Diseases of the eyes in children

One third of ophthalmic patients in the west are children, and there are around 1.5 million children with severe eye disorders and completely blind throughout the world, many of them suffering from genetically determined diseases. Naturally, the study of the features of the structure of the organ of vision in children and the treatment of eye diseases and the visual system in childhood rightfully becomes an independent specialty. In many countries there is an artificial division of pediatric ophthalmology and its section devoted to the study of strabismus. This is a historically formed, but absolutely unfounded, division. Although the desire of some physicians to show interest in certain aspects of ophthalmology is inevitable, strabismus, being the most common eye disease for childhood and observed in many children with both the pathology of the organ of vision and systemic diseases, will lose relevance without understanding this problem specifically for children's ophthalmologists. Similarly, it is pointless to assume that any ophthalmologist will show interest in pediatric ophthalmology, ignoring the problem of strabismus at the same time, or will be interested in strabismus, ignoring extraocular manifestations of this disease.

Children have the whole life ahead of themselves, and the loss of sight has a devastating effect on them, affecting all aspects of a child's development. That is why the fact of the existence of 1.5 million blind children in the world is much more important than it seems at first glance.

A pediatric ophthalmologist must not only understand the diseases of the eye organ in children, but must be able to find an approach to the child for clinical research, history and assistance. The formal approach is usually not successful. A doctor dedicated to working with children should be able to help the child feel "at home" even after such an unpleasant procedure as instillation of drops. Children should have special compassion, be able to delve into the problems of their family and understand issues that complicate the life of the child, his parents and his entire family.

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Epidemiology of eye diseases in children

In 1992, there were 1.5 million children with severe eye disorders in the world and absolutely blind. These children are blind all their lives and all those years that they have lived in this condition are a huge price for the imperfection of modern ophthalmology. 5% of blind children die in childhood. In Canada, the incidence of congenital blindness is 3% of all newborns.

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Causes of eye diseases in children

The developed countries.

1. Genetically determined diseases:
   • diseases of the retina;
   • cataract;
   • glaucoma.
2. Intrauterine infections.
3. Acquired diseases:
   • retinopathy of prematurity;
   • visual impairment of the central genesis;
   • injury;
   • infection (rarely);
   • cataract.

Developing countries.

1. Dysfunction - avitaminosis A.
2. Genetically determined diseases:
   • retina;
   • the lens;
   • measles infection;
   • traditional medical treatment.

Other countries.

The proportion of retinopathy of prematurity is increasing.

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Screening

Screening can be defined as a thorough identification of subclinical signs of the disease. It must be remembered that screening is not 100% effective. Inevitably, the appearance of erroneous diagnoses both in the direction of overdiagnosis, and in the direction of hypodiagnosis. When conducting screening, the following rules must be adhered to.

1. The disease to be screened for should be an important health problem for both the individual and society as a whole.
2. The features of the clinical course of the disease should be known.
3. There must be a latent or subclinical period.
4. There must be an effective method of treating this pathology.
5. Tests used in screening should have technical simplicity, accessibility for mass use, do not contain invasive manipulation and do not require expensive equipment.
6. When screening, use effective tests that have an appropriate level of specificity and sensitivity.
7. For the disease that is being screened, there should be a full diagnostic service and adequate therapeutic treatment.
8. Early intervention during the course of the disease should have a beneficial effect on the possible outcome of the pathological process.
9. Screening programs should not be expensive.
10. Screening programs must act continuously.

Screening for amblyopia and strabismus

The question of the need for screening to detect this pathology is still controversial in connection with the following theses:

1. being a unilateral condition, this pathology does not have a significant negative effect on the life of the child and the level of his health in general;
2. the treatment does not always produce the expected result (low efficiency of treatment is due mainly to the difficulty of providing full occlusion);
3. screening for these diseases is an expensive procedure.

