Squint

Can you explain to us what is Squint ? And what is the treatment.

When you look at something both your eyes are looking together.

Therefore this requires three or four assumptions for good vision.

One, your eyes are aligned in same direction.

Two, they have to move in conjunction.

Imagine a chariot, that is your brain, the 2 horses are the eyes and the multiple 8-10 reins are the muscles. The horses have to be of same strength, same speed and to turn together on pull of reins.

Thirdly your eyes have to be seeing clearly (means they have NO refractive errors).

Fourthly your brain has to be able to mix all the images (messages) from both eyes and show you one picture (with depth, 3 Dimension).

To understand how 2 eyes are different and yet brain mixes and show you one Picture, do this experiment.

Close your left eye and look at a scene with right eye, now close right eye and look at same scene with left eye. This is how 2 different pictures are then mixed by the brain and you see a single picture.

Now, when the 2 eyes are not aligned straight , in simple words it is known as Squint. (Your horses are not in synchronicity)

The commonest cause in children is Refractive error, and hence the treatment is right correction, that is Glasses/ Spectacles.  Therefore every child, should be seen by a Kids Eye Doctor , at the latest by four years of age. Especially Kids with Squint should be seen as early as possible..

There are other causes of Squint too : Birth Trauma, Infection, Paralysis, Weakness of Muscle, Weak eye, Lazy eye, etc etc.

Everything can be treated. But how much treatment is necessary, when to treat, how to treat, whether to delay is the decision of the Kids Eye Doctor.

The next common treatment for Squint is Surgery. Where the muscle is shortened, lengthened or position is changed. This sounds easy, but is a delicate surgery, as you have to adjust the 8-10 reins of your horses, so that the horses align perfectly.

Trust your Kids  Eye Doctor and ask as many questions as need be.

The other treatments of Squint are dependent on the specific cause.

What if we do not treat the Squint, as per the instructions of Kids Eye Doctor?

Then you stand to definitely have one of these, or more:

Permanent Squinting Eyes.

Weak Eyes.

Double Vision.

Impaired mobility for lifetime of the child.

Abnormal head posture, leading to it becoming permanent.  .

Can you please talk a bit about Cataract, Children and Treatment.

Can you please talk a bit about Cataract, Children and Treatment.

There is a clear lens hanging in the eye, when this lens gets dirty it is called cataract, and the lens has to be changed.

Imagine a window, when it gets dirty, this simple process prevents you from seeing things clearly, you have to replace the window.

Now Cataract is usually an age related problem.

Hence seen in Children in a very small percentage.

But when seen in Children it is a Medical Emergency.

If this is not treated urgently, and with utmost knowledge and precision, it will surely lead to Weak eyes, Blind Eye, Squint, Glaucoma and many other problems.

The first step of treatment of Cataract is removal of the cataract.

In the past it was deferred to a further age as the Anaesthesia and its equipment for very small babies could not guarantee the safety of the childs life. Not so now. Therefore Cataract removal is taken as soon as Pediatrician gives clearance.

The further treatment plans may differ depending upon age and eye size of the child :

Lens to be implanted or at a later date.

Treatment with glasses, follow up every 4 months.

Contact lenses.

Glaucoma surgery.

Glaucoma treatment.

Eventually Lens implantation.

Yes the journey will be long.

But the Child will get back very good workable vision.

Your Pediatric Ophthalmologist will be with you all through this journey.

MYOPIA

What is myopia ?

It is a Refractive error of the eye which is corrected by minus number glasses (eg -2.25 D spherical).

In very layman terms, near objects are seen clearly and distant objects , or things far away are seen blurred.

What is the best treatment ?

Myopia can  easily and commonly corrected with (a) glasses (b) contact lenses. There are also newer surgeries for Myopia but they have to be taken up only after a certain age of the patient , after thorough assessment and after reviewing the side effects.

How does age affect myopia ?  or

Why do numbers increase ?

Normally every one is born with a little plus (+) numbers and as we grow (till  10-12 years) due to changes or growth in the eye this becomes zero (emmotropia).

But suppose you are detected with minus numbers (myopia) at age 4-10 then these numbers will increase till you grow to 18-21 years of age and then they will stabilize. Usually there is no change in numbers after this.  

Why should a myopia patient get a Retina check regularly ?

