygen for the newborn, can be associated with retinal problems.  This is one reason why we examine the eyes of virtually all preemies, and in the (unusual) circumstance of  finding this so-called retinopathy of prematurity (often called ROP), appropriate treatment may be begun at a time where it can be effective.

Children certainly can have many of the same problems as adults including simple "pink eye" ( infectious conjunctivitis), allergy problems, cataracts or glaucoma. The eyes may be involved in other systemic illnesses of children such as juvenile rheumatoid arthritis or childhood diabetes.  Remember that ophthalmologists are physicians who have completed medical school and who have  training not only in eye problems but also in other bodily illnesses in which the eyes may be involved.  Within our practice, Drs. Turtel and Pardon are fellowship-trained subspecialists in pediatric ophthalmology.

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