What is strabismus?

Strabismus is a very common childhood disorder that affects 4% of the general population and is an eye condition in which the visual axes of the eyes are not aligned. In this case, one eye looks straight while the other diverts towards inside or outside. Based on the direction of the eye, there is esotropia when the eye is turned towards the inside, exotropia when it is turned towards the outside, anotropia, when it looks up etc. Strabismus can appear in the first months of the infant's life, especially esotropia, or after 18-24 months, when the child starts focusing on close objects.

When a child presents strabismus, and this is more easily observed by his mother, then he will need to be examined to diagnose if it is true strabismus or pseudostrabismus, especially in the ages of 3 and 4, when ocular muscles and the child's vision are not yet stabilized. A very common cause of pseudostrabismus is epicanthus (eye fold) and a wide nose. Pseudostrabismus corrects itself and needs no treatment, while real strabismus must be corrected as soon as possible, because apart from a cosmetic problem (parents consider it a major problem), there is also the danger of amblyopia. The eye that squints in a child may gradually become “lazy”, which means that it stops seeing clearly even with the help of glasses. This is practically irreversible after the first decade of a child's life and the “lazy” eye will stay “lazy” for life. Immediate diagnosis and proper treatment help in order to avert such a possibility.

How is strabismus treated?

When a child shows signs of strabismus, he needs to be examined by an ophthalmologist to diagnose the type and cause of strabismus. Vision and refraction should also be checked using dilating drops to see what the precise dilating strength of the glasses is. At the same time, the fundus is checked for possible abnormalities.

There are cases of strabismus corrected only with glasses, which the child must wear constantly and must be checked every 6-12 months. In esotropia, hyperopia is also found, which increases until the age of 6, stabilizes by the age of 8 and gradually decreases by the age of 14. With the gradual decrease in glasses strength, the degree of strabismus is also decreased. Strabismus that cannot be corrected with glasses will need surgery. With surgery we can strengthen or weaken the muscles in order to align the eyes. In case strabismus is high or complex, e.g. horizontal and vertical, a second surgery might be needed.

It is very important to point out the importance of eye exams before the school age, even if parents cannot observe any problems in their child.

What is amblyopia?

Amblyopia, or “lazy” eye, is not only caused by strabismus. Big differences in the refractive ability of the two eyes, e.g. one-sided high congenital myopia (anisometropic amblyopia), conditions that don't allow light to reach the posterior segment of the eye, e.g. ptosis, congenital cataract (amblyopia ex anopsia), high ametropias, usually hyperopia (ametropic amblyopia), from non-corrected astigmatism (meridional amblyopia) and other disorders, e.g. congenital nystagmus, are all possible to cause amblyopia to a child. Diagnosis and etiological treatment is the basis of proper medical care of this not at all rare disorder, since about 7% of people have some degree of amblyopia acquired during their childhood.

How is amblyopia treated?

The first and most serious issue is proper diagnosis and prevention of amblyopia and this can happen only with a full ophthalmological examination. Treating the basic cause, e.g. strabismus, cataract removal, or prescribing the proper glasses is not enough to correct amblyopia. Besides all that, the good eye needs to be covered so the child will need to use the amblyopic eye to see and thus acquire good vision.

The younger the child is when amblyopia is diagnosed, the better his vision will be after treatment. We need to point out how necessary it is to do an eye exam before school age, because if the diagnosis is made at that age, the child can have perfect vision, while if it is diagnosed at the age of 7 or 8, amblyopia will be permanent for the rest of the child's life except for exceptional cases.

A very important role in the success of this technique is the positive opinion of the parents and their insistence on the treatment, because no child wants to have his eye bandaged. It is better to be pressured early by the parents than have a lazy eye for the rest of his life that might be an obstacle in his personal career, for example, he will not be able to acquire a driver's license or be accepted in a military academy.

Covering the eye is needed for a few hours every day and for as long as it is necessary, months or even years, since it depends on the degree of amblyopia and the regular application of the cover. In small children, improvement is rapid, but the child will have to be monitored closely until the age of 8 to avoid any possible relapse.

