The Most Common Ophthalmic Diseases in Children
Eye problems in children are often congenital, but they can also occur as a result of accidents or trauma. The first assessment of vision in children is made when the baby begins to move his eye, at 3 months. If the doctor suspects a problem, then he recommends visiting a pediatric ophthalmologist. It can make thorough investigations and measurements to detect any ocular conditions and to take the best possible steps to get the little ones the right treatment. Ophthalmologist Mürüvvet Ayten Tüzünalp – part of the medical team of ACIBADEM Altunizade Hospital – has over 20 years of experience in treating ophthalmic disorders in children. The specialist further describes the main ocular problems she detects in children, but also the solutions she uses to successfully solve complicated cases.
What are the most common ocular conditions and problems you diagnose in children?
Dr. Mürüvvet Ayten Tüzünalp: The most common eye diseases we diagnose in children are the refraction errors. But there are other situations that require wearing eyeglasses to improve vision.
What is the cause of refraction errors?
Dr. Mürüvvet Ayten Tüzünalp: These are usually congenital, but there are cases when they occur later in the children’s lives.
When is the first eye assessment needed to be done for children?
Dr. Mürüvvet Ayten Tüzünalp: First check-up must be done before the age of 1 year. We, the ophthalmologists, make certain measurements, and if we notice that there are certain vision problems, we continue the investigations. If we find a serious problem before the age of one year, that child should wear glasses before the age of 3. Often, we diagnose a sight, a lazy eye, or strabismus, and for each case, we estimate if that 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 sight. The baby is seen by us every 6 months and, depending on the size of the diopter, we decide whether it needs glasses from 2 years or later. If the problem is very serious, we can recommend wearing glasses before the age of one. The decision depends on the results of the measurements: we can use some droplets to dilate the pupils and make advanced measurements. We continue to monitor the children, and if we have to prescribe glasses, we do the measurements once every 6 months. So before 3 years, children diagnosed with problems can begin to wear glasses. This is the case with refraction problems. For other issues, such as nystagmus (eyeball movement) or strabismus before the age of one year, the tracking schedule differs. If a child has a strabismus before the age of one, this is usually a congenital problem, so we make measurements, and if there are no problems of refraction, then we do the surgery when the kid is one year old. If there is no strabismus, but there are refractive problems, medical measures differ from case to case: if they affect both eyes, we can wait for a while. If there are large differences between the two eyes, then we can recommend eyeglasses or contact lenses for the lazy eye. We can also recommend wearing a patch (occlusion of the normal eye). Each treatment is personalized, as the case may be.
How important is it to take these measures on time and what are the risks of postponing a consultation later than one year of age?
Dr. Mürüvvet Ayten Tüzünalp: Every child needs to be evaluated before the age of one, because problems need to be carefully monitored. If a child reaches a doctor late, at 3 or 5 years old, the situation is more complicated:. Glasses or patching 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 or even earlier. So, if we put glasses on time, the baby will not have strabismus or lazy eyes. Thus, timely diagnosis is very important for any ocular problem in children.
How do you make the examinations to children before 1 year old?
Dr. Mürüvvet Ayten Tüzünalp: Ophthalmologists can not see all the children up to the age of one. At the beginning of my career, 20 years ago, I was doing this, but now I select the cases that require my intervention. Babies should be examined for the first time when 3 months old, when they start following objects with their eyes. The first 3-month examination is important to see if there is a congenital problem (cataract, glaucoma, an eyelid, strabismus). When 3 months old, we can measure without dilation. The first measurement guides us towards further conduct. If I suspect a problem, then I’m going to do the pupil’s dilation. Through this procedure, we can evaluate the retina and make measurements with the special baby equipment we have here, 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 (evaluation of the entire vision system), electrophysiological measurements. We use them if a child can’t foolow us with her sight, if she has a nystagmus or if we notice eye bottom problems.
Do you diagnose more children with vision problems than 10 or 20 years ago?
Dr. Mürüvvet Ayten Tüzünalp: The incidence of eye disorders in children is almost the same, but parents are more informed and come faster with their children to their doctor. Pediatricians also recommend the frequent ophthalmological check. In ACIBADEM, pediatricians know when to recommend the ophthalmological consultation, know at what age this consultation is appropriate and know how to evaluate the retina, at first. If they suspect a problem, they send the children to me. My advice is for any child to have an ophthalmologic consultation before 3 months old.
How important is the examination to be done by a pediatric ophthalmologist?
Dr. Mürüvvet Ayten Tüzünalp: Any ophthalmologist can examine a child, but an expert who has experience in treating children is often needed. For example, a diopter of 3 in hypermetropia can be a lot for an adult, but for a 3-month baby, it may not be important. Children are growing and these values can decrease over time. For example, a value of 6 diopters in a 3-month-old child may indicate a problem, so we’ll evaluate it for one year. And then we may see that the value is 3, so the sight normalizes. Follow-up programs differ from those of adults.
