Very often it is simply necessary. Premature babies can suffer from retinopathy of prematurity. A prompt diagnosis allows to bring it under control. In case of children with a low birth weight (1000 grams or less) who were born prematurely a screening for this disease is required (in the 4th, 8th and 12th week and at the age of one year). Ophthalmological assessments of babies are also necessary, if parents notice something alarming (which we describe below).

OPHTHALMOLOGY FOR CHILDREN AND YOUTH

If nothing alarming is happening, a child has routine ophthalmological appointments with a paediatrician during well-child care visits at the age of one, two and four. Our specialists think, however, that is it worth taking a 2-year-old for an additional appointment with a paediatric ophthalmologist. It will allow to diagnose early any potential sight defects, especially a poor eyesight. A next appointment with an ophthalmologist should be booked before the child starts school (a referral is not required) and then in the year 3 or 4. It’s also very important to assess children’s eyesight during adolescence when they experience significant physical changes.
Children’s eyes have a well developed accommodative mechanism, which means that a sight defect can be hidden for many years as a young eye corrects it by itself with some effort. During as assessment we can remove this ability for a couple of hours. It allows us to make a correct diagnosis. At the same time we can do a detailed eye check (so-called funduscopy which allows us to see inside the fundus of the eye). Apart from that, an ophthalmologist can also check lacrimal canals and translucency of the layers of an eye.
Assessments should happen more often if there is a history of eyesight problems within the family (for example parents wearing glasses) or a history of systemic diseases which could affect eyes. The schedule of appointments should be discussed with a specialist.

What symptoms observed in pre-school and school children should be a sign to book an appointment with an ophthalmologist?

• squinting
• narrowing eyes (for example while watching TV, reading, drawing)
• frequent rubbing of eyes (also frequent headaches)
• avoiding reading and writing
• difficulties with reading a small print
• holding books close to eyes
• inability to write in a straight line
• cocking head (as if the child was trying to look with one eye) while reading, writing or drawing
• leaning over a piece of paper while reading, writing or drawing
• difficulties with recognizing items in badly lit rooms
• difficulties with recognizing colours

Symptoms seemingly unrelated to vision, such as avoiding an intellectual effort (especially related to reading), inability to complete pre¬school and school tasks within a given time, difficulties with concentration while reading and writing etc., can also be worrying. All these things can be a result of uncontrolled sight defects.

WHAT ARE THE RECOMMENDATIONS TO AN OPHTHALMOLOGICAL ASSESSMENT FOR SMALL CHILDREN, APART FROM A SUSPICION OF RETINOPATHY OF PREMATURITY?

For example a lack of a red reflex on photos of the baby. Unless the camera used was equipped in the red eye reduction feature, such sign can be worrying. We are talking about photos taken in the evening with a flash, when a child is looking straight into the camera. If instead of a red dot we see a white reflex, it can mean that the child is suffering from congenital cataract or retinoblastoma. In such case an urgent appointment with an ophthalmologist is necessary as retinoblastoma is a life-threating cancer. Early diagosis means better chances for the child. Congenital cataract can be operated even in case of newborn babies.

Other symptoms, potentially requiring an appointment with a specialist, are:

• a lack of smile as a response to someone else’s smile
• a lack of response to light or hypersensitivity to light
• poor reactions to visual stimuli
• rubbing eyes with fists
• nystagmus
• an assymetrical appearance of eyes
• an inferior psychomotor development
• red eyes, puss secretion
• eyes often close when awake
• lazy eye (both at once or in turns), i.e. a squint

It’s worth mentioning that a squint is a hereditary disease, which is treatable with a prompt medical intervention (sometimes surgical).