Methods of screening

1. Screening at birth is effective only to detect a rough extraocular pathology. Ophthalmoscopy helps to identify opacities of the optical medium of the anterior segment of the eye. In connection with the fact that screening of this type is not carried out by ophthalmologists, but other specialists, refractive disorders and pathology on the fundus are, as a rule, rarely detected.
2. A vision study at the age of 3.5 years. Despite the feasibility of this study, it allows us to identify only relatively resistant to treatment of visual impairment. Conducting at this age of occlusion is difficult due to the child's intransigence. With good training, it is possible to conduct research by mid-level medical personnel.
3. Screening for the detection of amblyogenic factors. Detection of refractive and strabismus disorders can be performed by the average medical staff using a photorefractometer and simple methods of investigation.
4. School screening. In developed countries, vision testing is conducted in many schools. The survey is usually conducted by a school nurse or teacher and if the child has a visual acuity less than 6/9 (0.6), the study is repeated, and with a visual acuity of 6/12 (0.5) and lower, they are sent to the ophthalmologist. It is desirable to conduct a study of visual acuity for both near and far. Treatment of amblyopia, revealed at this age, is usually ineffective.
5. Screening in groups of children at high risk of developing the disease, for example, among children with a hereditary predisposition to cataract, aniridia, retinoblastoma, etc.
6. Screening for the detection of retinopathy of prematurity. Once it was established that the progression of retinopathy of prematurity may be suspended by cryo-or laser-therapy, screening for the detection of this pathology in many countries has become an indispensable procedure.
7. Screening for the detection of infectious diseases. The question of the need for screening for this purpose remains controversial. For example, many countries have refused mass screening to detect toxoplasmosis due to the complexity of implementing all the necessary screening criteria - treatment of toxoplasmosis does not guarantee 100% safety. The clinical course of the disease has not been fully understood and the probability of fetal damage in case of toxoplasmosis in the mother is unpredictable. Therefore, early intervention in the course of the disease is not sufficiently effective. Screening for the detection of toxoplasmosis is more appropriate in countries where there is a high prevalence rate.

Significance of visual disorders

Visual disorders arising in childhood, in addition to their isolated effects on the visual system, have a special effect on the entire development of the child.

1. They can be combined with common diseases.
2. Contribute to the delay in development in other areas, for example:
   • speech development delay;
   • difficulties in dealing with parents, other family members and peers;
   • autism;
   • stereotypes of behavior - repeated aimless movements, jerky and oscillatory movements of the eyes, etc .;
   • decreased intellectual capacity;
   • learning difficulties;
   • delay in motor development, hypotension and weakness;
   • obesity.

Mental retardation in blind children is common and, in addition, there is a high correlation of the combined visual disorders in children with mental disorders.

Treatment in the early stages of the disease

The beneficial effects of early assistance to a blind child and his family have been established, including instructing parents about the timely initiation of incentive measures, the purchase of appropriate toys, furniture (for example, a chair where the child can sit and see the objects around him using residual vision). It is necessary to explain in detail to parents the peculiarities of the upbringing of a sick child.

The first diagnosis of a lack of vision in a newborn

1. Correctly to establish the diagnosis help:
   • identification of genetic defects;
   • clinical experience of the doctor.
2. Postpone all discussions of the situation until the final confirmation of the diagnosis.
3. Bring to the attention of parents information obtained during the survey.
4. Periodic meetings and interviews with parents are mandatory. Remember that most people are only able to perceive a certain amount of new information at a time.
5. Try to bring the information to parents, using diagrams and drawings, as easily as possible. It is important to honestly describe to parents the level of your own competence in this matter.
6. If treatment is impractical, explain to parents why.
7. In the available words, explain the prognosis of the disease to the parents.
   • Are the difficulties of the child's movement possible in the future?
   • Is it possible to get a regular education?
   • Will the child be able to drive a car?
8. If necessary, get the opinion of another specialist.
9. Explain to parents the difference between the total loss of vision and the disorder of vision that is revealed in their child.
10. Carry out stimulating measures in the presence of any residual vision; organize the earliest possible help to the child.
11. Avoid the pessimistic coloring of the forecast.
12. Think about what additional factors can complicate a child's life:
    • mental retardation;
    • loss of hearing;
    • others.
13. Involve parents in active participation in the conversation.

Family of a child with visual disorders

1. Parents:
   • they hardly realize the full gravity of the situation;
   • Since the diagnosis is established, qualified medical care is needed;
   • Common psychological support is beneficial;
   • unification of parents with similar problems in groups;
   • the formation of groups on the disease's nosology - neurofibromatosis, tuberous sclerosis, and so on;
   • the organization of the nanny's service, helping parents in the care of sick children;
   • home care;
   • help through home appliances that facilitate the organization of the life of a blind child.
2. Brothers and sisters:
   • Do not allow the appearance of jealousy, due to the increased attention of the whole family to a poorly seeing child;
   • parents should remember that healthy children are no less important to them than a sick child;
   • family income must be distributed fairly.
3. Grandmothers and grandfathers:
   • are often concerned about the low vision of their grandchildren, psychological assistance for them may be participation in the life of the family;
   • can bring great benefits, caring for the child and providing moral support to the parents.