Retina, as it is is a very thin and delicate , innermost layer to the eyeball. In myopia it is extra thin. Further more there are some extra thin, frayed areas, called as Lattice found majorly in Myopes. These have to be specially looked for by a Retina Specialist.

These make a myope more prone or liable to Retina Problems (especially Retinal Detachment).

Cautions or Self Tests in Myopia ?.

Decrease in vision

Decrease in field of vision

Sudden increase in floaters (black spots)

Flashes of lightening

Curtain of darkness (Retinal Detachment)

The above 2 ** are an Emergency and you should contact and see your eye doctor immediately.

Why do I see these Black spots (Floaters) or Wiggly lines ?

In certain conditions the jelly that fills your eye (vitreous) it starts converting to liquid. The strands that float in the pockets of liquid formed, you see them as black flecks (floaters)  or wiggly lines. They will not harm you. You will learn to ignore them.

What is Laser therapy sometimes advised to a Myopia patient, even children?

When the thin areas, Lattice, seem likely to produce a potential to damage, they are welded more firmly to the eye by Laser. It is a very painless, OPD procedure.

Can Myopia be cured by “Special medicines” / Yoga / exercises ?

Myopia can be treated, it can not be cured. Patients can lead a normal life with the aid of glasses and contact lenses and should enthusiastically do so.

Updated February 2019: American Academy of Paediatric Ophthalomology has published that the new figures for Myopia in USA are 40% of kids below 15 years of age. Use of iPads, Phones and TV being the main culprit again.

What is this new "Atropine to prevent Myopia" ?

This is a updated version of June 2024 to the old post. This contains newer relevant information. We have retained the old post to just lend you a perspective. Under the guidance of a Kids Eye Doctor the Atropine drops does work.  The Drops are available in India. 

Old post=

This "New Treatment" of "Atropine drops to prevent progression of Myopia" has originated from a Study being done in Singapore, SNEC. 

Treatment: Atropine drops are instilled daily to prevent the progression of Myopia in Children.

100% of the Children of Singapore are Myopic (also a high percentage in Chinese).This is an alarming factor, as a statistic and a health concern for a nation.

When Atropine was used for other purposes, the progression of Myopia was arrested.

So a prospective study was started. 1% atropine drops were instilled once a day in eyes of Kids. This definitely arrested the myopia progression. But it got along with it, a dilated pupil, allowing much extra light to enter the eye, hence discomfort and unknown long term ill effects. It also brought along difficulty in near vision, where Kids had to be given glasses for near vision or progressive glasses. Plus logically, the treatment has to stop at some time, when the myopia came back, known as rebound myopia, in a much severe progression. So it did not serve the purpose.

So the next prospective study was done with 0.5 %  Atropine drops. Again same results. This definitely arrested the myopia progression. But it got along with it, a dilated pupil, allowing much extra light to enter the eye, hence discomfort and unknown long term ill effects. It also brought along difficulty in near vision, where Kids had to be given glasses for near vision or progressive glasses. Plus logically, the treatment has to stop at some time, when the myopia came back, known as rebound myopia, in a much severe progression. So it did not serve the purpose.

So now the latest study is on with 0.01% Atropine drops. It does stop the progression of Myopia. But the questions and ill effects still remain. 

So whenever my patients hear or read about these "New treatements" i talk to them in detail about this. Ask them to read about it. Then again discuss. Then ask them to get drops from Singapore . The 0.01 % drops are not available in India, and the doctors in India are diluting physically the 1 % drops and giving to their patients.

After all these deliberations , only a small % of my patients have opted for this treatment.  But as a researcher i am as yet not dismissing it, i am awaiting definite conclusions.

THESE  DROPS  ARE  NOW  AVAILABLE  IN INDIA  BY INDIAN COMAPNIES.

Updated February 2019: American Academy of Paediatric Ophthalomology has published that the new figures for Myopia in USA are 40% of kids below 15 years of age. Use of iPads, Phones and TV being the main culprit again.

My baby is born Premature. Do i need to know anything special about the eyes?

Your baby is premature.

The Vision of your baby depends upon the baby’s RETINA, which also is premature bcos your baby is premature.

You require a ROP check by a Retina specialist to prevent risk of blindness in your baby.

·        What is this ROP ??? (Retinopathy of Prematurity)

·        Why should I be worried about the eyes of my premature baby ?

The innermost layer of the eye (the retina) is not fully developed (it too is premature) in a premature baby due to early birth. This premature retina layer is further exposed to factors, which are aiding this condition called ROP.

