Ophthalmologist Sergey Rykov: "Every third child can correct strabismus without surgery"

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“Do not write with your nose,” “do not sit at the computer for a long time” ... Parents of schoolchildren try to make sure that children do not strain their eyesight. Pay attention to this and teachers in school. However, the quantity of students with eye diseases is increasing. Why? In what cases strabismus can be eliminated without surgery? When is it better to operate on myopia? How to remove a visual computer syndrome? These and other questions of our readers at the direct line "FACTS" were answered by the President of the Association of Children's Ophthalmologists of Ukraine, Head of the Department of Ophthalmology of the National Medical Academy of Postgraduate Education named after P. L. Shupyk, Doctor of Medical Sciences, Professor Sergey Rykov.

* - Hello, Sergey Alexandrovich! I’m Yuri Sergeyevich from Kyiv. My granddaughter (she is two and a half years old) has a left eye running up and slightly squint. We went to the doctor, and he said that nothing needs to be done, it will pass by itself. Is it true?

- I think that it should be. You just have to wait for some time, an eye forms up to four years. Every six months you will show granddaughter to ophthalmologist. The eye may slightly squint due to the neurological disorders, but if the girl did not have a birth trauma, other problems with the nervous system, then the structure of the eye is correct and treatment is not required. Quite often, squint occurs due to accommodation spasm (the ability of the eye to see well at different distances). This is not a diagnosis, but a symptom, for example, myopia, overwork with hyperopia, astigmatism. If the internal muscle is overstrained, it needs to be relaxed by putting special drops into the child’s eyes (ten days once a night). If the muscles are relaxed, the blood supply to the muscle tissue of the eye improves, and correct vision is restored.

* - "FACTS"? My name is Irina. We live in the Kyiv region. My son (he is four years old) has his eyes squint down to his nose. We are afraid to operate. What to do?

- It is important to know that convergent squint in 95 percent of cases is accompanied by congenital farsightedness. Children are born with a far-sightedness of two to two and a half diopters, but the eye does not begin to squint immediately (at first accommodation works well), and after two - three years. With farsightedness, the internal muscles pull the eye to the nose (the so-called convergent squint), and with myopia, the external muscles pull it out (diverging squint).

A child with a squint, sees the world around us with one eye, because the second one, cornered, is essentially “turned off”. With a low angle of strabismus, surgery is not needed, and we successfully treat about 30 percent of children. You need to show your son to an ophthalmologist. The doctor will find out the degree of farsightedness by expanding the pupils to the boy with special drops, and determine the true structure of the eye. A few days later, then the pupil narrows, it will correct for hyperopia, selected of glasses. If the glasses straighten the eyes, it means that the muscles compensate the angle of strabismus. But if there are squint even with glasses, special rigid micro prisms should be used so that the axes of both eyes (healthy and squinted) would be parallel.

The method of diagnosis and treatment of strabismus using microprism was developed by the staff of the Department of Ophthalmology of the National Medical Academy of Postgraduate Education named after P. L. Shupyk, The Kyiv Eye Microsurgery Center and scientists of the Institute for Information Recording of the National Academy of Sciences of Ukraine. Using microprisms, it is possible to accurately determine the angle of strabismus of a child, to choose him spherical lens glasses that help the eye to correctly perceive the image. That children wear them, they train their eyes all day long. Previously, a child had to be led to an ophthalmologic office in an outpatient clinic in order to increase visual acuity (a squinting eye always sees worse) and to develop solid (three-dimensional) vision.

If the squint angle is big enough, microprisms help to prepare the child for surgery. The doctor with their help first of all aligns the eyes to understand how the baby will see. If you have an operation and then develop the correct vision, the result will be worse and you may need a second and even a third intervention. To perform the operation accurately, it is important to correctly calculate the angle of strabismus. Here we also use microprisms at special lines that help to clearly calculate how many millimeters you need to lengthen or shorten a muscle.

