Pediatric Ophthalmology

the care your child needs

Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions, and are not always able to be patient and cooperative during a medical examination. At Shiv Jyoti Eye Hospital, our ophthalmologists know how to examine and treat children in a way that makes them relaxed and cooperative.
Common signs that your child needs attention

Undetected vision problems can impact your child’s performance both in and out of the classroom. Therefore, it’s important to understand eye health so you can recognize the signs that your child may have a vision problem and possibly get it treated.

Here are a few signs that indicate your child may be experiencing vision problems and need glasses:

Squinting

Squinting may be a sign that your child has a refractive error or glasses, which affects how well the eyes focus on an image. By squinting, your child may be able to temporarily improve the focus and clarity of an object.

Tilting head or covering one eye

Your child might cover one eye or tilt his or her head to adjust the angle of vision in an attempt to increase clarity. This might be an indication that the eyes are misaligned or that your child has amblyopia , also known as lazy eye, which is one of the most common eye disorders in children and it is mostly detected at a later stage in life unless the parents get the eyes checkup done on a regular basis.

Sitting too close to the television or holding hand-held devices too close to the eyes

All of these are all possible signs of poor vision. People who have myopia, or nearsightedness, have clear vision at close range and poorer vision at a distance. Bringing an object closer makes an image bigger and clearer.

Rubbing eyes excessively

Excessive eye rubbing may indicate that your child is experiencing eye fatigue or strain. This could be a sign of many types of vision problems and conditions, including Keratoconus (change in the shape of cornea from round shaped to cone shaped).

Complaining of headaches
or eye pain

If your child complains about eye pain or headaches at the end of the day, he or she may be overexerting the eyes in an effort to increase focus of blurred vision.

Having difficulty concentrating on school work

Because children need to quickly and accurately adapt their visual focus from distant to near and on a number of different objects ranging from chalkboards and computers to textbooks and tablets, vision problems may manifest as a lack of focus on schoolwork.

Cataract & Your Child

Adults are most likely to develop cataract. However, they can also affect babies and young children. It is important to treat cataract as soon as possible because the eyes are still developing. Putting off treatment can increase the risk of getting lazy eyes and gradual decrease in vision.

If you have a family history of childhood cataract, your child may be at a greater risk of either getting congenital cataract or juvenile cataract.

Congenital Cataract
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  • Found in newborn babies
  • The main causes of congenital cataract are genetic disorders (like Down’s Syndrome) and infections during pregnancy (like measles and rubella).
Juvenile Cataract
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  • Develops in toddlers or young children
  • The main cause of Juvenile Cataract is diabetes at an early age, eye trauma, infection by a parasite, or galactosaemia (a condition where the sugar in milk cannot be broken down by the body).
Symptoms of Cataract in Children

Cataract symptoms may be difficult to notice in young children. If your child has a hard time recognizing or following people, it may be a warning sign that something is wrong. Listed here are some of the signs of Cataract among children:

White reflex as noticed by parents

Poor vision

Rapid, uncontrolled eye movements (may look like shaking)

Searching eye movements

Treatment for Cataract of Children
  • Cataract surgery is the only treatment for this disease. The earlier the surgery, the better the outcome. During surgery, your child will be put under general anaesthesia, meaning your child will be asleep so they don't feel pain. However, the child has to be nil by mouth atleast 12 hours prior to the surgery. The surgery is very quick and safe. In most cases, it can restore clear vision. In all cataract surgeries, the cloudy lens is removed. However, the doctor may then choose that your child wears glasses or contact lenses after the lens is removed or implant an intraocular lens (IOL) in the eye in place of the cloudy lens
  • Your child’s doctor will decide which type is best based on the age of the child, type of cataract or any other pre-existing eye diseases.
  • 2-3 days Hospitalization for healing from general anesthesia
  • Regular Eye Checkups depending on the severity
  • Reduce injury risk by avoiding outdoor activities for 4-6 weeks
  • Regardless of the type of surgery, wearing prescribed glasses
Lazy Eye & Your Child

Lazy eye is an eye condition where one eye is weaker than the other. It occurs in children and usually affects only one eye. This “lazy” eye looks normal, but has poorer vision. Children with lazy eyes have a weaker connection between the affected eye and the brain. This causes one eye to see a lower-quality image than the other. Over time, the brain starts to ignore the blurrier image, so the lazy eye becomes even weaker. In certain rare cases both eyes may be affected since early age.

How to determine if your child has a lazy eye?