This premature retina can develop abnormal blood vessels.  This can cause bleeding inside the eye and also a retinal detachment.  

This is called ROP (Retinopathy of Prematurity).

If developed and progressed, ROP surely leads to low vision and even blindness.

The sad part is that it is a condition exclusive to premature babies.

The sadder part is that it is a condition which progresses very fast. If not detected and treated at the crucial time, it can lead to irreversible low vision or even blindness.

·        How can I help detect ROP in my premature baby?

A Retina Specialist or a Pediatric Ophthalmologist or a trained eye surgeon can detect ROP by detailed examination of your premature baby’s eyes. All it requires is for you to remind your Pediatrician or directly request for a Retina Specialist.

This test is done inside your Neonatal Unit or the hospital, during a visit by the Retina Specialist or Pediatric Ophthalmologist. The pupils of the eye are dilated using drops and the Retina is examined by an Indirect Ophthalmoscope for any signs of ROP.  In fact, you can ask your Paediatrician to help you with an ROP Eye check.

·        Should all premature babies be examined for ROP?

ALL premature babies should be examined ……..at the soonest.

And after all it is a simple exam, done in the hospital without any inconvenience to your baby. And this one simple examination to detect ROP could mean the difference between normal vision and blindness.

Babies with a birthweight of less than 1700 gm or those born before 35 weeks of pregnancy are at the highest risk to develop ROP.

Any premature baby who has other problems after birth (oxygen line, blood transfusion, infections, etc) is also at a risk.

·        What is treatment for ROP?

ROP is best treated with laser rays. This treatment can be done in the Neonatal unit or the hospital, with the help of the Pediatrician and team. The treatment helps stop further growth of abnormal vessels, thus preventing complications.

The thing to remember is that ROP is a very fast disease. The time period between early detection and complications is just 2-3 weeks. The treatment has to be decided on at the soonest. ROP should be treated as soon as it reaches a critical stage called as threshold ROP. There is a 50% greater risk of vision loss if left untreated after this.

The treatment is successful in majority of the case. Only some rare, late diagnosed or complicated retina’s may go into further complications.

They may require advanced treatments like Injection Anti VEGF or Vitrectomy.

·        When should the eyes of my premature baby be examined.?

Follow the “Day – 30” strategy.

The eye exam should be done at soonest or atleast completed before “Day-30” of the life of a premature baby.

It is a simple exam, done in your hospital without any inconvenience to your baby.

ROP can progress rapidly and seriously in 2-3 weeks. Therefore it may require 2-3 check ups in that period.

·        What is the after Treatment or regular follow up schedule of a premature baby?

If treated on time, majority children will not go into complications.

Yet all premature babies require a yearly eye exam by a Pediatric Ophthalmologist.

All babies who have developed ROP will develop some other eye conditions. They may require treatment for glasses, lazy eye, cross-eyes, or even cataract, glaucoma  and retinal detachment. This again indicates a yearly eye exam by a Pediatric Ophthalmologist till atleast 15 years of age. 

FAQs about Kids Eyes

Answers to commonly asked questions:

Question 1: Can reading for long hours weaken my eye sight?

Answer 1: No. Reading for long hours  does not weaken the eyes in the long term. What could happen is that the eye muscles could get tired temporarily and cause eye strain, discomfort, feeling of eye pain etc      

   

Question 2: Can reading in bad light eventually weaken my eye sight?

Answer 2: No. Reading in bad light does not weaken eyesight. Reading in good light is recommended to prevent eye strain and fatigue.

Question 3: Too much artificial light is harmful for my eyes?

Answer 3: No. Artificial light is not harmful in the short or long term. As mentioned earlier natural light is recommended to reduce eye strain.

Question 4: Is any light better than the other?

Answer 4: White light is preferable especially in the kids room and the light at the reading desk should come from the behind you.

Question 5: Is too much mobile time or i Pad time harmful for my kids eyes ?
Answer 5: Yes. It affects your childs eye sight, it affects his health (cause of childhood obesity) and his mental health. In fact China and Singapore are doing a study into this. They were the first onto an electronic gadget boom. Now almost 99% of their children are Myopes.

Question 6: Is colour blindness common, and if detected early can it be cured?

Answer 6: Colour blindness in not common, but is more prevalent in boys than girls. There is no cure for colour blindness at any age. There are some new glasses being marketted as making a vast difference in the vision of a Colour blind. It is not so. Check them out yourself.