* It’s Alexandra from the Lubny, Poltava region. My three year old son has a squint. When is it better to have surgery?

- It is necessary to have time before the school, so the child goes to the first grade without glasses or wearing glasses, but without a squint. We insist rhat after noticing a baby’s squint, immediately contact an ophthalmologist. Timely prescribed treatment will allow to straihten the eyes, develop a three-dimensional vision, and the child will be able to study normally. For children with bad eyesight we offer the so-called inclusive education in secondary schools. In Kyiv, for example, special classes have been opened, where students can study and develop their vision: schools have equipment for treatment.

- Hello! I’m Oksana from Kyiv. How to eliminate strabismus?

- Do you mean surgery? It depends on the type of strabismus. The eye capsule is held by six muscles: four allow you to drive the eye to the right and left, up and down, and two more oblique  to look to the sides at different angles. If strabismus, for example, friendly, need an operation on the horizontal muscles.

The intervention lasts about 15 minutes, and the child is asleep at this time (up to 16-18 years old, all children are operated on under anesthesia). The doctor, through micro incisions, pulls out a muscle with special tools, clears it and notes how weak or tighten it is. After the operation, droplets are instilled into the child at home during the week. With farsightedness of up to three diopters, glasses are usually not needed. A higher degree is compensated by glasses, which help to see normally near, prevent eye fatigue.

* - Good day! I’m Alla from the Melitopol. My teenage son has myopia up to minus four diopters. He wants an operation to fix it. Is it possible

- About 15–20 years ago, ophthalmological surgeons with myopia hemmed special sclera petals that stop eye growth in children. There was a definite effect, but then it turned out that myopia progresses: the child grows and the skull and eyes increase with it. In addition, there is a genetically determined myopia: myopic parents with a probability of 50 percent have a son or daughter, that can see less well from the beginning of eight years.

Today new technologies are emerge, laser treatment of myopia. The operation is effective if myopia is less than six diopters. It is made after 18 years of age, after a preliminary examination by the patient (measure the thickness of the cornea, the depth of the anterior chamber, the length of the axis of the eye). Often they want to get rid of myopia young people who go to serve in the army or work in the SBU, where you need one hundred percent vision. But for the future pilots intervention is undesirable, because after it patient can see rainbow circles or light scattering, and for the pilot it is not safe.

* - Sergey Aleksandrovich! I’m Nina Andreevna, from Kyiv. My two-year-old grandson can turn on a computer himself, find games. Is it bad for the eyes?

- Fear not the computer, but the time spent in front of the monitor. Overexertion of the muscles inside the eye (they are called “accommodative”) can lead to early myopia. If the child prone to developing myopia is protected - to engage in exercises on the development of accommodation, to monitor the visual load, then visual impairment will begin at age 12. If you do not do anything, and long-term loading of the eyes at close range, myopia may appear even eight and six years old. The later the eye lengthens, the more favorable myopia proceeds, fewer complications occur.

To distract the kid from the computer, offer him to read children's books together. Choose publications with a clear high-quality font, bright drawings, interesting content. Do not forget that the computer can be useful, because there are computer programs for the treatment of poor vision (amblyopia), special games that develop vigilance.

- How much baby can play on the computer?

- It is desirable that the first acquaintance with a computer happened not earlier than six years. A preschooler can be practiced no more than 15 minutes a day, and a first grader is allowed two such “approaches”. Every year another five minutes of time are added. It is important that the distance from the monitor to the eyes of the child is 45 centimeters, and the background color of the monitor is gray or green, or close to it, but by no means blue or cyan. These colors are considered toxic: they cause severe eyestrain and eye strain. You also need to make sure that all signs on the screen are clear. For students  of elementary school students, it is advisable to use a font those letter height is at least eight millimeters.


* - I’m Yulia from Kyiv. My daughter (she is 11) wears glasses. Can she go to contact lenses?

- Children are prescribed lenses when it is necessary to equalize the difference between the eyes: one eye, for example, stands minus six, and the other one stands minus two. If a child is embarrassed to wear glasses and is able to independently remove and put on lenses, let him use them.

