Pediatric Ophthlamology

Ophthalmology addresses the physiology, anatomy and diseases of the eyes. Pediatric ophthalmology focuses on the eyes of children. Pediatric ophthalmologists examine children’s eyes to see if they need corrective lenses or other treatments to improve their vision.

Training for Pediatric Ophthalmologists

Pediatric ophthalmologists graduate from medical school just like other types of doctors, but they decide to specialize in children’s eye health. In addition to studying about the structure and disorders of the eyes, these specialists undergo additional training in examining children. They go to extra lengths to make sure that children feel safe and comfortable within the medical setting and with the sensitive proceedings of an eye exam.

Benefits

Vision develops neurologically until a child is about 12 years old. Early detection of problems can make them easier to solve during these crucial years of growth. For example, diagnosing and treating strabismus — commonly known as being cross-eyed — in a young child ensures she has the best chance of developing and maintaining good vision. Nearsighted children will do better in school once they have glasses. Pediatric ophthalmologists also address diseases elsewhere in the body that affect children’s eyes.

What to Expect During Your Child’s Visit

Expect your first visit to be longer than your average doctor’s appointment. Allow at least 90 minutes for a thorough exam. If the pediatric ophthalmologist orders special testing, the appointment could take even longer.

The doctor will ask about your child’s health history and any eye-related concerns you might have. Be sure to bring your insurance information and a list of any medications your child takes. Notify the doctor of any allergies.

Pediatric ophthalmologists have different ways of testing children’s eye health, depending on their ages. These may include looking at pictures and reading eye charts. The doctor will check each eye separately as well as both together, and test muscle function around the eyes. Expect the ophthalmologist to use an ophthalmoscope, an instrument that shines a powerful light into the eyes.

Your child’s eyes will probably be dilated with eye drops so the doctor can check how the pupils react to light, and to measure the eye’s focusing system. These drops can sting and cause blurry vision. Reassure your child that this is temporary, and necessary to let they doctor see inside his or her eyes.

Once testing is through, your pediatric ophthalmologist will recommend treatment, if needed. This could include exercises, glasses, medications or surgery.

Pediatricians and family doctors should check children’s vision as a routine part of an examination. If a doctor has referred your child to a pediatric ophthalmologist, call us today so we can optimize your child’s developing vision.

Learning-Related Vision Problems

Learning disabilities may include dyslexia, math disorder, writing disorder, auditory processing deficits, or visual processing deficits. Although each child with a learning disability is unique, many also have associated visual problems. Addressing these vision disorders may alleviate some symptoms of learning disability.

How Are Learning Disabilities Diagnosed?

Most often, a teacher recognizes a child falling behind in a particular subject area and recommends that the child receive further assessment. A school psychologist may conduct tests to see if the child has processing difficulties or significant problems learning certain types of information. Although this type of assessment may include a cursory vision screening, it is important to receive a comprehensive vision exam to rule out vision problems that may contribute to learning difficulties.

Learning Disabilities and Vision Problems

Children with vision problems often report having difficulty with reading, writing, or written math problems. All of these require accurate close vision, making them challenging for people with focusing problems. Problems in the following areas may have a negative impact on learning, leading to a learning disability diagnosis:

  • Poor binocular vision. The eyes must work together properly to blend information from each eye into one coherent image.
  • Accommodative dysfunction. Focusing problems can lead to blurred vision or the perception that words are shimmering on the page.
  • Eye tracking dysfunction. Accurate reading requires the eyes to move back and forth skillfully; eye movement problems may impair this ability.
  • Visual-motor integration. Integrating visual information with motor output is essential for eye-hand or eye-body coordination. Poor visual-motor integration may result in learning difficulty.
  • Visual processing deficits. Poor visual memory, ability to attend to visual information, or ability to identify visual objects may make reading and writing challenging.

Vision Therapy for Children with Learning Disabilities

Special corrective lenses may improve some eye problems associated with learning disabilities. In many cases, doctor-supervised vision therapy can correct visual problems. Vision therapy might include viewing information through prisms, wearing a special eye patch, doing puzzles, practicing eye movements, or related exercises.

Over time, vision therapy can retrain the eyes to work more effectively with the brain. After a course of vision therapy, many children with learning disabilities experience less frustration with learning as well as improved academic performance.

Accommodative Dysfunction

Simply put, accommodative dysfunction means that the eyes have difficulty focusing properly. Studies suggest that between 2 and 17% of children may suffer from accommodative dysfunction. The nature of this disorder means that it sometimes goes unnoticed in standard vision screenings conducted at school. Thus, it is important that parents schedule a comprehensive eye exam for children, particularly if an issue with focusing is suspected.

What Is Accommodative Dysfunction?

In kids with normal vision, each eye functions independently, while the brain ties visual information to create a cohesive visual image. The brain directs eye movements, allowing a person to focus on nearby objects as well as those that are far away. These calculations are done subconsciously, meaning that it requires no effort to switch from near vision to distance vision.

For people with accommodative dysfunction, however, the eyes and visual system do not work together appropriately. Particularly when trying to look at nearby objects, the eyes do not focus properly. A variety of symptoms may result, including:

  • Blurring of nearby objects
  • Visual discomfort, such as soreness or strained eyes
  • Headaches (often in the front or sides of the head)
  • Sensitivity to glare
  • Dizziness
  • Difficulty sustaining attention on nearby objects, such as during reading
  • Rapid fatigue
  • Moving work closer or farther away, or tilting the head to improve focus

Having accommodative dysfunction makes it difficult and unpleasant to do close-up tasks such as reading. As a result, some children are incorrectly diagnosed with a learning disability.

