On the effective prevention and treatment of childhood eye diseases, “Matrona” talked with Marina Dzhavidovnoy Magaramovoy , ophthalmologist, MD, PhD, senior researcher department of microsurgery and functional rehabilitation of the eye in children IRTC “Eye Microsurgery” named after academician SN Fyodorov.
Marina Dzhavidovna recently began a new school year, the children went to school. What preventive measures are necessary to have the child-student is not spoiled vision?
First of all, compliance visual mode. Rest between lessons, the lack of games on mobile phones and tablets, regulated while using the computer. His patients I allowed to play on the computer a maximum of 20 minutes per day, because even junior high school students already have jobs that they perform on a computer.
It is important to properly equipped workplace. The computer must be set so that the monitor center was located below the horizontal line of sight at 15-25 cm. The distance between the eye and the monitor should be 60-70 cm. The height of the table and the chair must be chosen so that the child’s feet were on the floor. The child must sit so that there is no inclination of the head. Children often stacked on the table, based on hand – it causes the rotation of the head, and therefore a different load on the left and right eyes. Hence, deterioration of health and reduction of eye function.
It is important to lighting: in the dark you can not work on the computer, but can not be to bright lights lit up the screen – additional glare cause eyestrain.
Accordingly, the child’s age is required sleep. Walking in the fresh air, exercise improves overall health and physical condition.
Do you face the so-called computer vision syndrome in school children who spend a lot of time on the computer?
Computer Vision Syndrome – a set of applications which include: disturbance of visual acuity, fatigue, which manifests itself in reddening of the eyes, pain in the eyes, and dry eyes. To avoid this, you need to respect the work at the computer, you need to take breaks.
European ophthalmologists have suggested the following rule: 20-20-20. It is suitable not only for children but also for adults. 20 minutes of work at the computer, break 20 seconds, and 20 seconds into the man looks into the distance at 20 feet – is 6 meters, which is the maximum eye relaxation.
As for children, they are not for nothing that the changes between lessons. The same changes should be done at home between homework and lessons with a computer.
As for the dry eye is due to the fact that when we look at the monitor blinking becomes rare, and the cornea is not washed by tears. The feeling of dryness in the eyes of sand – a manifestation of dry eye syndrome. If a person is connected to a computer, it is, of course, is to bury rewetting drops. Now a lot of them, you recommend a particular drug ophthalmologist.
Blurred vision in healthy children is associated with impaired eye health, in violation of the accommodation. The possibility to consider clearly objects at different distances – this is accommodation. In order to train the accommodation, there are different tools, techniques, exercises. But in order to prevent the decline of view, it is necessary to follow all the rules, we talked about: workplace ergonomics, lighting, visual compliance regime.
Up to 7 years without gadgets, or How to keep your child good vision
A pre-school children?
Preschoolers need to, first of all, to give children a normal life. Now we parents do not want to deal with children, they are sitting in the mobile phones. Even before the doctor’s office, looking – in children in the hands of tablets and phones. Games on the tablet and phone, you should not give small children.
Computer and Gadgets child up to seven years, just not physiologically shown. Therefore, all the games in the gadget – it’s very bad for the eyes. Suffers accommodation, accommodation at the violations occur violation of visual functions: and decreased vision, and a violation of binocular function, and strabismus appears. Little baby to play with toys. In the youngest must be large colorful toys. In the future – books, publications good, clear, with large pictures. Puzzles, puzzles – all this according to their age, of course. And no early learning: do not need to teach a child to read in three years.
After three years, you can watch cartoons, but not the whole day! An hour and a half, with breaks – it is permissible for older preschoolers.
Do we need children sunglasses? And at what age?
I do not advocate to assign them to small children, because the expensive glasses children do not buy, and points acquired on the regular market, on the contrary, have a negative effect. Hats, caps, with a peak, with the fields – that is necessary for children. Either it must be sunglasses with UV protection, chosen in optics.
The exceptions are children who have retinal disease, macular degeneration, for which we recommend sunglasses with special filters. This is a case where ultraviolet light, bright sunlight can be harmful. But in this case, the doctor assigns points.
