The importance of ophthalmic consultation in children

Do not neglect the baby’s sight in her first year of life! This is the recommendation of top pediatric ophthalmologists who frequently diagnose ocular problems in children. Among these, the most common are refractive errors (large diopters), strabismus, nystagmus, but also cataract or glaucoma.

“Babies should be examined for the first time when 3 months old, when they start fixation with their eyes. The first 3-month examination is important to see if there is a congenital problem (cataract, glaucoma, an eyelid, strabismus). After 3 months of age, we can measure without dilation. The first measurement guides us towards further conduct. If I suspect a problem, then I’m going to the pupil’s dilation. Through this procedure, we can evaluate the retina and make measurements with the special baby equipment we have at ACIBADEM. As the case may be, we can move on to more detailed measurements. The equipment differs from those used in adults and allows us to make measurements for babies. Very, very rarely, we do them under anesthesia. In some more serious situations, we need more detailed examinations like electroretinography (ERG) or VEP (to evaluate the entire vision system), electrophysiological measurements. We use them if a child does not follow the signs with her eye/s, if she has a nystagmus or if has eye problems”, recommends Dr. Mürüvvet Ayten Tüzünalp, a pediatric ophthalmologist with more than 20 years experience who evaluates and treats children with sight problems at ACIBADEM Altunizade Hospital.

At present, pediatric ophthalmology departments in top clinics have experienced specialists, as well as the most advanced technologies to evaluate children’s sight at very young ages. Thus, the best decisions can be made in time to successfully correct vision problems in children.

“If we find a serious problem before the age of one, that child must wear glasses before the age of three. Often, we diagnose a sight, a lazy eye, or strabismus, and for each case, we estimate that the child will need glasses. Depending on the situation, we assess future developments and determine what to do step by step to resolve the situation or improve the eyesight. The baby is seen by us every 6 months and depending on the size of the diopter, we decide if she needs glasses from 2 years or later. If the problem is very serious, we can recommend wearing glasses before the age of one. We continue to monitor the children, and if we have to prescribe glasses, we do the measurements once every 6 months. And before 3 years, children diagnosed with problems can begin to wear glasses. This is how, we proceed in the case of refractive problems”, adds to the story the experienced pediatric ophthalmologist.

Strabismus is one of the common eye problems frequently seen in young children. Strabismus means that the eyes do not look at the same point at the same time and occurs when there are problems in controlling the muscles of the eye. If an eye is affected and it is not treated, then the brain will temporarily ignore the images received from the diseased eye. The major risk is the complete loss of sight in the diseased eye.

“If a child has strabismus before the age of one, we usually deal with a congenital problem, so we make measurements, and if there are no refractive problems, then we do the surgery at the age of one year. If there is no strabismus, but there are refractive problems, medical procedures differ from case to case: if they affect both eyes, we can wait for a while. If there are big differences between the two eyes, then we can recommend eyeglasses or contact lenses for the problematic eye. We can also recommend wearing a patch. Each treatment is personalized as the case may be”, describes Dr. Mürüvvet Ayten Tüzünalp the frequent medical situations in children.

Dr. Tüzünalp is one of the most experienced in Turkiye in dealing with childhood eyesight issues. Every day, she consults dozens of children, and his advice, treatments and interventions address both simpler and most complicated affections such as Turner Syndrome or malignant tumors. A special category of patients is premature babies who need long-term care and monitoring.

“Normally, retinal vessel growth occurs until week 40 of pregnancy. If a child is born prematurely, especially before 28 weeks, the development of these vessels stops. So, we have to monitor the situation so that the baby’s sight does not suffer. But dangerous situations such as hemorrhage or lack of proper oxygenation may occur, which require interventions that may affect the eye. We can make some eye-level injections or laser therapy to stop premature retinopathy. But in the long run, there is a risk that these children will have great myopia, strabismus, low vision acuity, so they need monitoring and evaluation. We also have babies born prematurely with diopters of 7 or 8, with astigmatism (when we do laser therapy, the anatomy of the eye changes). So, we need to evaluate them periodically and offer them solutions to improve vision affected by prematurity”, says the eye specialist.

Although the incidence of eye disease in children is constant over the last few years, Dr. Mürüvvet Ayten Tüzünalp says parents are more informed and come to a doctor sooner. In fact, this is the key element on which the specialist insists: visiting the doctor in a timely manner. The risk of postponing medical consultation is the irreversible impairment of children’s eyesight.

“If a child gets to a doctor late, at 3 or 5 years old, the situation is more complicated: the lazy eye is the same, but squint requires surgery. Glasses or patch will not be enough. It all depends on the complexity of the case. For example, if a child has hypermetropia, we know he will make strabismus at 3 years old or even earlier. So, if we use glasses on time, the baby will not develop strabismus or lazy eyes. Thus, timely diagnosis is very important to any ocular problem in children”.

Nowadays, wearing glasses, contact lenses, patching (temporary occlusion), surgery, certain orthoptic exercises, or artificial cataract implantation are solutions that improve and heal vision problems. Glasses are getting lighter; the lenses are performing better and they help avoid over-correction with inappropriate diopters.

“Devices have developed a lot over the last 20 years. Lenses are very light, and the diameter has decreased to perfectly match the kids’ needs. The peripheral area was very thick, now is thinned, only the center of the lens is thicker. Thus, glasses are much easier to wear because materials are much lighter. Additionally, they are more easily adapted to various problems: for example, a child with strabismus inside will wear thick lenses in the middle, if strabismus is outward, the center of the lens should be very thin. This type of lens helps your eyes return to their normal position”, says Dr. Mürüvvet Ayten Tüzünalp.

But as beneficial is the use of technology in detecting and treating eye problems, as harmful is the exposure of children from very young age to devices with bright screens, like the mobile phone or tablet.

“The quality of vision is impaired, but strabismus can also occur. I see many children with strabismus from too much exposure to tablets or phones and they need surgery. This exposure to screens in the early years of life is very dangerous. The situation worsens after puberty, the children don’t get away from the screen. Refractive errors are more and more common, myopia is more and more serious when smaller screens are used. It happens that after the children are given their phones or tablets, they come to me with strabismus, after just a few months of use. This did not happened before using the screens; now we need to use surgery”, warns the doctor.

Thus, the advice of the pediatric ophthalmologist Mürüvvet Ayten Tüzünalp of ACIBADEM Altunizade Hospital is that the children should not at all be exposed to phones or tablets before the age of 3. After this age, it is allowed an hour a day, but in 20 minutes intervals, with breaks. After 6 years, the children could stay for two hours. But the recommendation is for parents to keep their kids away from tablets and phones as long as they can. It is the only effective measure to protect their eyesight in this era of technology.