Child Eye Care and Squint: What we all should know?

Dr Hemant D AnaspureAssistant Professor

Dept of Ophthalmology

Childhood Blindness

Childhood blindness• Globally approx 1.4 million children who are

blind1

• 2/3rd live in developing countries• The prevalence of blindness approx 0.3 –

1.2 /1,000 children2

• 40%of the blindness in children is avoidable

1. World Health Organization, Geneva. Global Initiative for the Elimination of Avoidable Blindness. Geneva WHO/PBL/97.61

2. Gilbert C E, Foster A. Childhood blindness in the context of VISION 2020 Ð The Right to Sight. Bull WHO 2001; 79: 227-232.

What we can do?

The Eyes Don't See What the Mind Don't Know

The Eyes See What the Mind Know

Amblyopia(LazyEyes)

Amblyopia• Amblyopia or "lazy eye" is weak vision or

vision loss in one or both apparently normal eyes that cannot be fully corrected with lenses

• Causes: Anisometropia, Squint, High refractive error in both eyes, Visual deprivation due to congenital cataract, glaucoma,corneal opacity

What we should know? Amblyopia is one of the most common causes

of visual impairment in both children and adults

Prevalence 0.2% - 12% (average 2-3%) Failure to develop binocular vision and

prevent the individual from pursuing certain occupations

Amblyopia increases the chances of blindness in the healthy eye, mostly from trauma

Fortunately , completely treatable cause of blindness

Timely diagnosis and treatment is key for successful treatment Using glasses at early age can prevent amblyopia in many cases Best age for treatment is < 8 years (Max 16 years)

Refractive Errors in Children

Refractive Errors in Children

• Refractive errors occur when the shape of the eye prevents light from focusing directly on the retina

• Types - Myopia

- Hypermetropia

• Factors: Length of the eyeball (Axial

Myopia/Hypermetropia) Shape of the cornea (Astigmatism) Refractive power of lens (Index)

Wandering eye moments, no response to mother’s face or attractive colourful objects, shaking of the eyes by 3 months

Watching TV from too close distance, frequent eye rubbing, holding books close to face, squinting, poor academic performance Think of glasses

All children should have one vision screening between 3 to 5 years

What we should know?

What we should know?

Myths about glasses• If your child wear glasses all the time, the

number will reduce• Your child watches too much T. V. and hence

has glasses• With Plenty of vegetables and drinking carrot

juice his number should go away• Vitamin A tablets help increase eye power• Using glasses will make him habituate

Squint

Squint• While one eye looks straight ahead, the other

eye is turned either inwards or outwards. This is called a squint.

• Major types Esotropia

Exotropia

• Effects: Children can lose stereopsis / binocularity Loss of vision in the crossing eye (amblyopia) Loss of confidence and self esteem• Depending on cause, treatment varies from

glasses to surgery• In infantile cases, best time for surgery is less

then 2 years of age to restore binocularity

What we should know?

• Keep in Mind : Retinoblastoma can present as squint at early age ….

What we should know?

Retinopathy of Prematurity (ROP)

Retinopathy of Prematurity

• The incidence of ROP in India 38 – 51.9 % in low birth weight infants

• Annual live births in India approx 26 million• In India 8.7% of newborns birth weight < 2000

grams• Almost 2 million newborns are at risk for

developing ROP

Retinopathy of Prematurity

• Birth weight have an inverse relationship with development of ROP

• NNF Criterias In whom: . < 34 weeks / Birth wt < 1750gms . 34 – 36 weeks / Birth wt 1750 –

2000 gms with risk factors When : Born > 28 wks : 4 weeks Born < 28 wk/ < 1200gms : 2 – 3 wks

What we should know?

• The children have more chances of refractive errors and squint

• Recommended follow up 6 months, one year, 3 years and 7 years

What we should know?

Retinoblastoma

Bruchner’s Test

• Retinoblastoma is the most common malignant tumour of the eye occuring in childhood

• White pupillary reflex is most common presentation

• 5 year Survival rate is > 95% • Early diagnosis helps not only to save life but

to save eye and vision

What we should know?

Paediatric Cataract

Paediatric Cataract• A cataract is any cloudiness or opacity of the

lens of the eye • White opacity seen in a child’s eye may be due

to several reasons. The most common of all is cataract

• Causes - Heredity - German measles - Injury to the eye - Steroids use

• Preventable and Treatable cause of blindness• Amblyopia sets in very early if not treated on

time• Ideal time for congenital cataract Unilateral < 1.5 months Bilateral < 3 months• Requires long term follow up and treatment

What we should know?

Summary• Amblyopia : Timely intervention is key• Refractive error : One check up bet 3 to 5 yrs• Squint: Needs early treatment to restore

binocularity• ROP : Screen any child < 2 kg birth weight• Retinoblastoma: White pupillary reflex is

dangerous sign• Pediatric cataract: Don’t waste time

• Child's future success depend on ability to see well

• While most children have good vision, any vision problem needs to be caught early

• Rarely will a child complain about his/her vision

• Young children think that everyone sees the way they do

Thank You …..