Medical & Surgical Treatments for Paediatric Eye Conditions available at Angel Eyes

At Angel Eyes, our Paediatric Ophthalmology team offers a wide range of treatments, both medical and surgical, for various eye diseases in children.

Amblyopia

Amblyopia is treatable in appropriate cases. Early treatment of amblyopia is critical for best results.

 This is achieved either by covering (patching) the good eye or by blurring the image in the good eye (by some drugs or by altering the spectacle number). Once amblyopia is diagnosed, it has to be managed by strict vigilance and monitoring of therapy. The amblyopia is treated with the use of glasses or contact lenses, eye patching, eye exercises, eye drops and, in some cases, surgical treatment may be required.

Glasses or Contact Lenses: The first step is to clear the retinal image by giving appropriate glasses or by removal of media opacities like cataract or corneal opacities. Glasses play a major role in treating amblyopia as this is the only way to correct the refractive error. In some cases where one eye has the higher refractive error than the other eye, use of contact lenses can be of great value than glasses.

Eye Patching: The second step is to correct ocular dominance, if present, by forcing fixation to the weaker eye and thereby stimulating it. Eye patches are used to occlude the eye with better vision to stimulate the lazy eye to see more. The eye with better vision is patched with the help of a biocompatible eye patch when the child is wearing glasses. In some children both the eyes are required to be patched alternatively. Duration of patching of eyes varies depending on the severity of the condition. Children who are not co-operative with the patching of eyes can be administered with the eye drops in the eye with better vision to blur its vision temporarily. This way the lazy eye is stimulated or forced to see more.

Eye Exercises: There are some computer-based eye exercises wherein the child is required to play video games and solve puzzles in a supervised manner wearing 3D glasses.

Surgery: Children with amblyopia due to squinting of the eye require surgical intervention.

Duration of the treatment depends on the levels of improvement of vision in the patient which usually continues until equal vision is maintained in both the eyes.

Paediatric Cataracts

Cataract is one of the leading causes of blindness in children. The prevalence of cataract in India is about 15 in per 10,000 children. Earlier detection of cataract in children helps in achieving a better visual outcome. If left untended, it could lead to complete or partial loss of vision. Paediatric cataracts can occur in one eye (unilateral) or both eyes (bilateral). They can be complete or partial and can be present at birth or occur sometime after birth. Cataracts can be partial at birth and later progress to become visually significant. In contrast to adults, cataracts in children present a special challenge, since early visual rehabilitation is critical to prevent irreversible amblyopia (lazy eyes). The earlier the onset, and the longer the duration of the cataract, the worse the prognosis.

Children born with cataracts are also at risk for developing glaucoma, strabismus, nystagmus, and poor stereopsis, further complicating successful outcomes. In most cases, it is the willpower and resolve of the parents or caregivers to follow post-operative management that determines visual success for the child. Patients with acquired progressive cataracts have less amblyopia and a much better visual prognosis than patients with cataracts that cover the visual axis since birth.

Generally, monocular (single -eye or unilateral) congenital cataracts have a relatively good prognosis if surgery and optical correction is provided by two months of age. Beyond this age, there is a possibility of having dense amblyopia in the operated eye.

Bilateral cataracts are often inherited. The work-up for bilateral congenital or infantile cataracts should include a careful paediatric examination and special tests. Dense bilateral congenital cataracts require urgent surgery and visual rehabilitation. In general, bilateral cataracts operated prior to two months of age have a good visual prognosis with approximately 80% achieving vision of 20/50 or better.

Tests

During a comprehensive eye exam, our ophthalmologists quickly and accurately determine your diagnosis. If needed, this is confirmed using one or more of the following tests or procedures:

Visual Acuity Tests – These tests help determine if your vision is impaired.

Slit Lamp Exams – By giving your doctor a magnified three-dimensional (3-D) view of your eye, this diagnostic tool makes it easier to find tiny abnormalities.

Retinal Exams – While examining your retina, your doctor checks your lens for signs of cloudiness.

Treatments

Some cataracts may not affect the vision considerably, in such cases, glasses can serve the purpose. If the cataract affects the vision significantly a surgical treatment is suggested.

Cataract Extraction Surgery – Surgical removal of a clouded lens is considered the best, most successful treatment for this condition.  Cataract surgery in children is done under general anaesthesia. It involves removal of the cataractous (opaque) crystalline lens which is then replaced with a new artificial lens, called intraocular lens (IOL).  Your doctor will guide you in choosing the intraocular lens that is right for you, depending on your condition and preferences. This is often accompanied by surgical measures (primary posterior capsulorrhexis /anterior vitrectomy) to ensure the clarity of the central visual axis in the postoperative period, which can otherwise get obscured by the ‘after cataract’ (collection of inflammatory cells and fibrous tissue) formation. We currently consider IOL implantation in patients who are one year or older, and IOL implantation is the procedure of choice in children 2 years and older.