As food as affect vision? Blueberries, carrots – whether it makes sense to lean on these products with vision problems?
All this is good for the overall health of the child. But it is naive to believe that if there is all day carrot and blueberry jam, you can sit at a computer all day and night. All the vitamins, all natural products to improve the overall condition of the body, specifically in the refraction of the eye, of course, is not affected. It should just be a balanced and proper nutrition.
How often do I need to show ophthalmologist healthy baby?
A healthy child should once a year to check vision. This medical examination in kindergarten is mandatory medical examination in schools. Young children, infants, examined 1 month, 6 months, 1 year, 3 years for admission to kindergarten, and the design of the school. It is mandatory examinations for all children.
I must say that the children of parents who have a pathology of organ of vision, such as high myopia, cataracts, hereditary diseases, hereditary dystrophy, are automatically placed at risk. Of course, they are inspected more frequently.
Are there some things that should alert parents? When an urgent need to go to the ophthalmologist?
Yes, there are signs. Let’s start with the babies. By the end of the first month of a child appears short pursuit. That is, the child watching her mother, begins to follow the toy. If this tracking no, it should be very alert parents and doctors. Parents, of course, can not conduct research, but must see whether there is a reaction of pupils to light.
If a child who has himself can take a toy, puts it very close to his face to see – this should also be alert, because it may indicate a low visual acuity. Or when a child who can already sit, does not play with toys that look pushed down. This indicates the absence of any objective view, or a decrease in the expression of his. Strabismus, nystagmus (tremor Eye) – the situations that should lead to the patient’s doctor to be sure. This applies to children.
It is necessary to remember that children do not complain about the decrease in vision. Young children do not know how to do it, they do not know how it should be. Parents should alert the following situation. When visual load – watching TV, painting, working with small toys – the child is marked redness of the eye, or it starts to blink frequently or begins to look sideways. Older children begin to come close to the TV, not for the sake of interest, namely, watching TV is very close. Either low bend when paint or trying to write, that is a question of low inclination of the head when working near.
By the way, turning the head when the child begins to look askance or sideways – it is also evidence of changes in visual acuity.
These situations should lead you to the doctor to find out why. The cause in these cases is always.
As there is strabismus and how to treat it?
Strabismus – is a serious violation because it is not just a cosmetic position of the eyes, is a violation of binocular function, it is a violation of the perception of space, perception of volume. There are congenital strabismus, there is acquired strabismus. Congenital it considered all that is shown to one year.
With regard to acquired strabismus, often we realize that the reason the early load, when the child for some reason moved to the sight of one eye. But it is not only the reason, of course, there is ametropia – change of refraction, high farsightedness, astigmatism – different refraction of the eye, and therefore there is a difference in visual acuity. Naturally, the eyes, which is easier to work with, it is fixed.
The doctors first do a survey and determine the refraction of the eye. In older children, you can determine the visual acuity using tables. In young, do not speak, determined refraction, eye position. Strabismus Treatment usually begins with the selection and wearing glasses. Then, at the age when it is possible, it added hardware and treatment.
From what age?
It all depends on the child. But usually up to three years, it does not work. Need feedback from the child, it is necessary that he watched the instruments, knew what he should do. Therefore, up to three, someone even up to four years, it does not work.
If necessary, required surgery, i.e. surgery.
One of the first challenges that are often faced by parents of young children – dacryocystitis of newborns. How to treat it properly?
This massage the lacrimal sac and medication. If there is a purulent discharge – always need antibiotics, anti-inflammatory drugs in the form of eye drops, which must appoint a children’s ophthalmologist. If conservative treatment is ineffective, if required intubation lacrimal system to restore their patency.
How much should you spend conservative treatment, to understand that it does not help?
All individually, of course. But on average, to decide on the lacrimal probing can be a month or two active treatment. Previously also need to consult an ENT doctor to make sure there are no problems with the nasal mucosa.
What are the different types of conjunctivitis and how to treat it properly?
Conjunctivitis can be viral, bacterial, allergic, and then, of course, it is necessary to see a doctor, because different types of conjunctivitis are treated differently. View conjunctivitis can identify only a doctor. Engage in self can not in any case, because there are complications that arise keratokonyuktivity.
