Pediatric ophthalmology is a sub-speciality of

ophthalmology Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a medic ...

concerned with

eye disease This is a partial list of human eye diseases and disorders. The World Health Organization publishes a classification of known diseases and injuries, the International Statistical Classification of Diseases and Related Health Problems, or ICD-10. ...

s, visual development, and vision care in children.

Training

In the United States, pediatric ophthalmologists are

physicians A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

who have completed

medical school A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, M ...

, a 1-year

internship An internship is a period of work experience offered by an organization for a limited period of time. Once confined to medical graduates, internship is used practice for a wide range of placements in businesses, non-profit organizations and gover ...

, 3-year

residency Residency may refer to: * Domicile (law), the act of establishing or maintaining a residence in a given place ** Permanent residency, indefinite residence within a country despite not having citizenship * Residency (medicine), a stage of postgrad ...

in ophthalmology, and a 1-year

fellowship A fellow is a concept whose exact meaning depends on context. In learned or professional societies, it refers to a privileged member who is specially elected in recognition of their work and achievements. Within the context of higher education ...

in pediatric ophthalmology and

strabismus Strabismus is a vision disorder in which the eyes do not properly align with each other when looking at an object. The eye that is focused on an object can alternate. The condition may be present occasionally or constantly. If present during a ...

. Pediatric ophthalmology fellowships in the United States are accredited by the

American Association for Pediatric Ophthalmology and Strabismus The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) is an academic association of pediatric ophthalmologists and strabismus surgeons. The pediatric ophthalmology fellowships in the United States are accredited by the AAPOS. ...

Clinical expertise

Pediatric ophthalmologists focus on the development of the visual system and the various diseases that disrupt visual development in children. Pediatric ophthalmologists also have expertise in managing the various ocular diseases that affect children. Pediatric ophthalmologists are qualified to perform complex

eye surgery Eye surgery, also known as ophthalmic or ocular surgery, is surgery performed on the eye or its adnexa, by an ophthalmologist or sometimes, an optometrist. Eye surgery is synonymous with ophthalmology. The eye is a very fragile organ, and requ ...

as well as to manage children's eye problems using

glasses Glasses, also known as eyeglasses or spectacles, are vision eyewear, with lenses (clear or tinted) mounted in a frame that holds them in front of a person's eyes, typically utilizing a bridge over the nose and hinged arms (known as temples or ...

and medications. Many ophthalmologists and other physicians refer pediatric patients to a pediatric ophthalmologist for examination and management of ocular problems due to children's unique needs. In addition to children with obvious vision problems, children with head turns, head tilts, squinting of the eyes, or preferred head postures (

torticollis Torticollis, also known as wry neck, is a dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term ''torticollis'' is derived from the Latin words ''tortus, meaning "twisted ...

) are typically referred to a pediatric ophthalmologist for evaluation. Pediatric ophthalmologists typically also manage adults with eye movement disorders (such as

nystagmus Nystagmus is a condition of involuntary (or voluntary, in some cases) eye movement. Infants can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in reduced or limited vision. Due to the invol ...

) due to their familiarity with strabismus conditions.

Eye problems in children

Children experience a variety of eye problems, many quite distinct from adult eye diseases. Pediatric ophthalmologists are specially trained to manage the following disorders: *Infections (

Conjunctivitis Conjunctivitis, also known as pink eye, is inflammation of the conjunctiva, outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may ...

). *

Strabismus Strabismus is a vision disorder in which the eyes do not properly align with each other when looking at an object. The eye that is focused on an object can alternate. The condition may be present occasionally or constantly. If present during a ...

is a misalignment of the eyes that affects 2-4% of the population; it is often associated with amblyopia. The inward turning gaze commonly referred to as "crossed-eyes" is an example of strabismus. The term strabismus applies to other types of misalignments, including an upward, downward, or outward turning eye. *

Amblyopia Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to fully process input from one eye and over time favors the other eye. It results in decreased vision in an eye that typically appears normal in other aspects. Amb ...

(aka lazy eye) occurs when the vision of one eye is significantly better than the other eye, and the brain begins to rely on the better eye and ignore the weaker one. Amblyopia affects 4% of the population and is clinically diagnosed when the

refractive error Refractive error, also known as refraction error, is a problem with focus (optics), focusing light accurately on the retina due to the shape of the human eye, eye and or cornea. The most common types of refractive error are myopia, near-sightedne ...

of one eye is more than 1.5 diopters different from the other eye (

anisometropia Anisometropia refers to a condition when two eyes have unequal refractive power. Generally, a difference in power of one diopter (1D) or more is the accepted threshold to label the condition anisometropia. Patients can tolerate 3 D of anisometro ...

) or one of the eye is misaligned for a long period of time (

). The management of amblyopia involves correcting of significant refractive errors and using techniques that encourage the brain to pay attention to the weaker eye such as patching the stronger eye (occlusion therapy). *Blocked

tear duct The nasolacrimal duct (also called the tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The ...

s. * Ptosis *

Retinopathy of prematurity Retinopathy of prematurity (ROP), also called retrolental fibroplasia (RLF) and Terry syndrome, is a disease of the eye affecting prematurely born babies generally having received neonatal intensive care, in which oxygen therapy is used due to ...

Nystagmus Nystagmus is a condition of involuntary (or voluntary, in some cases) eye movement. Infants can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in reduced or limited vision. Due to the invol ...