Does Eye Yoga / Sampoorna Eye Yoga help?

I say this plainly and unreservedly : Eye Yoga / Sampoorna Eye Clinic (and Yoga) to reduce your spectacle power or your squint is all bunkum and tomfoolery. It is a risk and game played with your childs eyes.

If anyone can prove via scientific methods and measurement, that it worked and permanently reduced the numbers or the squint, i shall pay for the entire treatment, whatever the cost.

You can show this Blog/Statement to any of these Yoga Centres, if you wish, and ask for their written response. Do not waste my time with conversations and words said by someone else. Please get written response and guarantee from the Eye Yoga people.

Lets us get some facts straight.

If your child has glasses, firstly, your child needs to be seen by a Kids Eye Specialist every 6 months.

If you ignore the 6 month check and get involved with nonsense like Eye Yoga/ Ayurvedic medicine, you are risking making your child weak in vision, for lifetime.

If your child is Myopic (minus numbers) the numbers will increase till age 21. No power on earth can prevent that.

If your child is Hypermetropic, the numbers may reduce with advancing age, but needs to be monitored.

If your child does not wear the exact glasses, the risk he faces is : weak eyes, headache, squint, weak health.

Now coming to this Eye Yoga.

If you obsessively wished to be like the strongest man on earth, you can exercise and temporarily bring your body into a state 'near' that well built body state. That does not make you the strongest man. Also once you leave the obsessive exercising, your body will go back to how it was before. THIS is what Eye Yoga does. Fools you into a sense of improvement and well being.

So these Eye Yoga people, like magicians who hoodwink you, they fool you with changed measurement systems and distances to show you improvement and deceive you.

And even if they can show you a temporary and minimal change, that change shall revert back to as it was in a short time. The "short time", shall have wasted your time and money and the "window period" available for your childs visual improvement.

The treating of Number/ Squint/ Cataract/ Retinopathy with Eye Yoga and Ayurveda is nonsense and it is a game you are playing with your eyes.

Does my Child need glasses?

It is a very tough question, to answer flippantly via broad answers. We are talking about a child"s health and vision and future. 

And yet how does a parent recognise whether their child has an eye problem?

If your child is born premature or underweight, then an Eye Exam, or more specifically: a Retina Exam, is necessary in within 30 days of birth, even if the child is in the Neonatal Unit or NICU.

After this in the early months usually a mother picks out small  signs. 

When the child is not able to focus on mothers face or toy handed to it. 

When the child is not interested in surroundings. 
When the child absolutely does not want to move from the position it has been placed in. 

When there is a Face turn or a Head Tilt (abnormal Head Posture).  

When there are Rapid jerky movements of eyes (Nystagmus). 

When there is aversion to light. 

When there is abnormal watering. 

A white coloration in centre of the black cornea. 
Too large eyes. 

There is a squint.
Theses are some very easy and early markers.

After this, in the Developed Nations, an Eye Exam is mandatory to take admission into Pre school. This way the nation encourages Preventive Health Care, and encourages a healthier citizen.

The purpose is that a Kids Eye Doctor can pick out glasses at a very early age and hence give your child good vision and a healthier life style. 

You should also get your child examined at 2-3 years of age by a Kids Eye Doctor.

Now comes the age group of 2 years to 6 years. This is now assuming that you have NOT been to see a Kids Eye Doctor as yet. 

The signs that a parent can pick out are: 

The child sits too close to the TV. 

The child is not too interested in running around and playing.

The child has a face turn or head tilt while watching TV or normally too. 

The child puts a finger near the eye while watching TV and pressing at corner of eye. 

The child has a Squint. 

There is Nystagmus. 

Child bangs into things frequently while running around. 

Play a game with a child: read number plates/ road name plates while driving in a car. See if the child is able to read what you are able to read.

Holds a book too close while reading. 

Wrong copying of notes in a class room (improves when the child is brought to first benches).
These are all signs for a parent to pick out.

Because: The first some years are necessary for "development of vision" and the next years till age 10 are necessary for "consolidation and growth of that vision".

IF you miss this "crucial window period" your child will have weak eyes/ lazy eyes/ less vision for lifetime.

IF you have detected any problem with your tiny tots eyes, the earlier you see a Kids Eye Doctor, the more time the doctor gets in the "crucial window period" to do treatment or give glasses and bring your child's vision to normal.