Pediatric Ophthalmology:

Sierra Eye Associates is proud to have two ophthalmologists in Northern Nevada with fellowship training in Pediatric Ophthalmology and Strabismus (cross-eyed) treatment are L. Alan Johnson, M.D. and Pauline Hong M.D.

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What is a pediatric ophthalmologist?	Strabismus (crossed-eye)
Amblyopia (lazy eye)	Strabismus treatment
Amblyopia treatment	First eye exam?

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Why a pediatric ophthalmologist?

A pediatric ophthalmologist is a medical doctor, trained in the specialty of ophthalmology and in the subspecialty of pediatric ophthalmology and strabismus (misalignment of the eyes). Many pediatric ophthalmologists restrict their practice to children or adults with related problems and thus are particularly qualified to treat pediatric vision problems.

Ophthalmologists are medical doctors (MD's) who have had four years of medical school, at least one year of internship training in a hospital, and at least three years of residency training in ophthalmology. They are equipped to provide total eye care: they examine for and fit eye glasses; prescribe oral, intravenous, and topical medications; and perform all types of laser and incisional eye surgery. Pediatric ophthalmologists have chosen to specialize in eye disorders unique to infants, children and adolescents including inherited eye diseases, amblyopia (lazy eye), strabismus (crossed or wandering eyes), and refractive errors (nearsightedness, farsightedness, and astigmatism). Subspecialty training in pediatric ophthalmology requires at least one year of fellowship.

Children's eyes and vision are still developing after birth, so many of the diseases that affect their eyes can have a life-long impact if untreated. Pediatric ophthalmology evolved over the past 30 years in response to the exponential growth of information about children's eye problems and advances in surgical and non-surgical techniques to address those problems. In addition, as part of their training, pediatric ophthalmologists learn how to examine a frightened or uncooperative child in a manner which is non threatening but which is effective in obtaining the most information about that child's vision. In this way a more accurate and complete diagnosis and treatment plan can be achieved.

Thus a pediatric ophthalmologist is specifically trained to diagnose and treat children with eye and vision problems. Their training and expertise uniquely qualify them to protect a child's visual future.

Dr.'s Alan Johnson and Pauline Hong specialize in Pediatric Ophthalmology. Dr.'s Alan Johnson and Pauline Hong's areas of expertise include surgical correction for strabismus (crossed or wandering eyes), diagnosis and treatment for amblyopia (lazy eye), blocked tear ducts, congenital eye diseases, and eye examinations and glasses for children.

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What is a "lazy eye"?

Amblyopia, the medical term for "lazy eye" is reduced vision in an eye that can not be corrected by glasses and which has no other organic cause (for example a scar in the eye). Many people will call an eye lazy because the lid droops or the eye wanders but these are actually distinct conditions. An amblyopic eye often appears perfectly normal, so it is often detected only through vision screening. In childhood, the connections between the eyes and the brain are just developing. The brain must learn how to put together information from the two eyes to make one picture. If the image from one eye is clear and the other blurry, or if the eyes are crossed and send two different pictures, the brain will choose to ignore the pictures being sent by one eye. When the brain consistently ignores information being sent by an eye, that eye will become weak, just as an arm, which has been in a cast, will not have equal strength to the fellow arm. Amblyopia is treatable until the age of 7 or 8 years--the age at which visual maturation is thought to be developmentally complete. Amblyopia is treated by forcing the child's brain to use the weaker eye--this can be achieved by wearing a patch over the stronger eye, or blurring the vision in the stronger eye with glasses or eye drops. The predisposing conditions also require correction such as glasses or surgery.

What causes strabismus (crossed eyes or wandering eyes)?

The answer is not really known. Probably it is a combination of genetic and environmental influences. Misalignment of the eyes may present as one eye appearing to look straight ahead and the other eye pointing inward, outward, upward, or downward. When a child's eyes cross or one eye wanders, there often is loss of depth perception because the eyes are not working together. The sooner these conditions are treated, the more likely that this depth perception can be regained. The most common age for strabismus to be present is between age 2 and 4 years, although some children are born with strabismus and in others it may not be apparent until the child is slightly older. Treatment of strabismus often requires the use of glasses, sometimes surgery, and rarely exercises. Often, amblyopia is also present which must be treated as well. Strabismus rarely corrects itself, so it is not something a child will simply outgrow.

Medical term	Definition of term	Common term
Esotropia (convergent squint)	Eye turned in	Cross-eyed Boss-eyed
Exotropia (divergent squint)	Eye turned out	Wall eyes
Hypertropia (vertical)	Eye turned up
Hypotropia (vertical)	Eye turned down

When should my child have a complete eye examination?

Ideally, all children should have a complete, dilated, ocular examination between the ages of 2 and 3. Unfortunately, many insurance companies will not pay for a routine examination if there is no problem found. So many parents and pediatricians rely on the vision screenings provided by local organizations. A vision screening is not a substitute for a complete examination and certainly, if there is any suspicion that the child is having difficulty seeing or has strabismus or amblyopia. In these cases, the child should be examined as soon as possible. Even infants can have a complete examination so no child is too young to be examined.

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Amblyopia (lazy eye) affects 1 out of 20 children. It is the most common cause of visual loss in young people (more than eye disease and trauma combined!).

Strabismus (crossed eye) affects 1 out of 20 children. It occurs equally in boys and girls. Adults who develop strabismus usually will see double.

Glasses are prescribed for children to treat amblyopia and strabismus, and also to correct blurred vision. Glasses prescribed for blurred vision alone are simply aids to improve vision and the eyes will not be damaged if the glasses are not worn.

Learning disabilities are not caused by vision problems but are malfunctions in the area of language processing in the brain. Because amblyopia and strabismus are fairly common, some children with learning disabilities may have them and vice versa. Special glasses and vision therapy rarely will help a child with a learning disability and the best treatment is personal tutoring.

Please call (775) 329-0286 if you would like to schedule an appointment.