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At the moment of a child’s birth, the eye is still immature. The child’s vision is blurred, and because the eye is small, children are farsighted. After the birth, vision continues to develop for several years more, the vision functions are formed, and the eye and the brain learn how to look. The intensive development lasts until the age of 3, while vision is fully developed by the age of 12. While the vision develops, the disorders may be treated medically, to enable the normal development of the child’s eye. On the other hand, unless the disturbances are discovered in time, the results of treatment in later phases are much worse. Therefore, a child is never too small for an ophthalmological examination. It is noteworthy that every child, even if the parents believe that everything is all right with his/her eyes and that everyone in the family can see well, should see an eye doctor not later than until the age of 3. The examination is adjusted to the child’s age and is painless. The child should be prepared to see the checkup as a play.

 

EXAMINATION OF CHILDREN

 

An examination of the child includes the following:

 

  • Determining visual acuity up close and at distance
  • Determining orthoptic status of the child (tests for strabismus) with the tests of binocularity and stereovision
  • Dilating pupils and determining objective refraction (diopter) with skiaskopy
  • Full examination of the front and the back segments of the eye

 

 

The methods of determining the visual acuity are different depending on the age. With small babies special cards with a pattern are used that help determine which size of the pattern draws the baby’s attention and the result is then compared with the tables prescribed for that age.

For pre-school children the cards (Lea symbol cards) are used that are designed according to the same rules as the cards for the adults. For as good insight in the condition of visual acuity as possible, a child should be asked how he/she recognizes the cards both at near and far distances.

 

The procedure of determining an objective diopter with a child includes applying the drops a number of times; it lasts for about one hour. It is recommended to prepare the child at home already that the drops will be applied in the eyes and that after the examination its vision will be blurred. After the pupils are completely dilated, objective determining of diopter-skiascopy is performed, which is extremely important for determining a possible latent diopter or another vision impairment as well as for prescribing appropriate glasses. Although for visual acuity determination, the cooperation of a child is necessary, the diopter may be determined even with the smallest children, because for that we do not need the child’s cooperation.

 

Determining the orthoptic status is also a necessary part of the child’s examination and is done with the adults with strabismus too. Its aim is checking the position and regular mobility and cooperation between both eyes. In this way strabismus is detected and measured, dysfunctions of binocular vision determined (whether the child has regular cooperation of both eyes during looking), amblyopia (lazy eye) or nystagmus (titration) of the eyes. The level of the development of stereo vision (3D vision) is also determined with stereotests (Titmus test, Lang test). With the children and the adults that have nystagmus (eye titration), necessary measuring is done in this part of examination.

 

 

The disorders of binocular vision and amblyopia with children are often a consequence of strabismus (squinting – looking in X). In this part of the examination, not only strabismus but also its consequences on the sensory system of vision are detected and measured, and the adaptation mechanisms that can sometimes be harmful at child’s age, are detected and treated.

 

Different ophthalmological diseases, such as irregularities developed in growth, infections, allergies, injuries, foreign bodies, congenital cataract, etc. are determined by the examination of the front and the back segments of the eye. That part of the examination differs very little from the examination of adults.

 

To treat the problems occurring at the child’s age, sometimes it is necessary to prescribe appropriate drops, the glasses or to conduct occlusion (closing of one eye in order to exercise and develop the vision of the weaker eye), and sometimes the operative procedures are also necessary, such as, for example, in some cases of squinting, congenital cataract, injuries or eye tumor.

 

THE MOST FREQUENT EYE DISORDERS AT CHILD’S AGE

 

REFRACTIVE ERRORS (DIOPTER)

 

Diopter is the most common reason for a child’s visit to the eye doctor. Usually with small children the parents notice that the child cannot see as it brings the books and toys closer, watches TV at near distance or squeezes the eyes and blinks often when trying to fix remote objects. With older children the problems most frequently occur when they can’t see the blackboard in school.  Likewise, the children who have a refraction error, after a longer period of reading or playing games, complain about headache. Given the fact that the child’s eye is in development, every refractive error should be accurately corrected.

 

AMBLYOPIA

 

If the visual acuities are reduced on both eyes, the child clearly shows the signs of deteriorated vision. However, if the vision is weaker on one eye only, the parents and the environment do not notice the problem, as the child uses the better eye. In this, the brain takes the information that comes from the better eye, while the information from the other eye is suppressed leading to the development of amblyopia, i.e. lagging in the development of the eye that is not used.  If this happens at an earliest age when the brain and the eye are not developed yet, the vision on the affected eye may remain very weak, because the weaker eye gets neglected from the beginning and does not get a chance to develop. If someone in the family has a similar problem, chances that the child will have the same problem are bigger.

 

SQUINTING (STRABISMUS)

 

Strabismus is a disorder of the position or mobility of the eyes. With healthy eyes, both eyes are aligned and look at the same point, and the movements are synchronized. Every eye is moved by 6 muscles and the impulse for movement comes from the brain. Perfect cooperation of both eyes is achieved through synchronized movements of the eyes, thus enabling the development of binocular vision, i.e. cooperation during looking with both eyes at the same time, whereby two somewhat different pictures fuse together in the brain, where one picture is created in three dimensions (stereo vision). If both eyes are not aligned, or if, for some reason, the mobility in one direction is limited, the brain will exclude the eye that is not aligned or that does not follow, so the previously mentioned amblyopia will develop; at the same time, binocularity and stereovision will not be able to develop either.

In some cases when the development of the vision is complete already and when no binocular vision can be established any more, a strabismus surgery may be done for cosmetic reasons in order to reduce the deviation and properly align the eye, thus enabling the patient to have a better esthetic appearance. After the injuries, some muscles moving the eye may be paralyzed, so, besides the impaired appearance, the patient whose all vision mechanisms functioned well may see double pictures. In such cases, although the function of the muscle, i.e. the nerve that moves it, cannot be restored, the operation may help bring the eye in a position that suits more the normal natural manner of looking, and thus making the everyday tasks easier.

 

CONGENITAL CATARACT

 

Sometimes a child may be born with cataract on one or both eyes. Such congenital cataracts are usually developed due to a disturbance in the development or some infections while the child is still in the mother’s womb. Given the fact that the blurred lens prevents the penetration of the light in the eye, even if the remainder of the eye is completely healthy, unless the cataract is immediately removed, the child’s vision will not be able to develop, so it will leave the child with high amblyopia even after a successful operation. Therefore, the congenital cataract should be operated as soon as possible, while the child is still a baby. During the operation, an incision is made as small as a couple of mm, the blurred lens is removed with ultrasound and the artificial lens is inserted in its place, through a small incision. The artificial lens is therefore located in the same place where the natural lens was. See the patients’ most frequently asked questions.

 

MAKE AN APPOINTMENT FOR GENERAL EYE EXAMINATION

ZAGREB

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Phone: 01/ 777-5656

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10 000 Zagreb, Croatia

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21 000 Split, Croatia

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71 000 Sarajevo, BiH

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78 000 Banja Luka, BiH

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