 Remember: Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

Learning difficulties are related to vision problems

Good eyesight for children is certainly a basic requirement for school success. When the child's vision falls short, the same happens with his school performance. According to a recent study, up to 25% of children experience eyesight problems that affect their learning ability.

Learning difficulties is another thing to worry about regarding children of school age. Even though learning difficulties usually appear in children up to 7 years old, they are often not detected until the child goes to school. Many times, however, learning difficulties can be the result of simple eyesight problems. A refractive fault may be the cause of these difficulties in school or a refractive fault can be combined with a learning problem. If your child reversed letters while reading or writing, his writing is sloppy, he doesn't like or has difficulties with reading, writing or mathematics, he often confuses his right and left hand or the opposite, he faces difficulties in oral communication or has frequent antisocial behavior, then you should consult with an expert. Consult with your ophthalmologist in order for him to diagnose a potential vision abnormality and visit your paediatrician in order to get proper information and a recommendation for a specialist.

What are the vision disorders for children of school age?

The most common vision disorders regarding school age are:

amblyopia at about 4%,
strabismus,
myopia , 5% until the age of 8, 26% until the age of 14 and 30% until the age of 20,
hyperopia at about 90% until 5 years of age and 15% over 5,
astigmatism.

What are the signs that should lead us to the ophthalmologist in time?

Parents should look their children in the eyes and observe their reaction in various visual stimuli, since their performance and subsequent success in life is mainly dependent on the proper function of their eyes. If a child that starts school has normal language development, but faces learning difficulties or difficulty in reading, then he might have an eyesight problem.

The symptoms that the parents need to look out for are:

The child always sits very close to the television or reads a book close to his eyes
He loses track of where he is in a text, or skips words and sentences

He uses his finger to follow the words when he reads

He writes sideways

His posture isn't proper when he studies
He easily loses attention and can't concentrate
He squints
He leans his head to see clearly
He is sensitive to light
He rubs his eyes or blinks excessively

He closes one eye to read or watch television
His eyes are unnaturally aligned. Their movement is unnatural
He doesn't easily comprehend what he reads
He is too slow to finish homework
He avoids activities that require close vision such as reading or distant vision such as sports participation or other activities.
He complains about headaches or tired eyes.
He avoids using a computer at school because “it is tiring for his eyes”.
His school performance is decreased compared to the past.

If your child presents one or more of the above signs, you should schedule an appointment with the ophthalmologist. This visit to the doctor will usually show that the child has myopia, hyperopia or astigmatism. These refractive abnormalities can be corrected very easily with glasses or contact lenses.

How often should the child visit the ophthalmologist?

Expertise and available technology today offers to ophthalmology diagnostic methods, which prevent many problems, before they become damaging. Some eye disorders may exist without any obvious symptoms and that is why children of all ages should do preventive examinations.

Your child should definitely be examined by an ophthalmologist for the first time no later than 6 years of age. All babies, and especially infants, mainly those that are considered “high risk” (premature labor, family history of eye disorders) should be examined by a specialist pediatric ophthalmologist. This examination is done to verify the good health of the eyes and detect potential problems that may be rare, yet important, like congenital cataract, glaucoma, microphthalmia etc. After that, again in the age of 3 and again when he is starting school. Children of school age need an ophthalmological examination once every 2 or 3 years if they present no problems. But if your child needs glasses or contact lenses, you should schedule the visits to the ophthalmologist every 12 months. We should keep in mind that just as the child grows, so does his vision change which results in a need to also change prescription. Furthermore, your visit to the ophthalmologist will ensure that your child can have proper central and peripheral vision, use both his eyes and easily adjust from close to far distances and the opposite.

We should point out that an ophthalmological examination alone is not enough. The paediatrician will examine the child's vision to detect a possible problem, but he can't replace the ophthalmologist. So, while a paediatrician's examination can be useful, there is always a chance for this examination not to show any serious problems. Parents are mainly those who will need to take initiative and schedule the visits to an ophthalmologist, who will examine the vision of the child thoroughly.

Remember:Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.