What is the risk if one does not intervene in cases where one eye is healthy and another has problems? Is there a risk of vision loss?
Dr. Mürüvvet Ayten Tüzünalp: Vision development extends in a timespan of over 8 years, sometimes even 10 years. If there are refractive errors before this age, glasses, contact lenses, patching are used, and the problem can be managed successfully. But after the age of 8-10, nothing can be done. A lazy untreated eye in time will be so for lifetime: it’s not worsening, but it doesn’t improve its condition either.
What can you tell us about prematurely born babies? Do they need special care to get the best eyesight?
Dr. Mürüvvet Ayten Tüzünalp: Of course. Here, we have a special section for premature babies’ care: we monitor them closely. Normally, retinal vessels growth develops 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 that may affect the eye may occur, such as hemorrhage or lack of proper oxygenation; they require interventions. We can make some intravitreal injections or laser therapy to stop premature retinopathy. But, in the long run, there is a risk that these children will have severe myopia, strabismus, low vision acuity, so they need monitoring and evaluation. Among small patients, we also have babies born prematurely with diopters of 7 or 8, with astigmatism (when we do laser therapy in premature babies, the anatomy of the eye may change). So, we need to evaluate them periodically and offer them solutions for improving vision affected by prematurity.
Do you also diagnose glaucoma in children? What are the causes?
Dr. Mürüvvet Ayten Tüzünalp: Glaucoma in children is congenital, and occurs due to development problems in the anterior segment of the eye. These children are evaluated and monitored. If the problem is very serious, I recommend surgery, which is done by surgeons specialized in this type of problem. I operate strabismus, nystagmus, congenital cataract and I deal with treating and monitoring children with these problems.
Can these problems be genetically inherited?
Dr. Mürüvvet Ayten Tüzünalp: Yes, most of these problems are genetically inherited, even congenital cataract. I give you a case as an example: we have operated a grandfather, operated the nephew, and then the child’s mother was also operated for the same problem. Although cataracts occur mainly in adulthood, they may also appear intrauterinely, because of a lens development problem. This makes the crystalline no longer transparent one hundred percent, and the sight is affected. We do the surgery before the age of 2, but we do not use artificial crystalline. We apply the contact lenses, and later we can use the patching. After the age of two, we can insert the artificial lens. If the sight is severely affected, the intervention should be done quickly in babies. If the little patient has peripheral vision, we can wait up to 2 years and we can do a single intervention in which we insert the artificial lens, too.
Are artificial lenses and contact lenses personalized?
Dr. Mürüvvet Ayten Tüzünalp: Crystal is standard, but contacts are custom-made, So they are specially created for children because the diameter is smaller than those for adults.
Do you see children with sight problems because of accidents?
Dr. Mürüvvet Ayten Tüzünalp: We see cases of ocular paralysis after a trauma, these children develop strabismus. We wait for a while, we do magnetic resonance, the children can be examined by neurologists or neurosurgeons, and if the situation does not improve, we go for surgery. Also, children who go through various injuries can make cataract after a few months, even if they do not develop squint. They need surgery, patchwork for the lazy eye, bifocal lenses, depending on the case.
Can you tell us some spectacular cases, special situations that you have solved throughout your career?
Dr. Mürüvvet Ayten Tüzünalp: For example, a special situation is the third nerve palsy: these children can not move their eyes, the eyelids may be affected, and these children need at least 3 operations just for strabismus. But eyelid surgery needed is also needed. There are serious cases that we manage to solve. There are also cases of paralysis in which the eyes can not move upwards and the little patient needs surgery for both eyes.
Do you see children with cancers like retinoblastoma?
Dr. Mürüvvet Ayten Tüzünalp: We see quite a few oncological cases; in some of them we work with Dr. Memet Ozek, neurosurgeon. We also monitor children who in some cases have ocular problems after neurosurgical interventions. There are serious cases which we deal with pediatric neurologists and neurosurgeons.
A child with eye problems, treated correctly and on time, can become a normal adult with a good sight?
Dr. Mürüvvet Ayten Tüzünalp: The most important aspect is to be diagnosed on time. I often see 40, 50 children, and 30 of them have a very good health, except the sight problem. Perhaps one in 50 cases is a more complicated situation. If they are carefully monitored, at 1 year, 3 and 5, 7 years, children will be fine, there is no risk of missing something, and children can have a normal life.
Can the eye be regenerated?
Dr. Mürüvvet Ayten Tüzünalp: We are born with a genetic predisposition to certain problems, and the eye is born with a hypermetropia of 3-4 diopters. Over time, it adjusts to 0 and otherwise she may need glasses later. This is our physiological development. But if myopia occurs, the eye changes, and it is not a reversible process.
