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As the first hospital-based children’s ophthalmology department in the nation, Children’s pediatric ophthalmologists have the expertise to recognize and treat complex eye conditions in newborns, infants, and children.

The Importance of a Pediatric Ophthalmologist

A pediatric ophthalmologist is trained to recognize and manage eye diseases and disorders in younger patients whose visual system is still developing physically and neurologically.

Childhood cataract, for example, is a rare condition that occurs in only about 0.4 percent of children and symptoms are similar to different eye problems. Children’s pediatric ophthalmologists have extensive experience in the diagnosis and treatment of childhood cataract and other lens abnormalities.

Every year, our ophthalmology team also treats hundreds of children and adults with strabismus (misalignment of the eyes), including esotropia and exotropia, and more complex cases, such as hypertropias (vertical deviations), and restrictive or paralytic forms of strabismus due to orbital fractures, scarring, inflammatory disease, congenital anomalies, central nervous system disorders, or underlying conditions.

Each type of strabismus requires a different approach and so does every patient. We use the findings of a comprehensive eye exam to develop a treatment plan that is specific to the age of the patient and the particular condition. Whether surgery is part of treatment depends on the type of strabismus, the severity, and the age of the child. Children’s National ophthalmologists take all of these variables into account when presenting potential treatment options.

If surgery is suggested for your child’s condition, your child’s ophthalmologist discusses the options with you, including the potential risks and benefits, so you can make the most informed choice. Most evaluations and surgery are conducted on an outpatient basis, and follow-up appointments are scheduled over several weeks to several months.

Other conditions we treat include:
• Amblyopia (lazy eye)
• Cranial nerve palsies
• Congenital and developmental anomalies
Childhood glaucoma
• Nasolacrimal duct (tear duct) anomalies
• Nerve palsies/ocular nerves disorders
• Orbital and ocular tumors
• Ptosis and other eyelid abnormalities
Refractive errors (near-sightedness, far-sightedness and astigmatism)
Retinopathy of prematurity
• Retinal disorders

Children’s Expertise in Retinopathy of Prematurity
Premature babies are at a greater risk for retinopathy of prematurity (ROP), a retinal disorder that is a common cause of visual loss in childhood and can lead to lifelong vision impairment and blindness. The ophthalmology team at Children’s National is recognized for its expertise in screening and treating this highly complex and vision threatening disease.

Children’s National’s pediatric ophthalmology team has years of experience with ROP, and provides screening exams and retinal consultations for the hundreds of new patients seen annually in the neonatal intensive care unit at Children’s National. For the convenience of parents, ROP patients are also seen in Children’s main Eye Clinic and at our Regional Outpatient Centers.

Infants in the neonatal intensive care unit determined to be at risk for ROP are routinely screened:
• Premature infants, born at or before 32 weeks
• Premature infants weighing less than 3 pounds, 5 ounces (1500 grams)
• Premature infants, other than those in the first two categories, who are determined to have a complicated neonatal course

Timely follow-up is key to achieving a good vision outcome. Eye examinations take less than 15 minutes, are performed every one to two weeks until the retina is fully mature or needs treatment. The most extreme premature babies, who are very sensitive to any stress, are monitored during the examinations to measure heart rate and respirations.

Treatments for ROP include laser therapy, intra-vitreal injection, cryotherapy, scleral buckle, and vitrectomy. Children’s National’s ophthalmologists are highly trained to identify the infants needing urgent treatment and provide long-term pediatric ophthalmology care.

A child with ROP may need glasses early in life, or experience other problems such as strabismus (misaligned eyes), amblyopia (“lazy eye”), glaucoma, and cataracts. These eye problems, however, can be treated or controlled.

The entire care team at Children’s National’s supports the needs of your child and helps families understand the multiple needs of children born prematurely.

Specialized Ophthalmology Programs
Neuro-Ophthmolalogy Program for conditions involving the muscles and nerves that affect eye function
Ophthalmic Genetics Program for children and adults with inherited eye disorders

Vision Testing and Screening

A comprehensive eye evaluation takes approximately two hours. We use the most advanced equipment for accurate diagnostic tests and screenings:

• A-scan ultrasound biometry
• Anterior segment photography
• B-scan ultrasonography
• Corneal pachymetry
• Electroretinography (ERG)
• Electrooculography (EOG)
• External photography
• Fluorescein angiography (FA)
• Fundus photography
• Keratometry
• Ocular coherence tomography (OCT)
• Ultrasonography
• Visual acuity assessment
• Visual field examination

For patients found to have a less severe eye condition, Children’s team helps connect families with a community specialist for a more appropriate level of care.

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