The main cause of developing Refractive error is either in the Refractive Medium or the length of the Eyeball.
There are 2 refractive mediums. 1. Cornea 2. Lens.
If the Corneal curvature is not smoothly curved then Myopia or Myopic Astigmatism may come
If the Lenticular Curvature is not smooth that can also cause Myopia or Myopic Astigmatism
The Second Variant is the Length of the Eyeball. If the Eyeball continues to grow more and more, then the Myopia progression can be fast.

Symptoms:
1. Blurry Vision
2. Headaches
3. Watering from the eyes
4. Squeezing the eyes to see
5. Squinting of the eyes
6. Spelling mistakes in classroom
7. Losing interest to study

What causes Myopia?
1. Genetics: Near Sightedness may run in the families. If one parent is Myopic the chances of having child Myopic increases, if 2 parents are Myopic there are 4 times increased risk of children to be myopic
2. Environmental: Due to Modern Day living, outdoor activities have drastically reduced and Gadget exposure is more in kids and this may contribute to developing Myopia

What cause Myopia Progression?
When children have Myopia the power can go on increasing till 18-20 years of age as the Axial length grows along with the height of the child.
Progressive myopia is nearsightedness that worsens year after year in childhood. If myopia progresses enough, it can become high myopia, which is severe nearsightedness. High myopia increases a child’s risk of developing several sight-threatening complications in adulthood.
It isn’t fully understood why only some nearsighted children develop progressive myopia. But evidence points to clear links between myopia development, time spent outdoors and near-work activities.

Complications:
1. Retinal Weakness
2. Retinal Detachment
3. Impaired Safety due to poor vision
4. Academic Burden: Due to poor vision

How to Correct?
1. Glasses
2. Contact Lenses

How to prevent Progression?
1. Regular Checks and Changing Glasses when advised
2. Increasing Outdoor Activities in Sunlight
3. Reducing Gadget usage by kids
4. Using Myopia Control Eye Drops to prevent Progression

5. Using Myopia control Glasses to limit Progression

For Each patient the Pediatric Ophthalmologist will customize a Tailored Plan to help you and your child.

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It is Preferable to see a Pediatric Ophthalmologist for your child as

• There are specialized charts for Non-Verbal children or special children to assess the vision
• The Refraction evaluation is more accurate due to vast experience in non-subjective way of assessing children
• Stereoacuity and Binocularity are evaluated
• The Convergence and Accommodation (which are functions of the visual system) are also specially evaluated
• Preventive Medical Care in form of exercises, vision therapy and diet changes are also available
• The doctors in this speciality are trained with and molded to be very patient and empathic towards patient care that involves the child, parent and care givers.
• Surgeries on kids’ eyes requires much more precision and planning for the whole life of the child as is learnt by these professionals.

So, Book your Annual Eye Evaluation with our Pediatric Ophthalmologist for Holistic Eye Care for your Child.

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So Even in Eye Care, we have Specialities like Cornea Specialist (Who deals with specialized surgeries on the Front Layer of the Eye), Glaucoma Specialist, Retina Specialist, Cataract Specialist, Oculoplastic Surgeons and Pediatric and Adult Squint Surgeons. The field of Pediatric Ophthalmology and Adult Strabismus Started in India around 3 decades back. The need for Eliminating Needless Blindness in children was high and doctors from all over the country were trained to take care of this special group.

So, a Pediatric Ophthalmologist is a Doctor who is MBBS, MS/DNB in Ophthalmology and then Fellow in Pediatric Ophthalmology and Adult Squint which is an additional 2-year Course.

Some of the SERVICES OFFERED ARE:

• Screenings of Retinopathy of Prematurity (which occurs in Premature babies in the 1^st month of life),
• Refractive Errors,
• Lazy Eye or Amblyopia management,
• Squint Surgeries,
• Eye Watering Management,
• Nystagmus Management,
• Pediatric Cataract Surgeries
• Pediatric Low Vision management
• Adult Squint corrections
• Cosmetic squint surgeries
• Nystagmus Surgeries.

