Eye Care News for Children

In this study, ophthalmologist Gregg T. Lueder, MD, reviewed medical records of seven children injured by air bags, and concludes that serious ocular injuries in children may result, though most resolve without detrimental long-term consequences.

Dr. Lueder explains, however, that serious injury may result if the child is too near the air bag when it deploys. "In infants," he says, "the increased mortality risk results from the use of rear-facing infant car seats in the front passenger seat. This places the infant's head too near the deploying air bag. In older children who are unbelted or who use lap-only seat belts, the head may move forward during impact, resulting in head and neck injuries."

Many of these disorders can be detected, treated, and even prevented if caught early in a child's life, according to Dr. Glen T. Steele, clinical professor and chief of Pediatric and Vision Therapy Service at the Southern College of Optometry and private practitioner in Memphis. Dr. Steele recently spoke at the American Optometric Association's (AOA) annual meeting in Las Vegas.

It is currently estimated, however, that only 14 percent of children under age five receive a comprehensive eye exam.

"Most parents don't realize that it is critical to have a child's eyes examined early, at six months, to correct vision impairments early and not waste valuable time in a child's development," said Dr. Steele. "Current optometric practices are quite capable of early detection, diagnosis and treatment of childhood vision problems. But we can't make a diagnosis on patients who we are not meeting," continued Dr. Steele. "A conservative interpretation of our statistics indicates that at least 10 to 15 percent (eight to 12 million) of children are at risk for undetected vision impairments. This is a significant statistic, especially if your child is one of those affected."

Often, from a parent's or teacher's perspective, these children look like they suffer from a variety of problems, including reading difficulties and lack of self-esteem. Dr. Steele and the AOA suggest that every child have a comprehensive eye exam at six months, again at 3 years, and another before starting school.

What is the reality for a child with undetected vision impairments, such as amblyopia (lazy eye), strabismus (crossed-eyes), or severe nearsightedness or farsightedness? "Visual impairment, whether obvious or subtle, can have a profound effect on a child's development. Parents might suspect the child is not developing normally, but there are hidden factors a parent can't detect, like the lazy eye that is steadily growing weaker," said Dr. Steele.

The brain virtually ignores images being sent by the amblyopic or weaker eye, until that eye becomes unused. "It is quite difficult to effectively treat amblyopia at this point. Activities requiring good depth perception may be difficult or impossible to perform. In addition, should the good eye become injured or develop vision problems, your child may have difficulty maintaining normal activities," advises Dr. Steele.

Researchers at the Medical College of Wisconsin, in Milwaukee, studied 123 children, who were admitted to the Children's Hospital of Wisconsin with shaken baby syndrome (SBS) over a twelve-year period. Shaken baby syndrome is characterized by subdural hematomas of the brain (an accumulation of blood beneath the brain's outermost covering), hidden bone fractures, and retinal hemorrhages in children who are usually less than three years old. Although violent shaking alone can cause the injuries, many of the patients examined showed signs of impact injuries to the head, ranging from skull fractures to bruises. One-third of SBS victims die, and many survivors suffer from significant neurological handicaps.

According to the study, 35 (28 percent) of the patients had a medical encounter within the six weeks prior to their admission for the brain injury caused by shaken baby syndrome. In retrospect, it was determined that one third of these encounters had occurred because of abuse that was not recognized at the time of the initial encounter. Of the 35 victims, four children died and five lost their vision due to the subsequent abuse.

SBS victims are difficult to diagnose for several reasons:

-- SBS victims frequently present with non-specific symptoms such as irritability, lethargy, and vomiting commonly attributed to gastroenteritis or other infections.
-- External signs of head trauma are rarely obvious enough to prompt further tests by medical personnel.
-- The parents or caregivers, wanting the abuse to remain undetected, often withhold the history of the injury. The history of a patient's illness is extremely important in making a correct diagnosis for any medical condition. Medical personnel are trained to be empathetic with the patient's family rather than suspicious.
-- Physical findings of retinal hemorrhages, which have a high correlation with child abuse, are difficult for non-ophthalmic medical personnel to see. Non-ophthalmologists missed the retinal hemorrhages in 29 percent of the patients where they were later found by the ophthalmologist.

One of the study's authors, Jane D. Kivlin, M.D., said it is very important to make the initial diagnosis of child abuse as soon as possible to place the child in protection. "Repeated abuse is very common and may be fatal the next time." she said.

The study's authors suggest that young children who are admitted for lethargy and vomiting be given an ophthalmic evaluation if infections have been ruled out. "Ophthalmologists who examine SBS victims can detect retinal hemorrhages, which in most cases, is a sign of shaken baby syndrome,"

Dr. Kivlin said. "Unfortunately, ophthalmologists are not usually called in until the signs of abuse become more apparent, which can be too late.

The recommended dosage regimen for Optivar is one drop instilled into each affected eye twice daily.

Azelastine hydrochloride is a relatively selective histamine H1 antagonist/mast cell stabilizer and an inhibitor of the release of histamine and other mediators from cells involved in the allergic response.

The unique characteristics of Optivar allow this product to have a rapid onset of action (within three minutes) and a long duration of effect (approximately eight hours) with a twice daily dosing. Optivar has been proven to be safe in patients three years of age and older. The most commonly reported adverse events in controlled studies, where patients were treated for up to 56 days, were transient eye burning/stinging, headaches, and bitter taste. The occurrence of these events was generally mild.