Pediatric Ophthalmology PEDIATRICS Pediatric Ophthalmology service provides comprehensive, compassionate care of children's vision ranging from general eye exams to treatment of the most complex childhood eye diseases and disorders. HOW CATARACT IS MANAGED IN CHILDREN? Pediatric cataracts can occur in one eye (unilateral) or both eyes (bilateral). They can be complete or partial and can be present at birth or occur sometime after birth. Cataracts can be partial at birth and later progress to become visually significant. In contrast to adults, cataracts in children present a special challenge, since early visual rehabilitation is critical to prevent irreversible amblyopia (lazy eyes). Children born with cataracts are also at risk for developing glaucoma, strabismus, nystagmus, and poor stereopsis, further complicating successful outcomes. In most cases, it is the willpower and resolve of the parents or caregivers to follow post-operative management that determines visual success for the child. Patients with acquired progressive cataracts have less amblyopia and a much better visual prognosis than patients with cataracts that cover the visual axis since birth. Cataract surgery in children is done under general anesthesia. It involves removal of the cataractous (opaque) crystalline lens. This is often accompanied by surgical measures (primary posterior capsulorrhexis /anterior vitrectomy) to ensure the clarity of the central visual axis in the postoperative period, which can otherwise get obscured by the ‘after cataract’ (collection of inflammatory cells and fibrous tissue) formation. We currently consider IOL implantation in patients who are one year or older, and IOL implantation is the procedure of choice in children 2 years and older. MANAGEMENT OF AMBLYOPIA? Amblyopia is treatable in appropriate cases. Early treatment of amblyopia is critical for best results. The first step is to clear the retinal image by giving appropriate glasses or by removal of media opacities like cataract or corneal opacities. The second step is to correct ocular dominance, if present, by forcing fixation to the weaker eye and thereby stimulating it. This is achieved either by covering (patching) the good eye or by blurring the image in the good eye (by some drugs or by altering the spectacle number).Once ambylopia is diagnosed, it has to be managed by strict vigilance and monitoring of therapy. HOW IS AMLYOPIA DIAGNOSED? Subnormal best corrected vision (even after spectacle correction) points towards the possibility of amblyopia. Vision can be tested in children by many innovative picture/letter acuity/symbol charts. It can be done in a child as young as 2-3 year old. In a very young child, the ability of an eye to take up and maintain fixation is an indirect sign of the presence or absence of amblyopia. In children with eye deviation, strong fixation preference of one eye indicates amblyopia. WHAT ARE THE FACILITIES AVAILABLE AT GREENS MEDICAL CENTRE FOR EXAMINING PEDIATRIC PATIENTS? We have a Pediatric Ophthalmology and Strabismus Service with the overall goal to reduce blindness and suffering from eye disorders in infants and children. The service has a variety of equipments, necessary to perform an extensive pediatric ophthalmic examination including portable slit lamp, portable non contact tonometry, orthoptic equipments, synoptophore etc. There is provision for examining uncooperative children under general anesthesia. At our Center, we provide consultation and treatment for pediatric eye disorders and adults with strabismus (eye muscle problems). In the clinic, we approach each patient with specialized attention and assess the problems for appropriate diagnosis and treatment strategies. The centre has facilities for all kinds of pediatric ophthalmic surgeries. Besides, a separate play area section has been provided for the benefit of pediatric patients.