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The typical signs of visual difficulties to look out for in your child are:

1. Rubbing or watering of eyes

2. Squinting of eyes

3. Squeezing of eyes

4. Going near to books or television to see

5. Repeated Headaches

Every child, even without any symptoms or complaints should have eye checkup by a Pediatric Ophthalmologist to rule out any issues to this delicate and growing organ of the body.

Early Evaluation, Detection and Treatment prevents life long consequences of eye issues. The critical period of visual development is upto 6 years of age, and till this age, any unsolved eye issue can affect the visual development and binocularity of the child.

For any further queries, please feel free to ask your questions to Dr Aloka Hedau. She can answer the queries at   “dralokahedau@gmail.com“

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Eye is a growing organ and changes happening in the shape and size of the eyes every year till 18 months of age.

A newborn child should have an Eye Examination to look for any Birth defects or infections at birth.

Retinopathy of prematurity is a disease of the posterior or back part of the eye, where the Undeveloped retina of the child’s eye can have silent bleeding or retinal detachment and cause permanent vision loss. There will not be any signs of this silent disease for the parents to look out for and the only way ahead is to get the child to a Pediatric Ophthalmologist or Retina Specialist for early detection and management.

If the child is Premature Born or Born with many Post birth complications, the First eye test should be at or before 3 weeks of age to look for Retinopathy of Prematurity (ROP)

Any child with developmental delay should also have an eye examination to look for Visual Abnormalities or Diagnostic Clues like in Metabolic diseases. Issues like Squint or crossed eyes, reading difficulties, Myopic astigmatisms (glass powers) are very common in this age group.

All other kids should have annual eye evaluation.

A Child who is preverbal is tested with many Visual Clues and tests like Optokinetic Drum or Teller Acuity Testing. Visual fixation and followability can be made out by your Pediatric Ophthalmologist even as early as 4 months age.

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Who are more Predisposed to Progression of Myopia? 

Those who have a Parental history of Myopia, who have started wearing glasses at a young age, who have more Near work are more Predisposed to Progression of Myopia. 

Does Outdoor Activity Help? 

To Prevent Progression of myopia to high myopia requires public health interventions.  

There are many studies done to compare role of outdoor on myopia control. Outdoor environment may be effective due to bright light, high spatial frequency, better contrast, lesser hyperopic peripheral retinal defocus, wider field of vision, different chromatic spectrum of light and higher Vitamin D levels. Lingham et alⁱ found solid evidence that exposure to bright light can reduce risk of myopia. Many studies have recommended 90 minutes outdoor playtime to reduce the risk for developing myopia or progression of myopia.  

Role of Gadgets in Progression of Myopia 

Factors like Increased Near work indoors and lag of accommodation are also under analysis to be the cause for rapid progression of myopia.  

In an extensive study done by Huang et alⁱⁱ they found increased near work distance>30cm, stopping near work every 30 minutes and increasing the outdoor play time has a definite influence of prevention of prevalence and progression of myopia.  

Other Factors causing Myopia Progression

Also, make sure that during this time the kids are wearing their glasses. Visual blur can be a significant factor to cause progression of myopia.  

Also, the rule of 20-20-20 helps make sure that the children’s eyes are not too much strained while doing near activities. This rule means every 20 minutes ask the child to take break for 20 seconds and look at something 20 feet away.  

 Therapies for Prevention of Myopia Progression 

Pharmaceutical methods in the form of 0.01% Atropine eye drops have been found to help prevention of Myopia Progression. ATOM studiesⁱⁱⁱ went on to prove that 0.01%of Atropine is effective in preventing progression f myopia without the side effects of blurring near vision or causing pupillary dilatation.  

The Progressive Addition lenses^iv compared to single vision lenses have also been found to prevent progression of Juvenile Onset Myopia in many studies like the COMET studies. This has been found to work by reducing the Peripheral Hyperopic Defocus which has been found to cause progression of myopia.  

Annual Eye checkup is mandatory for all school going children to have early detection and treatment of eye problems 

Book your appointment with Dr Aloka Hedau, Pediatric Ophthalmologist and Adult Squint Surgeon through www.dralokaseyecare.com 

For more details contact Dr Aloka’s Eye Care at dralokahedau@gmail.com 

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