Vision Development & Your Child

This is an interview with Dr. Irfan Khan, a comprehensively (UK & Canada) trained ophthalmic surgeon with specialization in all aspects of Paediatric Ophthalmology and Ocular Motility. He works at Moorfields Eye Hospital, Dubai.

What is the story behind why you become a Pediatric Ophthalmologist?

I belong to a family of ophthalmologists. From a very young age, I was exposed to this wonderful field of medicine. I still remember my dad taking me to the hospital in Dublin-Ireland, where he used to work. I never realized that I would be working in the same hospital in 20 years time!

During my 7 years of General Ophthalmology training at Manchester Royal UK, I was exposed to Pediatric ophthalmology and I then realized that restoring sight to a young child could literally change his/her life. I then decided to refine my studies to focus on pediatric ophthalmology, thereby leading me to do a fellowship at Sick kids Hospital, Canada.

What does a Pediatric Ophthalmologist do?

A pediatric ophthalmologist treats all eye conditions related to children.

Children can have all the eye diseases that an adult has.

What motivates you everyday?

I love my work! Actually it is not work anymore it is more like a passion for me, as work can make you tired but your passion never does. Every good clinical and surgical outcome keeps me going.

What are common diagnoses that you see in your practice?

Dubai is very interesting as it is a melting pot of people from all over the world. We have the common eye problems that require glasses (Myopia or shortsightedness, Hyperopia or long-sightedness). The second most common diagnosis is strabismus or misaligned eyes.

The eye conditions seen in new born babies such as congenital cataract, congenital glaucoma and retinopathy of prematurity need to be treated very soon after birth.

Most of the Hospitals do a new born baby check and any immediate eye problems are picked up.

Are there particular childhood populations that should be more vigilant with their eye check ups?

I think all children should have their eye checked. I usually recommend the age group between 3 to 5 years, at the age when they are able to recognize shapes and the alphabet.

However, if there is a family of Cataracts, Glaucoma or the baby was born premature less than 31 weeks they should be seen.

What are the roles of various eye care specialists and how do I know who I should book in to see and for what purpose?

This can be very confusing especially in Dubai where every major specialty is sub-specialized. Ophthalmology itself has 5 sub-specialties! For the UAE my advise to parents would be to see a Pediatric Ophthalmologist for a vision assessment. Depending on the facility, your child may be seen by an Orthoptist prior to seeing the Ophthalmologist.

What are some red flags to look out for if my child may be having vision difficulties?

Most of the time it is difficult to pick up as one eye may be working perfectly fine while other may have a problem. The most common red flags would be:

  • Mis-aligned eye- meaning one eye is either aligned in towards the nose or the ears

  • If a child continuously rubs his eyes whilst doing a task- the inability to see makes them rub their eyes

  • A child that trips often on items on the floor could indicate a visual field defect.

  • A white reflex while taking a picture from a camera. This is called Leukocoria and instead of the normal red-eye effect, it causes a bright white reflection in an affected eye. I would suggest to use the flash at times as it is really good at pointing out abnormalities inside the eye.

If my child has an injury to the eye, what may indicate that I should make an appointment to see an ophthalmologist?

It depends on the injury- mostly kids come in with a scratch to the cornea by a paper edge or a fingernail. Unfortunately any injury to the cornea is very painful and should be attended to. Severe injuries involving sharp objects need to be seen as soon as possible.

What are the developmental consequences of having vision difficulties that are not treated early?

Vision has a major role in our developmental milestone; it is a form of communication. A child unable to see would never smile back at you. Similarly if the eyes are not working or moving together, they will not develop depth perception, which could lead to difficulty with gross motor skills e.g., walking.

How does vision develop through the early years?

This is a simple milestone checklist:

0- 4 weeks: Move eyes from side to side

Smiles and regards faces

0-3 months: Looks at objects placed in hand

4 months: Reaches and grasps

Excited to see a toy

5 months: Distinguishes family from stranger

9 months: Explores objects in hand

24 months: Can thread a shoe-lace