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Fort Myers:

15640 New Hampshire Court Fort Myers, FL 33908 239-466-3111

Fort Myers:

5248 Bank Street Fort Myers, FL 33907 239-332-1990

Bonita Springs:

3940 Via Del Rey Bonita Springs, FL 34134 239-498-7666

Your Child's Eye Care

A comprehensive examination of your child's eyes by a skilled ophthalmologist is highly recommended as an important step in detecting and correcting potential vision problems, says Rachid Aouchiche, M.D., of West Coast Eye Care.

Why Worry About A Child's Eyes?

Babies are able to see as soon as they are born. For the visual system to continue to develop properly, children need clear input from both eyes to the brain. If there is some problem which interferes with vision in either eye or both, the connections form the eye to the brain can become weak or not develop properly. Crossed or turned eyes or imbalance in the way each eye focuses can interfere with this normal development of the visual system.

Because of the importance of maintaining normal vision in infants, and because an ophthalmologist is able to recognize and treat problems early, we are interested in examining very young children. This is especially true if the parents or the child's doctor feels that there may be some problems or if there is a family history of eye problems.

What Questions Are Asked At The Exam?

A child's eye examination begins by discussing any problems the parents recognize. It is important to find out if there were problems with the pregnancy or with the child's birth, and if the child's growth and development are proceeding normally. A history of eye problems in the family is important. The ophthalmologist needs to know about the child's health in general. Are there other medical problems? Has the child had any treatment with medications or surgical procedures? Does the child have any allergies?

If your child has been treated with medications, glasses or contact lenses, these should be brought to the eye examination. The names and addresses of other physicians who may be treating the child should be supplied so that they may be informed of the findings.

How Do Ophthalmologists Examine A Baby's Eyes?

Many parents are quite surprised to find that a complete eye exam can be performed on babies. A skilled ophthalmologist can get a good idea of how well a baby can see based on the way he/she uses his/her eyes to look at and follow attractive toys or lights.

No matter how the vision is tested, it is important to check each eye separately. Two to five percent of children have one eye which does not see as well as the other, a condition called amblyopia or "lazy eye."

For older children who can talk but who do not yet know their numbers or the alphabet, special charts are used, which have pictures common in a child's world such as birds, birthday cakes, stars. Some test may require the child to point to a letter, matching the letters on a chart. All of these tests show a child smaller and smaller items in order to get an idea of the child's best visual acuity.

Testing for binocular vision (the ability to use both eyes together) and depth perception can also be done early in childhood.

In some special situations, measurements may be made of a young child's vision based on brain wave measurements while the child watches striped patterns or by observing the way the child looks at black and white stripes on flashcards.

Lights, Lights, And More Lights

Lights are used to examine the pupils to see if the eyes are working properly. During this portion of the examination, the areas around the eyes such as the eyelids and the tear canals, are also examined.

The tiny flashlight can also be used to see if a child's eyes are straight or turned. If a child is looking straight at the flashlight, it will reflect off the front of the child's eyes in a way that allows the ophthalmologist to tell whether the eyes are turned or straight. This important in infants because their wide nose bridges may make their straight eyes look crossed. Sometimes, the ophthalmologist will cover one eye and then the other. If the eyes are not aligned properly, they will jump back and forth when looking at the light or a toy. Wedge-shaped pieces of clear plastic called prisms can be used to measure the amount of misalignment of the eyes.

Why Are Eye Drops Needed?

One of the less enjoyable but most essential portions of an eye exam is the dilation of the pupil. This not only allows the ophthalmologist to view the inside of the eye, but the dilating drops temporarily relax the child's focusing power so that nearsightedness, farsightedness or astigmatism (refractive errors) can be accurately measured. Most doctors have preferences for which dilating drops they use. Some drops are given once, some are given more than once, and all take about 30 to 60 minutes to be fully effective. It may be necessary to have special drops or ointment put in at home and to return to complete the examination at a later date.

What Happens After The Drops?

Whether your child is attentive of not at this point, or even if he is asleep, it can be determined if your child's eyes are out of focus, using small lenses and a special flashlight (called a retinoscope). By shinning a beam of light into the eye, the ophthalmologist can see the back of the eye reflecting the light and, by holding lenses in the path of this reflection, see whether the child is nearsighted, farsighted, or has astigmatism. It is a nonetheless, very accurate. This tells us if your child needs glasses.

How Are The Insides Of The Eyes Checked?

Once your child's pupils are dilated, your ophthalmologist can get a very good look at the inner eye structures to make sure the inside of the eye is healthy. The inside of the eye holds the retina, which functions much as does film in a camera, processing the visual information into signals, which are sent down the optic nerve to the brain. The optic nerve itself, as well as the blood vessels which supply the retina, can be seen in the back of the eye. Special instruments allow the inside of the eye to be seen in great detail.

What Are Common Eye Problems In Childhood?

Four percent of children have ocular problems that can diminish vision in one or both eyes. The three most common type of problems that occur are strabismus (misaligned eyes), amblyopia (lazy eye), and refractive errors (focusing problems).

What Is Strabismus?

Strabismus is a general term referring to eyes which are pointed in different directions. One eye may drift in or out, up or down. A crossed eye is known as esotropia. Exotropia refers to the eyes that are turned out. Strabismus may be present all of the time or intermittently. Children with strabismus are usually unaware of the problem. Strabismus interferes with the development of coordinated use of both eyes together. Treatment of strabismus includes glasses, special lenses called prisms or surgery.

What Is Amblyopia?

Amblyopia, which is sometimes called "lazy eye," refers to the development of poor vision in one or both eyes. It occurs in infancy and early childhood during the sensitive period of visual development has passed, during late childhood, the ability to lose vision to amblyopia is no longer a substantial threat.

Amblyopia can be caused by ocular problems which prevent normal visual development. The most common causes are strabismus and refractive errors, but any ocular disease which prevents a clear image from being formed on the retina can cause amblyopia. In order to restore vision, not only must the abnormality causing the amblyopia be treated but also the amblyopia itself. Patching the good eye, under the supervision of the child's ophthalmologist, forces the brain to develop vision in the lazy eye. This is the cornerstone of therapy for amblyopia. Sometimes "penalizing" the good eye by blurring it with drops or with extra power in the glasses can be used as an alternative to patching, especially in mild forms of amblyopia and in school-age children who will not cooperate with patching therapy.

When Should I Have My Child's Eyes Checked?

Most physicians examine many parts of the eye during a child's medical examination. However, they may refer a child to an ophthalmologist if there is difficulty in measuring vision, any sign of amblyopia, or if they suspect an abnormality of the eye alignment or structure. It is recommended that all children have their vision checked by their pediatrician, family physician or ophthalmologist by 3 years of age or even sooner ( around 6 months to 1 year) if there is a family history of problems. Fortunately, the ophthalmologist can perform a complete eye exam on children of any age.

At West Coast Eye Care, our staff also includes Kim Aouchiche, C.O., a certified Orthoptist specially trained in the evaluation and diagnosis of eye muscle disorders, double vision and lazy eyes. For more information on your child's eye health, call West Coast Eye Care at 239-466-3111. Offices are located at Fort Myers, Bonita Springs and North Fort Myers.