Lazy eye is closely linked to eye development. So, the younger the child, the greater the risk. Children under the age of 8 are at the greatest risk for developing lazy eye. Lazy eyes can be hard to notice. Visit your child’s eye doctor if their eyes wander or point in different directions. Regular vision checkups are also important if:

You have a family history of weak eyesights

You have a family history of lazy eye

Your child is a premature baby

Your child has had cataract

You notice squint i.e. eyes are crossed or point in different directions

You see a difference in refractive power (spectacles) between the eyes

Pathologic droopy eyelid, also called ptosis, may occur due to trauma, age, or various medical disorders

You find difficulty in reading subtitles on TV or signs outdoors

You can check for lazy eye by covering each eye one at a time. If you cover their good eye, but not their lazy eye, they will become reluctant. This could indicate that one eye is weaker than the other.

Treatment of Lazy Eye

The best treatment is to make your child use their lazy eye. Patch therapy is a treatment where one eye is covered to encourage the use of the weaker eye. It is most effective in helping young children strengthen an under-developed eye. The earlier the treatment begins, stronger the weaker eye becomes. This is commonly used to treat lazy eye and squint. In both cases, one eye is weaker than the other. The patch covers the good eye, forcing the child to use the weaker eye. In this way, the weaker eye becomes stronger. This patch therapy is effective for all the children under age 12 years.
Revital Vision Therapy

We at Shiv Jyoti Eye Hospital provide this therapy. The only FDA approved therapy for ADULT AMBLYOPIA (Age 9+) RevitalVision enables significant vision improvement in amblyopic adults, when patching therapy is no longer effective! Clinical studies demonstrated that the vision improvement gained with 20 hours of RevitalVision in adults was equivalent to 500 hours of patching in children.

  • Ease in reading subtitles on TV
  • Ease·in reading signs on the street
  • Recognizing faces from distance and seeing better at night
  • Improved stereo and binocular functions
Squint & your child

Squint is a condition where the eyes point in different directions. It is most common in young children. While one eye looks straight ahead, the other eye may turn up, down, in, or out. This may occur constantly or from time to time. If untreated, squint can cause Lazy Eye and your child can start to lose vision in that eye. Luckily, visual loss can be prevented if treatment is started from a young age.

Causes of Squint

Family history of squint

Weak eye muscles

Blurry vision from cataract, glaucoma, refractive errors, etc.

Eye injury

Treatment of Squint

Shiv Jyoti Eye Hospital has the best treatment possible for squint. Early treatment is the only way to prevent permanent visual loss. Most treatments will require frequent follow-up for the best results. If the squint is detected later in life, it may not be possible to improve vision. However, surgery can be used to straighten the eyes so they look normal.

When the squint is caused by uncorrected refractive errors, wearing spectacles will correct the same. Patients may develop vision after squint surgery, only if treated in early stages else, chances of recovery in visual loss is difficult. Hence, one might have to opt for cosmetic surgery in later stages.
When the squint is minor and occurs transiently, specific exercises can help to strengthen the eye muscles there by the squint.
Surgery is recommended to straighten the eyes, so that they point in the same direction.
Patch therapy is a treatment where one eye is covered to encourage the use of the weaker eye. It is most effective in helping young children strengthen an under-developed eye. The earlier the treatment begins, stronger the weaker eye becomes. This is commonly used to treat lazy eye and squint.
Revital Vision treatment is used in later stages to improve the vision to some extent.
Retinopathy of Prematurity & Your Child

Having abnormal blood vessels in the eye caused due to premature birth or low birth weight leads to retinopathy of prematurity (ROP). As the retina develops, blood vessels grow from the center outward. Process completion typically occurs a few weeks prior to delivery. In premature babies, however, it is incomplete. It is impossible for ROP to occur when blood vessels grow normally. Alternatively, as the baby grows, blood vessels branch abnormally leading to ROP.

As many as 80 - 100% of newborns weighing less than 900 grams or having a gestational age of *25 weeks are at risk for ROP in India, whose incidence ranges between 38 and 51.9%. The incidence has increased as NICU care has improved. There has been no proportionate increase in awareness among medical professionals. Children whose blindness could have been prevented are going irreversibly blind in the absence of a comprehensive screening strategy. Such childhood blindness imposes a heavy socio-economic burden.

Is your child at risk for ROP?
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You should have a retinal examination for your child in case your baby is under 2000 grams at birth or when your baby is born within 36 weeks of gestation.
Prematurely born babies with severe perinatal illness (RDS, sepsis, blood transfusions, IVH, apneic episodes, etc) are at higher risk of ROP.

When should you consult a doctor for ROP?
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As a parent you must follow a 30 Day Strategy‘ in very low weight babies ( <1200 gm) or in babies with very low gestational age ( <28 weeks).
A retinal exam should be performed on or before the 30th day of life. If possible, do it as soon as possible after the birth of the baby.

What if your baby has ROP?

The treatment plans include lasers, intravitreal anti-VEGF injections, or surgery to reduce the chances of unfavourable disease outcomes. ROP can resolve on its own in mild forms without any active intervention. However, if a severe form of the disease is not yet in stage 3, then there may be no need for medical treatment. In the fourth or fifth stage of the disease, surgical intervention is needed.

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