Pediatric Eye Diseases - Treat Them Before It's Too Late

January 01, 2015

It’s easy to observe a child’s body develop, but parents can’t readily tell if their child’s eyesight progresses as it should.This inability to “see” pediatric vision development only increases the need for parents to be vigilant.

Pediatric eye diseases are ailments with deadlines. There is usually a gradual, but steady progression before the damage becomes apparent and irreversible. Thus, it’s vital to have your eye doctor screen for diseases to catch them well before the deadline, while it’s still possible to intervene, halt, and correct.
This issue of Better Health features Dr. Sudarat Yaisawang, who specializes in pediatric ophthalmology. An expert in diagnosing and treating eye diseases in children, Dr. Sudarat knows and understands parents’ concerns about how eye disease can severely damage a child’s present and future quality of life. 


 Critical time for caring

Dr. Sudarat Yaisawang
Pediatric ophthalmologist

Children’s eye health has a key window from birth until eight or nine years old. “Children’s eyes remain highly vulnerable in this development period,” says Dr. Sudarat. “Diseases that degrade a child’s healthy eyesight need prompt treatment because once damage occurs, at some point, it cannot be corrected.”  
Dr. Sudarat explains that children’s vision develops very quickly during the first three to six months of life. That’s when the child starts to use both eyes simultaneously for color, three-dimensional perception, and distance estimation.
“In the first three months, babies’ eyes are not coordinated simultaneously, so they are not in alignment,” she says. “That’s why we can properly diagnose strabismus (abnormal alignment of the eyes) after three months. Further, the doctor needs to wait about six months to estimate what the child’s eyes would be like as anadult. Eyes reach full development at eight to nine years old.”

Common pediatric eye ailments

Common eyesight disorders in children include nearsightedness, farsightedness, and astigmatism. These problems likely have genetic causes and can start at a very early age, when the child cannot determine if he has abnormal eyesight. Parents, guardians and other concerned adults must observe their children’s behavior. Watch for glaring, narrowing of their eyes, needing to be very close to the object being looked at, or rubbing of their eyes often. Prescribing glasses is the usual treatment for these kinds of eye disorders, even before the child reaches one year.
Some factors that cause strabismus, or abnormal alignment of the eyes, include genetics and various eye disorders that weaken eye muscles, diminishing their ability to balance left and right eyesight.         

“Many people think that strabismus is not a serious concern and will go away by itself when a child grows up, or that it is only for cosmetic reasons and can be cured when a child gets older. That’s all wrong,” says Dr. Sudarat. “With one misaligned eye, the child will only use the good one. The unused eye grows weak, gets blurry, and develops into lazy eye.”

To treat strabismus, the doctor prescribes glasses to correct the condition if he finds that the child also has myopia, presbyopia, or astigmatism.         

Surgery is the common treatment in realigning the eyes to normal position.           

Patients with Amblyopia or lazy eye can only perceive clear vision in one eye. Children that suffer from this condition range from infants to eight-year-olds. Strabismus and neglected eyesight disorders, such as severe nearsightedness, farsightedness, or astigmatism cause most cases of lazy eye. The wider the gulf between the good eye and bad eye, the higher the chance that the child will only use the good eye and let the other go blurry.
“There are cases where children complain to their parents about blurry eyesight, (or not being able to see the blackboard), but the parents fail to take notice,” Dr. Sudarat says. “Then two or three years later, when doctors finally examine them at around eight to eleven years old, many have developed lazy eye.”

The name may sound lighthearted, but ophthalmology medicine considers lazy eye a severe eye condition because if left untreated, it results in permanent vision loss. But if caught when the child’s eyesight is still developing, doctor scan put a patch over the dominant eye or prescribe drops blurring its vision, allowing the weak eye to regain vitality.         

The weakening of eyelid muscles causes Ptosis at Birth. The condition occurs in either one eye or both. If in both eyes, children will lift up their faces to find a better angle of vision. If only on one side and the eyelid covers the pupil entirely, this can lead to amblyopia (lazy eye) because the child will stop using the diminished eye. Doctors may recommend surgery to rearrange the eyelids into a normal position.             

Retinoblastoma or retinal cancer ranks as the most severe pediatric eye disease. The most common symptom is white color in the center circle of the eye (pupil). The average age of children diagnosed with the disease is between one to three years old.             

Ensuring children’s eye health requires that parents take notice and deal with problems when they are treatable. They must closely observe their children’s vision development, get them regular checkups, and immediately report any symptoms. 


Screening: the most important task 

A child’s first screening should be at around three to six months old, and again at three or by the time he enters kindergarten. For childhood problems, doctors recommend another exam at six years old or when the child is about to start primary school. There is an exception, of course. If there’s a family history of eye disease, checkups should start earlier than usual.
Diagnosing pediatric eye disease is different from diagnosing adults,” says Dr. Sudarat. “Sometimes children can be uncooperative mostly due to their fear of pain or that the test is too complicated for them to understand. A three-dimensional perception test or visual field test where children need to answer for themselves might be beyond their ability. The doctor must find test techniques that are suitable for each patient.”
Even if the first screening has no anomalies, parents should still take their children for subsequent tests as scheduled because caring for eye health is a fundamental process to every child’s development. 


The next big threat to children’s eye health: Smartphones and Tablets


The Facts:           
  • Childhood shortsightedness has increased. Currently, 30 percent of Thai children under fifteen are shortsighted.*      
  • Children develop shortsightedness at a young age and it’s getting younger each year.               
  • Pseudomyopia from staring too closely at monitors is on the rise.        
  • Increased sensitivity to light from smartphone and tablet monitor-related conditions such as dry eye, red eye, and teary eye leads to children’s inability to tolerate natural sunlight.
The solution: Limit children’s tech usage time. Don’t let them stare at the monitor for hours at a time. Device users should take a break approximately every 30 minutes to one hour. Very small screens or using any gadget in dim ambient light make children glare into the screen even more intensely, which can lead to dry eye, inflammation, and a host of other problems.

* Data from Bureau of Information, Ministry of Public Health



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