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FAQ'S

THE CHILD'S EYE

Although structurally the child’s eye is similar to that in adults, the visual pathways continue to develop in a child. Hence, any obstruction to vision at a young age can cause permanent damage to the system that cannot be corrected later. 

Since small children often may not notice such changes, it is very important that all children undergo a screening eye exam at an early age. The best time points for screening are at birth by the neonatologist, at year 1,3 and 5 by an ophthalmolgist.



A common problem is a refractive error –high myopia, hyperopia, or astigmatism may exist in one or both eyes, especially if these are also present in the parent. These may be associated with misalignment of the eyes, or squint, which can however, also exist by their own.

Other problems can be structural – cataracts, glaucoma, corneal or retinal disease, and these may be present from birth. A rare but a very serious problem is a tumor of the retina – retinoblastoma. If the normally black pupil appears white (white reflex) in the eye of a child, please arrange for an immediate eye examimation. Children born premature have a high risk of developing sight threatening Retinopathy of Prematurity and other problems like refractive errors ( short or long sight ) and squints.



Amblyopia, also known as ‘lazy eye’, is reduced vision not correctable by glasses or contact lenses . The brain,does not fully acknowledge the images seen by the amblyopic eye. This may be due to visual deprivation due to an obstruction in the passage of light to the back of the eye (eg) Cataract or may be due to a squint where in the squinting eye gets ignored by the brain. It can also occur in an eye that is more short or longsighted than the fellow eye.

This almost always affects only one eye but rarely both eyes can be involved. A simple vision screening test can detect this condition, and should be performed in all children since amblyopia is best treated in early childhood prior to reaching the age of 7-8 years.



Strabismus or ‘squint’ is a condition in which a child cannot align both eyes simultaneously. One or both of the eyes may turn in, out, up or down. A squint may be constant or intermittent (turning only at certain times ). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment. Children do not outgrow strabismus! A child with strabismus faces a number disadvantages in life ranging from inability to have binocular vision , stereopsis and depth perception on one hand to socially being ignored by peers and this could lead to the development of an inferiority complex . Further into adulthood there is evidence to suggest that they will have only a 1 in 10 chance of being successful in an interview setting.



Nystagmus is an involuntary rhythmic shaking or wobbling of the eyes. The eyes move constantly in various directions, although horizontal movements are the most common. The presence of nystagmus in a child is often an indication of visual problems. Treatment will depend on the cause. Sometimes, the presence of a nystagmus can indicate neurological dysfunction, and rarely, it can be a side effect of medication .

A child may adopt an abnormal head position to minimise the nystagmus in order to be able to see clearly. The constant head turn or tilt can affect the development of the cervical spine adversely. By performing surgery to change the ocular position an improvement in the abnormal head position can be achieved.



Children may not complain of problems, and a detailed, routine examination is needed. Parents may notice peculiar head posturing, constant side-to-side eye movement, squinting, sitting very close to the TV, or a white reflex in the pupil. The eye examination includes assessment of vision, special tests for stereopsis, (ability to use both eyes simultaneously), eye alignment and thorough examination of the front and back of the eyes.



If a refractive error is detected early, simply providing the correct glasses will correct the problem. If detected late, and one or both eyes are already ‘lazy’, then in addition to glasses, other measures may be required – these include patching or occluding an eye to force the child to use the weaker eye, thereby ‘strengthening’ it. If there is a squint, occasionally glasses may be corrective, although quite often surgery may be required. For other problems, like cataract, glaucoma, corneal and retinal disease, the doctor will discuss in detail the options for treatment. These could include the use of medical treatment or surgery. If a retinoblastoma (eye tumor) is present, early treatment is necessary to save the eye and life of the child. 



Your child should have his or her first eye exam at birth prior to the discharge from nursery . This can be done by the pediatric team who will look for the presence of the red reflex that would suggest a clear ocular media for good visual development.The next eye examinations will be at the ages of 1,3, and 5 years by an Ophthalmologist. Thereafter, your child should receive a comprehensive eye exam at least every two years.



Tests for assessment of visual function according to age of a child

Colour Vision tests

Prism Bars for Squint Assessment

Assessment of stereopsis

Portable Slit lamp examination 

Tonopen intra ocular pressures if Glaucoma is suspected

Indirect ophthalmoscopy

Cycoplegic Refraction 



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