child eye care and squint: what we all should know? dr hemant d anaspure assistant professor dept of...
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Child Eye Care and Squint: What we all should know?
Dr Hemant D AnaspureAssistant Professor
Dept of Ophthalmology
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Childhood Blindness
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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.
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What we can do?
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The Eyes Don't See What the Mind Don't Know
The Eyes See What the Mind Know
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Amblyopia(LazyEyes)
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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
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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
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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)
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Refractive Errors in Children
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Refractive Errors in Children
• Refractive errors occur when the shape of the eye prevents light from focusing directly on the retina
• Types - Myopia
- Hypermetropia
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• Factors: Length of the eyeball (Axial
Myopia/Hypermetropia) Shape of the cornea (Astigmatism) Refractive power of lens (Index)
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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?
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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
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Squint
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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
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• 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?
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• Keep in Mind : Retinoblastoma can present as squint at early age ….
What we should know?
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Retinopathy of Prematurity (ROP)
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Retinopathy of Prematurity
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• 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
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• 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?
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• 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?
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Retinoblastoma
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Bruchner’s Test
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• 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?
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Paediatric Cataract
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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
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• 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?
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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
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• 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
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Thank You …..