It should be emphasised that in no case should a child miss a full ophthalmological examination with a thorough assessment of the refractive defect and a fundus examination with an assessment of the optic disc and macula, after pupil dilation and accommodation paralysis. This is to exclude the existence of organic conditions that may be the cause of poorer visual acuity in the visually impaired eye.

In anisometropic and isometropic visual impairment, the therapeutic measure is to use full correction of the refractive defect (the defect should be fixed after accommodation paralysis). In the overwhelming number of cases, these visually impaired patients improve significantly within a few months after appropriate correction of the visual defect is applied.

Deprivation of vision requires surgical treatment. Surgery should not be delayed. The younger the child, the greater the ultimate impact of cataract occurrence on vision. The most serious prognosis is for cataracts present from birth, and irreversible loss of vision can occur if they are not removed by 6-8 weeks of age. Opacities occurring in infancy and early childhood have a better prognosis, but prompt surgical intervention is still required. If congenital cataracts occur bilaterally, the other eye should be operated on within 1-2 weeks.

In the case of an acquired cataract in a child under 6 years of age, it should be removed within a few weeks after the injury. After surgery, lensless correction is required. The most common is the use of spectacles, which can be easily replaced taking into account the child's growth and change in refraction. Eyeglasses are not used in unilateral lenslessness, as this can cause varifocality.

Contact lenses are an excellent correction alternative in this case. However, when using them, it is necessary to observe good wearing hygiene and to be prepared for higher treatment costs. In some children, an intraocular lens implant can be used. In addition to pharmacological treatment, post-operative therapy for visual impairment, introduced as soon as possible after surgery, is necessary. As mentioned above, glasses or contact lenses should be used as early as one week after surgery. Indications for covering the better eye include unilateral aphakia and asymmetric cataracts in both eyes. The success of good visual acuity results consists not only of the timing of the surgery, but also of conscientious postoperative management including visual rehabilitation to prevent visual impairment.

References:

1/ M.H. Niżankowska: Basics of ophthalmology, Wyd. Med. Volumed, Wrocław 2000.

2/ M. Grałek: Paediatric ophthalmology and strabismus, Wyd. Med. Urban & Partner, Wrocław 2004.

3/ J.J. Kański: Okulistyka kliniczna, Wyd. Med. Urban & Partner, Wrocław 1997.