“DOCTOR , MY CHILD CANNOT

SEE”
PEDIATRIC OPHTHALMOLOGY
-DR. GEETOPAM BORDOLOI
• As a Pediatric Ophthalmologist,I face this
situation regularly
• Parents anxiety and hopes of a miracle ,one
preferably without glasses or surgery
• Joys of new parenthood or a future shining
career are diminished by the child’s visual
disability
• Not a mini adult, no methodical fixed
examination rules
• Requires a bright colorful room, friendly soft
smile and voice, no typical hospital
equipment; even teenager’s ego needs to be
satisfied
• Trained staff- Optometrist, Pediatric nurse,
Pediatric Anesthetist work in tandem with us
• Prefer no restraints or sedation
• Coloured lights,toys,cartoons,video based
vision assessment
• 50% examination done if the baby/toddler
nestles quietely in my arms or sits still on the
chair
• Pediatricians are our best partners,commend
our colleagues here
 Who is a visually impaired child?
• Measurement of functional vision
• Measurement of vision-related quality of life
• BCVA in better eye < 6/18[LOGMAR 0.5-1.0]
• Prevalence In India: 0.80/1000(0.75 in world)
• Anatomical and etiological factors
 Why is referral to a Pediatric
Ophthalmologist needed?

• Motor development

• Cognition development

• Language development

• Social & emotional development

 Reaction of parents
• Shock , denial , grief , guilt , despair , anger

• Our approach..
• G : go to a specialist
• S : see the options for management available
• T : treat the child
 Children with special needs

• Cognitive disorders
• Cerebral palsy
• DDM
• Epilepsy
• Birth asphyxia
• Deaf / dumb children
 CONDITIONS WITH PEDIATRIC OPHTHA REFERRAL
• Pediatric cataract
• Corneal opacity
• ROP
• Amblyopia
• Optic atrophy
• Pediatric epilepsy
• Vitamin A deficiency
• Hypoxic Ischaemic injury
• Deranged globe/coloboma
• Trauma
• Refractive error
• Tumours – RB,Rhabdomyosarcoma
• Squint
• Nerve palsies
AMBLYOPIA
Pediatric glaucoma
 Retinopathy Of Premturity
• Incomplete development of retinal vasculaturein
preterm LBW babies
• India has highest number of preemies with
consequent ROP risks
• Every NICU needs a screening programme
• All preterms< 34 weeks gestational age;less than
1750 gm,or others with risk factors
• Within 4 weeks,digital screening with photo
preferred
• Preventable and treatable
 Pediatric cataract
• important preventable cause of blindness
• As early as possible surgery
• Difficulties in examination and workup
• Basic equipments – handheld,phaco with
vitrectomy,foldable hydrophobic single piece
acrylic IOL
• Amblyopia management is critical challenge
 RetinoBlastoma
• Most common intraocular tumour in
childhood
• Long arm of chromosome 13
• Incidence-1/15000-18000 live births
• India-2000/5000 new cases worldwide
 Squint
• XT
• DRS
• OBLIQUES
• LR PALSY
• NOT JUST COSMETIC NUT ALSO
FUNCTIONALAND RESTORATIVE
Pediatric eye trauma
Vitamin A deficiency
PEDIATRIC CATARACT
• Post MS three years residency
• One year full term fellowship(ORBIS supported
Institution)
• > 250 independent squint and cataract surgeries
• > 200 miscellaneous surgeries and procedures
• Lots of knowledge gained about pediatrics and genetics
• Only 80-100 trained Pediatric Ophthalmologists out of
20,000
• IS IT WORTH IT?
• A SMILING CHILD WHO “SEES” YOU FOR ATLEAST NEXT
70-80 YEARS…bonus..whole family in your OPD