Now there are high-quality silicone and hydrogel lenses. They suspend the development of myopia, because when blinking a little they press the eye and do not allow it to stretch. In addition, the lens slightly massages the eyes, and also protects the cornea from harmful external factors (dust, germs, uncomfortable temperature, dry air). Many children use glasses and lenses at the same time. For example, they go to school in lenses and wear glasses at home. Contact lenses are needed and the guys who play sports: glasses could mist or break, while lenses could not.

* - My name is Olga, I’m calling from the Uman, Cherkasy region. The son is student of high school, he works with computer for a long time and complains that his eyes are as if filled with sand. What to do?

- I think your son has a visual computer syndrome. This is the same dry eye syndrome, but arises due to long-term work on the computer. Visual computer syndrome first recorded and described by Canadian experts. It occurs in those who focus heavily on work and rarely blink. If you blink less than 18 times per minute, the cornea dries up, inflamed. The eye turns red, there is a feeling of sand, itching, visual fatigue. Canadian scientists have suggested every two hours to bury an “artificial tear” in their eyes, which restores the tear film. These drugs are available for children from the age of four.

- Can you drip them yourself by buying at the pharmacy?

- First, the doctor must confirm the visual computer syndrome by determining with the help of special tests how many tears stand out, whether there is a tear film gap. And you can try to drip your son’s eyes with a cool chamomile decoction (pour a teaspoon of grass with a glass of boiled water twice and boil again). A bath, especially Turkish, with an abundance of steam is also useful for the eyes: the cornea is well moistened, the nutrition of the eyelid edge is improved.

* - I’m  Anna, from Kyiv. The 14-year-old son has myopia, and he began to go to the gym to “rock”. Vision will not deteriorate?

- I advise you to pre-examine the son at the ophthalmologist. If there are no changes in the fundus, dystrophy or thinning of the retina, then physical activity is not contraindicated. With myopia over six diopters, when there is dystrophy of the retina, there were laser interventions on it, it is necessary to limit the load and engage in a special group. It is not recommended to sit for a long time, with your head bent down, and also to engage in work related to vibration.

* - Antonina from Buchach, Ternopil region calls to you. I have intense myopia, and my two twin sons have normal vision so far (they have moved to the second class). Do they need extra vitamins?

- Vitamins of group B, C, PP, microelements are useful for the eyes, and fat-soluble vitamins A and E are for the retina. We try not to prescribe synthetic vitamin preparations to children, and recommend full nutrition. We tell parents that the child should more often be offered liver, fish, cottage cheese. A carrot is useful, but you should not overdo it: a seven-year-old child, for example, once a quarter for ten days should drink half a cup of carrot juice. Blueberry is very useful for vision, such should be mixed with sour cream, and you can add more sugar or honey. This food contains fat-soluble vitamins, the lutein pigment necessary for the retina. Blueberry and sour cream are preferably eaten every day in the season: half a glass of berries for a child and a glass for an adult: this will improve the vigilance.

- How often do children need to check their eyesight?

- If there are no complaints, it suffices once a year. Usually at school this is done by a nurse. If the child sees less than 80 percent, he is referred to an ophthalmologist.

- I’m Inna Stanislavovna from Kyiv. My grandchildren watch cartoons on TV for a long time. I'm wondering how bad it is?

- Watching TV is not harmful to a child with one hundred percent vision, which sits four to five meters from the screen. But parents need to be wary, noticing that the child is coming closer to the TV, his eyes are squinting to improve image clarity. This may indicate myopia.

It is important for children and adults to watch TV with a side light, especially for people over 40 who have positive glasses for distance. The pupil expands in the dark, and in some diseases the outflow of intraocular fluid can be blocked and an acute attack of glaucoma can occur.

Prepared by Natalia SANDROVICH, "FACTS"

Photo by Sergey Datsenko, "FACTS"