*Visual inattention *Pediatric

cataracts A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble w ...

Pediatric glaucoma Primary juvenile glaucoma is glaucoma that develops due to ocular hypertension and is evident either at birth or within the first few years of life. It is caused due to abnormalities in the anterior chamber angle development that obstruct aqueous o ...

*Abnormal vision development *

Genetic disorders A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosomal abnormality. Although polygenic disorders ...

often cause eye problems for affected children. Since approximately 30% of genetic syndromes affect the eyes, examination by a pediatric ophthalmologist can help with the diagnosis of genetic conditions. Many pediatric ophthalmologists participate with multi-disciplinary medical teams that treat children with genetic syndromes. *

Congenital malformations A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can r ...

affecting vision or the tear drainage duct system can be evaluated and possibly surgically corrected by a pediatric ophthalmologist. *Orbital

tumours A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

*Refractive errors such as

myopia Near-sightedness, also known as myopia and short-sightedness, is an eye disease where light focuses in front of, instead of on, the retina. As a result, distant objects appear blurry while close objects appear normal. Other symptoms may include ...

(near-sightedness),

hyperopia Far-sightedness, also known as long-sightedness, hypermetropia, or hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blurred effect is due to incoming light being focused behind, i ...

(far-sightedness) and

astigmatism Astigmatism is a type of refractive error due to rotational asymmetry in the eye's refractive power. This results in distorted or blurred vision at any distance. Other symptoms can include eyestrain, headaches, and trouble driving at nig ...

can often be corrected with prescriptions for glasses or contacts. *

Accommodative insufficiency Accommodative insufficiency (AI) involves the inability of the eye to focus properly on an object. accommodation (eye), Accommodation is the adjustment of the curvature of the lens (eye), lens to focus on objects near and far. In this condition, ...

Convergence insufficiency Convergence insufficiency is a sensory and neuromuscular anomaly of the binocular vision system, characterized by a reduced ability of the eyes to turn towards each other, or sustain convergence. Symptoms The symptoms and signs associated with con ...

and

asthenopia Eye strain, also known as asthenopia (from Greek ''a-sthen-opia'', grc, ἀσθενωπία, ), is a common eye condition that manifests through non-specific symptoms such as fatigue, pain in or around the eyes, blurred vision, headache, an ...

*Evaluation of visual issues in education, including

dyslexia Dyslexia, also known until the 1960s as word blindness, is a disorder characterized by reading below the expected level for one's age. Different people are affected to different degrees. Problems may include difficulties in spelling words, r ...

and

attention deficit disorder Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise Development ...

. Pediatric ophthalmologists often work in conjunction with

orthoptist Orthoptics is a profession allied to the eye care profession. Orthoptists are the experts in diagnosing and treating defects in eye movements and problems with how the eyes work together, called binocular vision. These can be caused by issues with ...

s in the treatment of strabismus.

History

Frank D. Costenbader was an American

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

frequently credited as the world's first pediatric ophthalmologist.Marshall MM
"The History of the Costenbader Society: Costenbader's Challenges."
March 19, 2000. Costenbader and

Marshall M. Parks Marshall Miller Parks (July 6, 1918 – July 25, 2005) was an American ophthalmologist known to many as "the father of pediatric ophthalmology".Joe Holley"D.C. Physician Illuminated The Ailments of Young Eyes."''Washington Post''. Sunday, August ...

(his mentee who would later be known to many as "the father of pediatric ophthalmology") began the first ophthalmology fellowship trained program of any subspecialty at the Children's Hospital in Washington, D.C., now known as the Children's National Medical Center.Joe Holley
"D.C. Physician Illuminated The Ailments of Young Eyes."
''Washington Post''. Sunday, August 21, 2005; Page C11."Marshal M. Parks, M.D."
Obituary. Accessed September 19, 2006. Parks trained many pediatric ophthalmologists during his career and was instrumental in the establishment of the

, a national organization dedicated to improving the quality and management of pediatric ocular disease. Over time, over 30 programs were developed for the training of pediatric ophthalmologists throughout the United States. The American Academy of Pediatric Ophthalmology and Strabismus works with the

American Academy of Pediatrics The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C. Background The Academy was founded ...

on issues related to pediatric eye disease and vision screening guidelines. Other notable pediatric ophthalmologists have included: Jack Crawford,

John T. Flynn John Thomas Flynn (October 25, 1882 – April 13, 1964) was an American journalist best known for his opposition to President Franklin D. Roosevelt and to American entry into World War II. In September 1940, Flynn helped establish the America Fi ...

, David S. Friendly,

Eugene R. Folk Gene Folk (September 7, 1924 - February 28, 2003) was an American ophthalmologist who specialized in the diagnosis and treatment of strabismus. A charter member of the American Association for Pediatric Ophthalmology and Strabismus, he later serve ...

, David Guyton, Robison D. Harley, Eugene Helveston, Arthur Jampolsky, Barrie Jay, Phillip Knapp, Burton J. Kushner, Henry Metz, Marilyn T. Miller, John Pratt-Johnson, Arthur Rosenbaum, William E. Scott, Gunter K. von Noorden, and Mette Warburg.

References

External links

American Association for Pediatric Ophthalmology and Strabismus
{{DEFAULTSORT:Pediatric Ophthalmology Pediatric ophthalmologists Ophthalmology, Pediatric Ophthalmology