Why Pediatric Ophthalmology?

Your child may be showing signs of having an eye problem, or having difficulty with a vision screening examination at school or at their pediatrician's office, and is in need of further specialized examination and treatment. Who can you take your child to see so that you may be assured that he or she will receive the most comprehensive, effective and up to date care possible?

To answer this question, several concepts must be explored:

  •   The different types of practitioners available for children's eye care
  •   The need for the practitioner selected to have mastered the huge amount of knowledge available about eye disorders, diseases of children and especially children's eye disorders
  •   The special nature of childhood diseases
  •   How children can best  be examined
  •   The nature and ideas behind specialization
  •   Eye Care Practitioners

There are two general types of practitioners that take care of eye problems:

1. Ophthalmologists: these are medical doctors who have had at least four years of medical school and one year of medical internship, have a license as a medical practitioner, and have chosen to specialize in eye disorders by taking at least three additional years of residency training in Ophthalmology. Ophthalmologists may prescribe any approved medicines, including eye drops and medicines given by mouth or injection, perform surgery and do any type of eye care which is legally permissible. Their range of experience and treatment options are very broad.

Some ophthalmologists, called Pediatric Ophthalmologists, have chosen to further specialize in eye disorders of infants, children and adolescents. This requires at least one additional year of fellowship training.

2. Optometrists: these are non medical practitioners who have received no medical training, have received little or no training in general medical diseases, have no hospital training, no surgical training and little or no experience in the use of medications. Their treatment options are limited to prescribing glasses and, in some states, using some eye drop medications only; they are legally prohibited from performing surgery and prescribing medicines given systemically, that is, by mouth or injection.

Some Optometrists have chosen to limit their attention to children; they may be called pediatric Optometrists but frequently choose to call themselves developmental Optometrists.

• Range of Information Needed for Complete Diagnosis and Treatment

In the past fifty years, and particularly within the past twenty-five years, the amount of information needed to diagnose and treat eye disorders has increased explosively. This is especially true of the development of new surgical techniques, including microsurgery, laser surgery and refractive surgery. The amount of material has become so vast, in fact, that it has given rise to specialization, since it has become practically impossible for one practitioner to master all of the important aspects of these many techniques and the mountain of information. Thus, Pediatric Ophthalmology has arisen during the past forty years in response, in part, to this wonderful modern information overload; by narrowing the range of information a practitioner must master to provide complete eye care mainly to children, the Pediatric Ophthalmologist has an excellent opportunity to truly master all of the information necessary to have the best possible chance to diagnose and treat a child's eye problem, no matter how difficult or unusual that problem might be.

• Children's eye disorders are not the same as an adult's eye disorders

Children are not just small adults. To a parent, this statement is quite obviously true and obvious, but its medical implications may not be so obvious: that children's eye disorders are not necessarily the same as those of a fully grown individual. The reason for this difference is that, obviously, infants, children and, less obviously, adolescents, are still under development. Their eyes are, unlike those of an adult, developing and growing and, thus, are subject to a different range of diseases, namely, those of growth and development. Statistically, there are different types of diseases and a different relative incidence of the different eye diseases when comparing disease in children to that present in adults. In addition, the potential impact of some visual problems is necessarily much greater in a child than in an adult, since failure to correct some problems during childhood might lead to visual loss for the entire remainder of the child's life.

• How children can best be examined

An interesting and vital corollary of the fact that children, particularly infants and young children, are not just small adults is that they do not behave like adults: they do not tell parents or physicians what may be bothering them, they do not answer medical questions well, and they do not react with patience to the medical examination and testing situation. Thus, they must be psychologically approached in a special way with greater patience and the equipment used on them must be specially designed or modified in many cases.

These considerations form the basis of the rationale for the use of the Pediatric Ophthalmologist for children's eye care. They have had the greatest training, not only in the broadest range of eye problems, but also in the special nature of children's eye disease. Since they examine and treat a large number of children, Pediatric Ophthalmologists have usually developed their technique in the examination of the child to a very high degree - the child will thus be treated in a manner by which he or she will be most likely to be relaxed and cooperative, something which is usually difficult to achieve in most "doctor's offices, where children are usually maximally apprehensive. In fact, since the Pediatric Ophthalmologist is likely to have a very high percentage of children in his practice, it is possible for the arrangement and decoration of his or her entire office to be tailored specifically to this point, the creation of an environment which the children will find as comfortable and non-threatening as possible, in terms of actual examination rooms as well as waiting areas, hallways, etc.

Since the accuracy and completeness of an examination in a child usually depends on their degree of cooperation, the ability to tailor the office environment, examination technique and equipment to children results in a greater likelihood of obtaining a more satisfactory examination and, thus, a more accurate diagnosis and treatment of whatever the eye problem might be. In the event that the child is not cooperative, however, the practitioner who is used to dealing with children frequently will still have an advantage in being able to perform an accurate examination since he deals with children more frequently than a practitioner who is more used to dealing with adult patients who can understand all his questions, respond to his requests and sit still in the proper position when requested to do so.

These considerations obviously apply to areas other than eye care and, in fact, form the idea behind the specialty of pediatrics itself, as well as all the many other pediatric subspecialties, like pediatric cardiology, pediatric endocrinology, etc. Most parents prefer to take their children to a pediatrician for their general medical care because that practitioner has devoted his or her practice to the care of children's medical problems; there are similar advantages to the use of pediatric sub-specialists for more specialized problems.

In summary, the answer to the question "Who can you take your child to see so that you may be assured that he or she will receive the most comprehensive, effective and up to date care possible?" is a Pediatric Ophthalmologist, since only that specialist will have the widest range of treatment options, the most extensive and comprehensive training, and the greatest expertise in dealing with children and in treating children's eye disorders.