Pediatric eye evaluation is a separate and specialized field of ophthalmology. One must always keep in mind that a child is a growing organism, constantly changing. That is also true for its optical system. Vision is not a fixed function of the optical system and the brain. Usually, up to the age of 8 years old (if not earlier) we “learn” how to see well and clearly. Thus, a systematic ophthalmologic screening is required, especially since the treatment of many problems is only possible at the youngest age.
1st preventive screening: This is performed within the first 2 years of the child’s life both using the method of retinoscopy, with or without eye drops, to accurately determine the degree of myopia – hyperopia and astigmatism, and ophthalmoscopically to examine the fundus. If a child develops a condition that attracts the parents’ attention (strabismus, blepharoptosis, lacrimation, white pupil, abnormal head position), he or she must be tested immediately (as soon as the condition appears).
Then (after the first screening test), if a refractive error is found (hyperopia, myopia, astigmatism), glasses are administered and after 1.5 months, a repeat examination is performed to evaluate the child's vision. If, despite the glasses, the visual performance of the two eyes is different (good eye, bad eye) the Pediatric Ophthalmologist may recommend patching the good eye, to improve the bad – lazy eye. The good eye is patched using a bandage for a duration which depends both on the child’s age and on the degree of vision impairment on the lazy eye.
Each case requires a separate treatment – monitoring, especially between 2 and 6 years old, crucial time for eyesight. It should be noted that it is internationally considered that the vision of a 9-year-old child has reached its full and final development.
Special reference needs to be made on retinopathy of prematurity. Premature babies between 28-32 weeks that must be placed in incubators must be tested from the 5th week after birth, with the dilation of the pupil and with the examination of indirect ophthalmoscopy. After this first fundoscopy and depending on the findings, the child should be tested every 2 weeks, and the appropriate course of treatment must be indicated to the parents.
Ophthalmological diseases of early childhood, from birth until the 7th year: Strabismus, lacrimation, blepharoptosis, white pupil (cataract, retinopathy of prematurity, retinoblastoma), hemangiomas of eyelids, congenital glaucoma, torticollis (ocular abnormal head posture) nystagmus, conjunctivitis.
Strabismus in adults – Double vision test
Strabismus in adults is expressed in a different way than in children. So, the first symptom to develop is double vision. Patients see all objects double with both eyes open, while they see objects correctly if they look at them with each eye separately. There are many causes of strabismus in adults (mainly secondary and paralytic type) and usually a complete and specialized screening for double vision is required for a diagnosis, followed by other examinations (fundoscopy, brain MRI, visual fields).
The preventive ophthalmologic examination of children is very important since many eye problems that appear in children do not show any symptoms that can be noticed by either the parents or the child.
The 1st examination is performed when the child is 2 years old preventively and then, depending on the findings, each case is approached differently.