Diagnostic Procedures

An optometrist can conduct a comprehensive eye exam to diagnose accommodative dysfunction and rule out other possible explanations for symptoms. After taking a thorough patient history, your eye doctor will test visual acuity and the performance of your eye muscles in controlling the eyes. You may be asked to follow a small object with your eyes, view objects through a prism, or perform other eye tests.

Treatment for Accommodative Dysfunction

Using reading glasses for close work is a common way to correct focusing problems. However, vision therapy is typically necessary to retrain the eyes to work well together. Vision therapy includes in-office appointments as well as at-home exercises. The purpose of this therapy is to improve the speed and accuracy of a typical focusing response, making the eyes used to working together to focus on nearby objects.

Convergence Insufficiency

Convergence insufficiency is a relatively common eye condition that is typically diagnosed in childhood. A study of two large optometry clinics found that 17.6% of children who received vision exams had convergence insufficiency. As this disorder may cause difficulty focusing on written pages, some children with convergence insufficiency are actually diagnosed with learning disability rather than a vision problem. This highlights the necessity of receiving a comprehensive eye exam that tests for this vision problem.

What Is Convergence Insufficiency?

Convergence insufficiency is an eye disorder in which the eyes do not work together properly when focusing on a nearby object. In general, looking at a close object causes the eyes to turn inward, allowing them to focus. If the eyes drift outward, this prevents accurate focusing and is labeled convergence insufficiency.

Symptoms of convergence insufficiency typically manifest when reading, writing, or doing other work that requires focusing on a nearby object. Common symptoms include:

  • Headaches
  • Double vision
  • Eyestrain
  • Difficulty concentrating
  • Difficulty reading. Many patients report that the words seem to swim on the page or blur.
  • Squinting or closing one eye when doing close-up work.

Diagnosis of Convergence Insufficiency

Unfortunately, convergence insufficiency is commonly missed on basic eye exams such as those performed as screening tools at school. A child may seem to have 20/20 vision but still suffer from convergence insufficiency and its associated symptoms.

An optometrist can diagnose convergence insufficiency during a comprehensive vision exam. First, the eye doctor will take a history of signs and symptoms associated with this disorder. Next, the optometrist will conduct a thorough vision exam to detect nearsightedness or other vision problems. Finally, the eye doctor will test the ability of the eyes to focus on nearby objects. This may involve asking the patient to hold the eyes together to focus on a small object or to read through a prism.

Treatment Options

Unlike many other eye problems, convergence insufficiency is not easily treated by eyeglasses (although reading glasses with built-in prisms may be prescribed). Instead, vision therapy exercises teach the eyes how to converge to focus accurately on an object. Your eye doctor can recommend exercises to perform at home or in the office. This may include focusing on a small letter as you move it toward the bridge of your nose, improving the ability of the eyes to turn inward to focus.

Ocular Motor Dysfunction

Parents are often aware of the need to screen children for nearsightedness or farsightedness, but fewer know about other pediatric vision problems. Ocular motor dysfunction is a condition that often manifests in childhood, although adults may also have this disorder. Because ocular motor dysfunction causes serious disruption of everyday abilities such as reading, it is important to receive a comprehensive eye exam to test for this condition.

What Is Ocular Motor Dysfunction?

Six muscles control the movement of the human eye. These tiny muscles work together to allow the eyeball to move up, down, left, and right. In most people, the brain signals the muscles to move the eyes without our conscious awareness. For people with ocular motor dysfunction, however, the eyes do not work together properly to contribute to smooth, fluid eye movements.

There are several movements necessary for proper eye function. Smooth pursuits involve following a moving object accurately. Saccades are often used when reading or tracking information; they appear as the eyes jumping back and forth very quickly. Additionally, the eyes must be able to move inward and outward to change the point of focus. Disruption in the effectiveness of eye muscle activity may significantly impair everyday abilities, resulting in the following symptoms:

  • Losing one’s place or omitting words when reading
  • Difficulty smoothly tracking or following moving objects
  • Academic difficulties
  • Difficulty sustaining attention on a task
  • Poor coordination
  • Vertigo
  • Nausea and motion sickness

If your child exhibits any of these signs, it’s important to schedule a comprehensive eye exam promptly to diagnose ocular motor dysfunction or rule out alternative explanations.

Diagnosis of Ocular Motor Dysfunction

An optometrist can diagnose ocular motor dysfunction by conducting a variety of tests. Your eye doctor may ask you to visually follow an object while keeping your head still. This allows the doctor to identify tracking difficulties. The doctor will also look for reduced accuracy of saccades (the quick back-and-forth eye movements), inability to follow objects in a particular sequence, and need to move the head or follow a finger to follow along on a page.

Treatment for Ocular Motor Dysfunction

Your eye muscles are just like other muscles in your body; exercising them can help them perform better. As a result, vision therapy is one of the best treatments for ocular motor dysfunction. Vision therapy allows you to practice new skills to strengthen eye muscles’ ability to work together effectively.