A child eye is different from adults, because it’s a growing eye. It undergoes series of developmental changes. Therefore, it is important to identify and treat the eye conditions at an early age as to achieve the best quality vision in them.

Dr. Kruti Shah is specialised in paediatric ophthalmology and is abreast with all latest technology and skills to give the best possible treatment to the child.

Refractive errors correction & Control of myopia progression

It is condition in which, the parallel rays of light entering the eye do not get focused on retina. Therefore, the child has to wear glasses to get clear vision. Refractive error can develop as early as infancy. So, it is ideal to get the child’s routine eye check-up as early as 2-3years of age, followed by 5 years or when he starts school and then annually.

A test called ‘cycloplegic retinoscopy’ is mandatorily done in children to measure their glass power, as it is more accurate and objective method of testing. This test also helps to derive an accurate measurement in preverbal and preschool children.

Myopia progression

The prevalence of myopia in India has significantly increased over the last 2 decades. The myopic power in a child is also seen progressing in their growing age. This can affect the retina

There are various modalities available by which you can reduce the progression if not stop the progression, like-

• Environmental modifications
• Eye drops – atropine with different concentrations
• Special glasses
• Contact lenses

You can discuss with the doctor, the best suited modality for your child.

Amblyopia (Lazy eye) treatment:

Lazy eye is a condition in which the child has poor vision in one or both eyes due to the uncorrected refractive error or squint or due to certain eye disorders like cataract, corneal opacity etc

It is very important to start the treatment at an early age to achieve better results.

Treatment options include:

occlusion therapy/ patching/ dichoptic therapy/ vision therapy

Squint Management

The misalignment of two eyes is called a squint / strabismus. It may be present from birth or may be acquired later in life. It is a myth that squint cannot be corrected.

Why squint should be corrected? – because there is

• Loss of binocular vision (inability to use both eyes together)
• Loss of stereoacuity (3 D vision)
• Decreased vision in the squinting eye (amblyopia / lazy eye)
• Abnormal head posture (head tilt or face turn)
• Diplopia/ double vision
• Negative psychosocial and emotional impact due to poor cosmesis.

Squint treatment-:

Squint can be corrected at any age. The earlier it is corrected; the better quality of vision is achieved. There are various options to correct squint depending on its type and grade-

Squint Surgery: There are total 6 extra ocular muscles in each eye. Squint surgery is performed on these muscles. There is a thorough squint examination done before surgery for measuring the amount of squint. Depending on type and amount of squint, we decide the number of muscles and type of muscles to be operated on.

Squint surgery cannot be done by laser. All across the globe it is done with the help of sutures. It is a relatively a safer surgery with minimal risk of complications

The type of anaesthesia used is

Local anaesthesia – for adults
General anaesthesia – for children.

Other Treatment Modality

• Spectacles
• Prism glasses
• Patching / occlusion therapy
• Exercises – home based & office based.
• Botox injections

Nystagmus (Shaky Eyes)

Nystagmus is an involuntary, rhythmic to and fro movement of the eyes. It may be present from birth or acquired later in life It can be seen in children and adults. The nystagmus can be caused by retinal diseases, vision deprivations or brain disorders

Treatment option includes-

eye medications, systemic medications, specialised glasses, contact lenses, surgery.

Paediatric cataract

Cataract can develop in neonates, infants and toddlers. It may affect one eye or both the eyes. There can be many causes for its development like metabolic diseases, infection& sepsis, genetic disorders, trauma, medications or idiopathic.

Treatment:

Cataract should be operated as soon as it is noticed in the child to prevent permanent loss of vision, squint and other sequale The intraocular lens may be put in the same sitting or at later date. Use of glasses and contact lenses is common post cataract surgery in children.

Paediatric Glaucoma

Glaucoma is defined as the raised intraocular pressure of the eye causing damage to the optic nerves and thus decreasing the vision. It is multifactorial.

Symptoms include:

• Watering of eyes,
• Increased size of cornea
• Photophobia

Treatment:

The mainstay of treatment is surgery. Followed by correction of refractive errors, lazy eye, squint if any Regular monitoring of eye pressure is mandatory.

Blocked tear duct treatment

Watering from the eyes of a child is most commonly caused due to blockage of nasolacrimal duct / tear duct that drain tears from the eye to the nose.

This is usually present since birth. It may affect one eye or both the eyes.

Treatment –

usually massage + eye drops are given till 1 year of age. If it does not resolve with that a procedure called lacrimal probing is done. If still no improvement surgical procedure called dacryocystorhinostomy is done.

Ptosis correction

Drooping of the eyelid is called ptosis. It may be present since birth or acquired later. If not treated the child may develop:

• Poor vision (lazy eye) in the eye
• Spectacle power (astigmatism)
• Visual field defect
• Negative psychosocial and emotional effects

Treatment-

Surgery is the mainstay of treatment. Depending on severity, your doctor may advice you the wait time to the surgery.

ROP Screening:

Retinopathy Of Prematurity is a condition in which the developing retinal vessels of preterm baby is damaged which can severely compromise the vision if not treated at right time.

ROP screening is recommended in preterm:

• with gestational age ≤34 weeks or
• with Birth weight≤ 2000gms or
• with Gestational Age ≥34 weeks with various risk factors like sepsis, poor postnatal weight gain, respiratory distress etc

Treatment options

Monitoring, Intravitreal injections, Lasers, Surgery