To help the doctor to correctly identify the type of parents can be traced, amid what appeared conjunctivitis. For example, a child in a state of acute respiratory disease, or had just been ill virus infection, or he played in the sandbox, and rubbed his eyes with his hands. In children who are prone to allergies, conjunctivitis may occur after contact with animals, with flowering plants, in violation of the food regime.
What role does heredity? If mom and dad with glasses – does this mean that the child will also be short-sightedness?
Yes, there is a genetic predisposition, and it is very often realized. If a high degree of myopia parents and their children at risk automatically. For such children need protective eye mode. When my mother high myopia, and the child is already reading in three years, and actively reads – is, of course, unacceptable.
But genetics – this is not the only factor. Many myopia appears, even if the parents perfect vision. The reason for this early learning, early load. Children walk a little, just look closely. All this, of course, affect the incidence of myopia.
How to treat myopia in a child? At what age can use the points from which – lenses?
If necessary – the right purpose of correction. The age at which prescribed glasses or lenses, is different. When my patients need to wear glasses to 5-6 months. Points chooses a doctor, and in each case, the recommendations for each child their own: spectacle correction, contact correction (ie lens), or a combination thereof. Contact lenses can be used at different ages, the question is that the child or the parents gave to wear lenses, or he has learned.
Well help accommodation training, hardware and treatment in the offices of protection. Such treatment twice a year is desirable to conduct. Pay attention to the visual mode, sleep mode, and walks the rest of what I said.
Hardware treatment is carried out only in the offices of the protection? Or you could theoretically buy a home phones?
There are computer techniques that can be purchased and used at home. But we must remember that in the office of the protection of the treatment takes place in a complex.
Does the child for vision correction surgery?
No such operations do not make children with myopia. All refractive surgery for myopia done after 18, with the proviso that not progressing myopia. With farsightedness do in rare cases, when the vision with two eyes is not possible, do not carry glasses, contact lenses are not transferred. It is usually the difference between the refraction of the two eyes – in these cases do.
Would you recommend some non-traditional methods of treatment of myopia? For example, the glasses-trainers?
I do not assign, because I do not think this treatment. It’s home to watch TV, that’s why they are called “Relax”. Sometimes it is difficult to determine, fake or real these points. In general, I am not a supporter of non-traditional methods.
A gymnastics for the eyes gives some positive effect?
They need more to improve blood circulation and, in principle, is shown to all. This is what you can do at home, and several times a day, while relaxing between visual loads, while working at the computer. Exercising improves blood flow. You can not only watch from side to side, up and down, but also open and close the eyelids – it also helps to improve blood flow. The degree of myopia is, of course, will not change, but when the blood flow is improved, patients get the feeling that the more clearly evident. It works.
What do you think the use of atropine?
Abroad in recent years it has become very actively use it even as a treatment. But we do not use, in any case, in our facility.
For diagnosis, we did not use, because after all atropine – quite a potent substance. Apply it is possible to strictly age dosage, because it can cause complications such as dryness, redness of the skin, nervous excitement. And as I atropine treatment to their patients not to appoint. For the treatment of spasm of accommodation appointed other drugs.
In our institution, we use to diagnose midriatiki short-acting, which are a maximum of one day. A atropine – mydriatic long-acting after a single instillation of his it can operate for several days (up to seven). Selection of atropine dosage – it really is not easy. In the clinic, where a large flow of patients, I would still did not. While abroad in the last couple of years and it is used as a treatment. But I must say that abroad virtually no hardware involved in the treatment
Question about pregnancy and childbirth. What is an absolute contraindication to natural childbirth?
It all depends on whether there is a change in the fundus, and what those changes. All pregnant women should undergo screening ophthalmologist, including those necessary to check fundus. If there are changes in the retina, such as detachment, tears, retinal dystrophy, and permitting stages of pregnancy, it is carried out the appropriate treatment. If treatment is not carried out, it is recommended that a cesarean section.
Thank you very much for the interview!
Interview Alain Khmilevskaya