Lens options include

Monofocal Fixed Focus Intraocular Lenses – Whether surgery is done to remove cataracts or to correct refractive error, the lens that was removed is replaced with an IOL that is positioned in the same place as the natural lens. The power of the lens is selected to create a focus at distance, intermediate distance or at near for reading. Various replacement lenses are available. The standard IOL is a monofocal lens that corrects distance vision. With this lens, you see well from a distance, but need glasses to read.

Toric IOLs – These fixed focus single-vision lenses help people with astigmatism see better for distance or for near vision than they would with a non-Toric single vision IOL. Although Toric lenses improve visual sharpness at a distance or near without glasses, they do not provide both near and distance vision simultaneously.

Multifocal IOLs – Multifocal lenses provide distance and intermediate and/or reading vision. The optical results are not always perfect and some patients are bothered by subnormal distance and/or reading vision. Other common side effects include halos around lights at night and reduced vision in bright or dim light.

Strabismus (Squint)

Strabismus or squint or crossed eyes affects about 3 to 4 % of children in India. Many children manifest strabismus at a very early age. The condition is concerning as it could result from a very simple eye problem to a much-complexed one, such as amblyopia or neurological or brain-related problem. Like any other eye condition, early diagnosis and subsequent appropriate treatment early on is very significant.

Strabismus could be a sign, that the child may have another eye condition like the refractive error or lazy eye or eye muscle imbalance. It also indicates the possibility of poor vision in one of the eyes, structural abnormalities like underdevelopment of optic nerve, issues in the brain and in very rare cases eye cancer.

Tests

A complete eye exam is the first step to developing an effective treatment plan. During this exam, the ophthalmologist may use several testing methods to determine the severity of the condition and the best course of treatment. 

These include:

Visual Acuity – The patient reads letters from an eye chart to evaluate the vision. Very young children may be tested by looking at pictures instead of letters.

Motility Exam – A doctor examines the eyes to see if they are properly aligned and if there is any muscle dysfunction.

Refraction – As part of the exam, the doctor places a series of corrective lenses in front of the eyes to find the correct lens power the patient needs to compensate for a refractive error (near-sightedness, farsightedness or astigmatism).

Treatments

Treatment of squint varies from person to person, depending on the cause and nature of the condition. Based on the findings of the tests conducted, the most appropriate plan of treatment will be decided by the paediatric ophthalmologist.

Eyeglasses or Contact Lenses – Special eyeglasses or contact lenses help straighten the eyes in some patients.

Prism Lenses – If needed, the patient can be fitted with special prescription eyeglasses that have a prism power in them.

Patching – Patching the normal eye a few hours each day forces the weaker eye to work harder. Over time, the vision in the weak eye becomes stronger, which may improve eye alignment.

Medications – Young children who cannot tolerate an eye patch may benefit from atropine eye drops. These drops temporarily blur vision in the normal eye, making the weaker eye work harder. This strengthens the vision in the affected eye.

Eye Muscle Surgery – If conservative treatments are not sufficient, an eye surgeon operates to weaken or strengthen the eye muscles and realign the eyes. Surgery is most successful when performed early, to establish binocularity – the ability of both eyes to focus on an object to create a single image.

The aim of strabismus surgery is to adjust the muscle tension on one or both eyes in order to pull the eyes straight. Strabismus surgery is usually a safe and effective treatment, but is not a substitute for glasses or amblyopia therapy.

Despite a thorough clinical evaluation and good surgical technique, the eyes may be closely aligned after surgery, but not perfect. In these cases, fine adjustment is dependent upon the coordination between the eye and the brain. Sometimes patients may require the use of prisms or glasses following eye muscle surgery. Over-corrections or under-corrections can occur and further surgery may be needed.

General anaesthesia is required in children. Recovery time is rapid and the patient is usually able to return to normal activity within a few days (2-3 weeks). As with any surgery, eye muscle surgery has certain risks. There is a small risk of infection, bleeding, excessive scarring, and other rare complications, which can lead to loss of vision.

Paediatric Glaucoma

Although it most commonly affects the elderly, childhood glaucoma (from birth to 18 years of age) affects 1 in 3300 children in India.  In these children, the fluid inside their eyes (which controls the intraocular pressure or IOP) does not drain properly. Normally, fluid flows in and out of the eye. When it builds up to high levels, however, it creates too much pressure inside the eye. This condition damages the optic nerve, the structure that delivers visual information from the eyes to the brain. Left untreated, glaucoma leads to irreversible blindness.

