Pediatric Ophthalmology

Pediatric ophthalmologists focus on the development of the visual system and the various diseases that disrupt visual development in infants and children. Pediatric ophthalmologists also has expertise in managing eye diseases that affect children. A pediatric ophthalmologists is a super-specialist eye doctor who is specifically trained and qualified to manage diseases affecting the eyes in children and is experienced to perform complex eye surgery in the young population. With the growth in knowledge and management options more and more pediatricians and ophthalmologists are recognising this specialized field of eye care and referring children with eye diseases. Understanding eye problems in children is more complex than adults as children cannot explain their symptoms and are not cooperative for examination. Additionally, there is a need for special equipment and vision charts for a proper eye checkup in the infants, toddlers and younger children. Most of all, proper eye evaluation in children requires keen observation which comes from special training and experience. Eye diseases in children are different from eye diseases in adults and present in a unique manner. Children may not be able to tell they are having eye trouble but signs such as reading from close distance, watching TV from close, have a face turn in one direction, head tilts, squinting of the eyes, frequent rubbing of the eyes, red eyes and difference in position of the eyelids point towards an eye problem. Pediatric ophthalmologists are trained to recognize and decipher the eye disease based on these presentations. Pediatric ophthalmologists typically also manage adults with eye movement disorders (such as nystagmus or strabismus) due to their familiarity with strabismus conditions.

It is very important to treat eye diseases in childhood itself. This is because many of these diseases may lead to a permanent vision impairment in adulthood if left untreated in childhood, even if they are treated in adulthood. If there is any eye disease that impacts the normal visual development in childhood such as presence of refractive error, squint, cataract etc, it leads to amblyopia or lazy eye development. This can only be treated in childhood as long as the brain is developing. After the brain has developed (usually by 7-11 years of age), it is not possible to improve vision any further. Another reason to manage eye disease in childhood is that if a child becomes blind or has severe vision loss, then there are many years of productive social and economic life which get impacted. This causes enormous strain on the child, family and society. Early treatment of many conditions can prevent this. Another reason is that many conditions associated with blindness in children are also causes of child mortality (e.g. premature birth, measles, congenital rubella syndrome, vitamin A deficiency etc.). If these are recognized early, one may save the sight and life of the child.

Since blindness in children is relatively rare, accurate prevalence data are difficult to obtain, because very large samples are required for population-based prevalence surveys. Some data are, however, available from population surveys. These show that in India, the prevalence of childhood blindness is around 0.17% with the major causes including treatable refractive error (33.3%), vitamin A deficiency (8.3%), amblyopia (8.3%), congenital eye defects (16.7%) and retinal degeneration (16.7%). [Dandona R, Dandona L. Childhood blindness in India: a population based perspective. The British Journal of Ophthalmology. 2003;87(3):263-265.] If all forms of childhood eye disease are considered, nearly one third children are affected. The eye diseases include refractive errors 22%, squint 2.5%,color blindness 2.3%, vitamin A deficiency 1.8 % and conjunctivitis 0.8%. [Gupta M, Gupta BP, Chauhan A, Bhardwaj A. Ocular morbidity prevalence among school children in Shimla, Himachal, North India. Indian Journal of Ophthalmology. 2009;57(2):133-138.] In New Delhi, it has been seen that prevalence of myopia was 13.1% with only 24.7% wearing appropriate spectacles. [Saxena R, Vashist P, Tandon R, Pandey RM, Bhardawaj A, Menon V, et al. (2015) Prevalence of Myopia and Its Risk Factors in Urban School Children in Delhi: The North India Myopia Study (NIM Study). PLoS ONE 10(2): e0117349.] Globally, 23 million children have vision problems, 95% of which can be corrected if detected and treated early. Over 10% of these problems manifest in the age group of 0-4 years. 86% don’t have eyes examined before first grade and only 14% have their eyes examined before age 18. There is a need to create awareness and change these practices.