Pediatric optometry
Pediatric optometry is a specialized branch of eye care focused on diagnosing and treating vision disorders in children. Practitioners in this field undergo extensive training beyond their optometry degree, including a one-year residency that equips them with the skills to handle conditions unique to children's visual development. Pediatric optometrists address a wide range of issues, from common refractive errors like nearsightedness and farsightedness to more complex conditions such as amblyopia and strabismus, which can affect a child's ability to see and interact effectively with their surroundings.
The role of a pediatric optometrist extends to understanding how vision problems can impact a child's overall development, including academic performance and social interactions. They conduct thorough eye examinations, including health histories, to assess potential disease risks and determine appropriate treatment, which may involve corrective lenses or vision therapy. Collaboration with pediatric ophthalmologists is also crucial for cases requiring surgical intervention or further specialized care.
Given the increasing demands of literacy and screen time in modern culture, the need for pediatric optometry services is on the rise, highlighting the importance of early detection and treatment of vision issues to support healthy development in children.
Pediatric optometry
Anatomy or system affected: Eyes
Definition: The diagnosis and treatment of vision problems and of diseases and injuries to the eye in infants and children.
Science and Profession
The pediatricoptometrist has received special training in the diagnosis and treatment of vision disorders in children beyond the four years of optometry college that are required for the Doctor of Optometry (OD) degree. Those who choose pediatric optometry as a specialty must, during a one-year residency, develop competency in the diagnosis and treatment of childhood vision disorders as well as develop knowledge about the various aspects of child development. They must learn to prescribe and carry out vision therapy that can help children overcome problems of eye movement, eye coordination, and perception.
The optometrist is concerned with the health and functioning of all parts of the eye: the eyelids, which act as a filter; the cornea, which covers the outer part of the eye, bends light for focusing, allows the light to pass to the retina, and protects the eye from infection; the conjunctiva, which covers the underside of the lid and allows for the proper wetting of the cornea; the lachrymal system, a glandular system that produces and eliminates tears; the orbit, the bony structure that holds the eyeball; the extraocular muscles, which control eye movement; the lens, which provides focus; and the pupil, which regulates the amount of light that enters the eye. Optometry is also concerned with the visual pathway, the route that light takes from an image through the pupil, through the lens, to the optic nerve, and to the brain for interpretation. Optometry also considers problems related to the visual field, which describes the area that can be seen to the left, to the right, up, down, and in front.
In general, children suffer the same range of visual problems that adults suffer, even cataracts and glaucoma. Conditions, such as amblyopia or strabismus, in which one eye does not function properly with the other eye, are also treated by pediatric optometrists. These conditions are characterized by eye turns that may be esotropic (inward) or exotropic (outward). Esotropic turning usually occurs at birth, while exotropic turning generally occurs after six months of age. Whether the eye turns inward or outward, the pediatric optometrist must work with the patient to establish or restore binocularity, the process of two eyes working together to send an image to the brain; individuals who do not have binocularity have problems with depth perception and distance judgment.
Like adults, children have problems with farsightedness, nearsightedness, and astigmatism as well as with eye injuries and diseases of the eye, such as conjunctivitis, a highly contagious infection of the conjunctiva. Various diseases occurring in childhood, such as rubella and juvenile-onset diabetes, might affect eye functioning and create vision disorders.
Even though children have many of the same eye and vision problems as adults, childhood is a special developmental period. Eye or vision problems can significantly affect the quality of a child’s early years as well as the quality of the child’s future. A child’s ability to read well, to complete schoolwork, to play sports, and to interact effectively with peers may all be hampered by poor eye health or by vision problems. Pediatric optometrists must have knowledge of all aspects of human development and must understand how vision problems can impact development.
Diagnostic and Treatment Techniques
Upon the initial examination of a child, the pediatric optometrist first takes the child’s health history. A health history is important because many types of diseases, such as diabetes, and many kinds of physical conditions, such as high blood pressure, can create vision problems. The optometrist also obtains a family medical history, since certain visual problems are genetically based.
Next, the pediatric optometrist examines the patient’s eyes for disease and injury. Certain tests are performed to determine visual acuity, perception, and reaction. An optometrist may prescribe visual therapy to improve or correct problems related to binocularity, perception, or reaction. Corrective lenses are prescribed to correct problems of acuity. When glasses are needed, the optometrist may work with an optician to make sure that the child receives eyewear that is flattering, as eyewear can affect the child’s social life.
In cases of amblyopia and strabismus, surgery may be indicated. If so, the pediatric optometrist refers the patient to a pediatric ophthalmologist. Modern practice generally involves the use of vision therapy to train the eyes to work together. Sometimes, surgery is performed for strabismus, but often such surgery is only cosmetic; vision therapy is still required. Pediatric cases involving glaucoma, cataracts, or tumors also require the optometrist to work closely with an ophthalmologist.
Perspective and Prospects
Research indicates that cultures that rely heavily on work requiring close visual examination, such as reading, have much higher incidences of vision problems than do other cultures. Thus, in the modern world, where there is a high dependence on literacy skills and computer use for recreational purposes, for communication, and for job functions, it is likely that all aspects of pediatric optometry will grow in the foreseeable future.
Bibliography
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Buettner, Helmut, ed. Mayo Clinic on Vision and Eye Health: Practical Answers on Glaucoma, Cataracts, Macular Degeneration, and Other Conditions. Mayo Foundation for Medical Education and Research, 2002.
Clark, Robert. Does Your Child Really Need Glasses? A Parent’s Complete Guide to Eye Care. Crown, 2003.
D’Alonzo, Thomas L. Your Eyes! A Comprehensive Look at the Understanding and Treatment of Vision Problems. Avanti, 1991.
Jennings, Barbara J., ed. Pediatric Optometry. Appleton & Lange, 1996.
Museum of Vision. "Healthy Eyes, Healthy Body." Foundation of the American Academy of Ophthalmology, www.aao.org/museum-education-healthy-vision/healthy-eyes-healthy-body. Accessed 25 July 2023.
Nathanson, Laura Walther. The Portable Pediatrician: A Practicing Pediatrician’s Guide to Your Child’s Growth, Development, Health, and Behavior from Birth to Age Five. 2nd ed., HarperCollins, 2014.
Remington, Lee Ann. Clinical Anatomy of the Visual System. 3rd ed., Butterworth-Heinemann/Elsevier, 2014.
"What Is a Doctor of Optometry?" American Optometric Association, www.aoa.org/healthy-eyes/whats-a-doctor-of-optometry. Accessed 25 July 2023.