Identifying Paediatric Glaucoma at an earlier stage is the best way to defy irreversible blindness in children. Usually, Paediatric Glaucoma exhibits between birth to 18 months of age, however, many children are born with this problem. Some children may also suffer from secondary glaucoma which could be caused by injury, some other eye surgery or as a result of using certain medication for a long time. Because paediatric glaucoma is uncommon and harder to detect, it is important to seek specialized care.

Tests

Comprehensive Eye Examinations – Our paediatric ophthalmologists use child-appropriate exam techniques to diagnose childhood glaucoma.

Imaging Tests – Optical coherence tomography (OCT) gives your child’s physician a 3-D view of the retina, optic nerve and other structures inside the eye. Other imaging tests may include photography and ultrasounds.

Treatments

Paediatric Glaucoma is usually treated with both, surgically as well as with medicines. The surgery requires a well-trained Paediatric Glaucoma Specialist. After the surgery, many children recover completely. However, a few may require medical treatment for a long time, in some cases, the entire life.

Surgery – Most children, especially babies with primary congenital glaucoma, have better vision results from surgery than medication. Options may include goniotomy, trabeculotomy, or a glaucoma drainage device. Some children need surgery more than once to control the eye pressure. In infants younger than 2 months of age or who were premature, sometimes an overnight stay is required after surgery. Otherwise, most children go home the same day after glaucoma surgery. 

Approximately 80-90% of babies who receive prompt surgical treatment will do well, and may have normal or nearly normal vision for their lifetime. Most babies who have glaucoma and do not obtain appropriate care quickly will lose their vision. Early detection and treatment can mean the difference between sight and blindness.

Eye Drops and Oral Medications – When glaucoma develops during childhood, in addition to surgery, your child’s physician may prescribe eye drops or oral medications to control intraocular pressure (IOP)

Glasses and Patching Therapy – Many children with paediatric glaucoma develop myopia (near-sightedness) and amblyopia (lazy eye), and will need glasses and patching therapy. 

Paediatric Medical and Surgical Retina

The retina is crucial to your child’s central vision. Located at the back of the eye, this thin, light-sensitive layer of tissue sends visual signals between the eyes and brain. We treat children from birth to adolescence — a time when vision is key to your child’s emotional, physical and social development.

Some babies and children develop retinal conditions from genetic disorders or eye injuries. We treat children’s retinal problems, including those listed below.

Retinal Detachment

Detachments occur when the retina pulls away from its normal position. In children, this can happen for reasons including:

• Traumatic eye injury
• Complications following eye surgery, especially cataract surgery
• Family history of detached retinas
• Severe near-sightedness
• Prior detachment in one eye
• Prior eye disease or inflammation

Symptoms of this condition may include:

• Sudden flashes of light or floaters – dark spots drifting across the line of vision
• Blurred vision
• Increasingly worse side vision
• Curtain-like shadow over the visual field

The longer a detachment goes undiagnosed, the higher the risk of permanent vision loss. Each of our five locations has a team of retinal specialists and operating rooms available to treat eye emergencies 24/7, throughout the week.

Retinopathy of Prematurity (ROP) 
ROP affects retinal blood vessels in premature or low birth weight babies. It can cause retinal detachments and blindness if left untreated.

If your child has a retinal condition, you need highly skilled physicians and the latest treatments to protect their vision.

Tests

Retinal Examination – As part of a thorough eye exam, your child’s physician may use an ophthalmoscope’s bright light and special lens to view the retina. This gives the physician a very detailed view of any retinal problems.

Ultrasound Imaging – If bleeding is present inside the eye, the doctor may use ultrasound imaging to detect any abnormalities in the retina.

Treatments

Pneumatic Retinopexy – In this method, we inject a gas or air bubble into the centre of the eye. The bubble presses the retinal hole against the wall of the eye, preventing intraocular fluid from leaking behind the retina. Any retinal holes or tears are also sealed with laser coagulation (heat) or cryopexy (freezing). Both methods prevent fluid from leaking under the retina. Over time, any remaining fluid under the retina and the bubble reabsorb and the retina reattaches to the eye wall.

Scleral Buckle – In this procedure, we sew a thin silicone band to the white (sclera) part of the eye. The buckle makes an indentation in the wall of the eye. This reduces pressure caused by the vitreous (a gel-like substance inside the eye) and keeps it from pulling on the retina. If there are several retinal holes, tears or a severe detachment, we may surround the entire eye with a scleral buckle. The buckle is invisible and positioned so it does not interfere with vision.

Vitrectomy – A vitrectomy removes the vitreous fluid and tissue tugging on the retina. To keep the retina in place, air, gas or silicone oil is then inserted into the vitreous area. Over time, this reabsorbs and the vitreous space refills with natural fluid. In some patients, a vitrectomy is combined with a scleral buckle.