We have eye surgeons who cover all subspecialties in children’s eyes. Our leading team of paediatric ophthalmologist diagnoses and manages all treatable childhood eye problems through conservative methods, or with eye surgery.
Our paediatric ophthalmologists and orthoptists have vast experience in assessing children, and have developed the necessary skills to obtain patient concentration and cooperation whilst endeavoring to make the patient feel at ease throughout the investigation.
At Eye Clinic London, our paediatric ophthalmologist use the most advanced equipment to make quantative judgments on the development and level of vision possessed by a child. This technique is reproducible and can even be tested in pre-verbal or newborn babies.
Coupled with the extensive training and skill of our paediatric ophthalmologists, we hope to enhance the quality of assessment offered elsewhere and thus provide a customised treatment plan for your child.
This specialist field principally deals with ocular motility disorders such as squint, amblyopia, nystagmus and binocular vision disorders.
Orthoptists work in close collaboration with paediatricians, ophthalmologists and neurologists in order to provide a comprehensive service for children and adults with eye movement disorder.
In addition to eye movement disorders, orthoptists commonly treat any accommodative imbalance problems which may cause eye strain (asthenopia). Eye strain from prolonged visual activity such as reading or computer work may be alleviated by manipulating convergence and accommodation with spherical lenses or through a series of exercises.
Vision screening services (including screening in children with learning disability, autism-spectrum conditions and dyslexia) is a supplementary service carried out by an orthoptist. During school screening, children with reduced visual acuity or an ophthalmic muscle imbalance can be referred to the necessary team to seek further investigation and treatment. This is very important for children with amblyopia who require occlusion therapy before the visual system has matured (approximately age 10). Some orthoptists are also able to decipher if glasses are indicated for children.
This is established by conducting retinoscopy and refraction testing. Orthoptists often work as part of a multi-disciplinary team such as with the electro diagnostic department in order to establish visual acuity levels in children.
This can be very valuable in pre-verbal children to indicate how well a child is seeing. They also assist in some surgical procedures such as proving measurements for adjustable sutures. Ocular motility specialists also provide a wider service to patients with neurological disorders and stroke patients requiring rehabilitation. Such patients may suffer from visual field loss.
Prisms can be used to move the area of remaining vision in some cases. Specialist orthoptists may take on extended role duties such as assessing and managing patients with glaucoma. Such patients require intra-ocular pressure readings, pachymetry measurement, fundus photography and visual field testing to be carried out before establishing whether pharmaceutical or surgical intervention is required.
In summary, orthoptists principally use 5 different treatment specialties to help facilitate a comprehensive service for a multitude of binocular vision abnormalities including:
• Provide occlusion therapy for amblyopic children.
• Present orthoptic exercises for symptomatic patients with conditions such as convergence insufficiency to alleviate symptoms.
• Assist in surgical procedures –adjustable sutures.
• Use of lenses-Prismatic and Fresnel lenses are used to treat double vision (diplopia). Spherical and cylindrical lenses are used to manipulate convergence and accommodation.
• Use pharmaceutical drugs to improve vision.
The duration of the visual electrophysiological tests depends on what tests are carried out and if infant or adult protocols are being used. For infants the tests will involve sitting with your baby on your lap for 20-30 minutes in front of a large TV screen. Baby can feed during the test. Electrodes will be placed on the baby’s head.
First small areas of scalp will be cleaned using a slightly gritty gel on a cotton wool bud, and then electrodes will be positioned on the head held on by a washable cream (three at the back and 2 at the front). Then your baby will then be turned towards the TV, and black and white squares of different sizes will be presented.
The electrodes will record the responses from the brain to the reversing patterns and are called visual evoked potentials. Sticker electrodes will then be gently placed on the cheeks under the eyes and on the temples to record the retinal responses called the electroretinogram.
A light will be flashed in order to stimulate the retina. The light and the patterns will first be presented to both eyes and then each eye will be covered in turn to compare right and left eyes.
At the end of the test the electrodes are easily removed and the cream washed off with cotton wool and warm water. Visual evoked potentials are recorded in adults in the same way to infants and encompass the international standard recommended recordings. Retinal recordings in older children and adults involve the use of corneal electrodes that are positioned in the lower fornix of each eye.
The pupils are also dilated during 20 minutes dark adaptation before recordings are carried out. Adult retinal recording take approximately 1 hour.
Electro-diagnostic investigations are used for a wide variety of reasons including determining the presence of cortical visual impairment in those who are too young or not able to comply with behavioural tests. It can identify congenital or hereditary conditions such as retinal dystrophies and albinism. It can also be used to investigate and monitor amblyopia, strabismus, brain injury, head injury and diseases such as Multiple Sclerosis (MS).