A pediatric cataract is a big problem. In babies, if the cataract is not removed as fast as possible the child will develop a permanent lazy eye and the pathway to the brain will not develop properly.

We have the best technology in the world and possibly the only center in Mumbai with a catalyst bladeless robotic laser to treat pediatric cataracts in children as young as 2 months of age.

• We do not need to give general anesthesia: In most cases, only short-acting sedation since the procedure is over in 4 minutes or less-In most pediatric eyes we can use the Catalys laser system to do a perfect Capsulorrhexis which is the most important part of the entire surgery.
• We can measure the eye power even in fairly mature cataracts on the table and procure the necessary lens from our lens stock. Our IOL Master 700 with TK is the best measuring device in the world.
• We specialize in implanting multifocal implants at a young age as we have the technology to measure accurately.
• Posterior capsule Opacification which occurs in all children after-cataract is treated easily under sedation with our high powered YAG Laser from Zeiss.

Congenital (present at birth) cataracts occur when the lens didn’t form properly due to some reason or the other.

About 30 percent of the time, congenital cataracts have a genetic cause, and may accompany a metabolic, hormonal or chromosomal abnormality (e.g., Down syndrome). Another 30 percent of the time, cataracts are hereditary, which means that the child’s mom or dad also had a cataract in childhood. Often no reason can be found for the development of cataracts. Infection in the womb-like with Rubella can cause cataracts in newborns.

Whatever was the cause the treatment is simple and straightforward.

Remove the cataract with the latest laser technology

Implant a correctly powered lens.

As soon as possible!

If your child is born with a dense cataract, we would like to remove it within the first two months of life, and definitely by four months. Often, the sooner we take the cataract out, the better the vision your child will be able to develop afterward.

100% for sure!

Usually, glasses are needed to perfect the focus. We often have to leave the eye with a plus number at first to allow for the eye to grow.  Also, the formulas, while quite exact, can never predict the final power of the eye perfectly. So a lens is added to promote the best possible vision development. We are implanting multifocal lenses in children as a routine for years together. At the World pediatric surgery congress, Dr. Cyres was invited to speak in an international debate when he showed that multifocal lenses in children are superior to conventional lenses.

Congenital Glaucoma, or Infantile Glaucoma, affects about 1 in 10,000 live births. It may occur without other findings (primary congenital glaucoma), associated with other syndromes, or after an injury like a blow to the eye from a ball.

Frequently congenital cataract extraction or cataract surgery is done in infancy or childhood results in glaucoma.

Allergy of the eye is treated with a high dose of steroids for months and years together can result in cataract. Inflammation of the eye, childhood uveitis can also lead to glaucoma.

Primary congenital glaucoma is due to the failure of development or abnormal development of the trabecular meshwork. It can be sporadic or autosomal recessive in inheritance.

Congenital glaucoma is usually detected by the parents. In infancy, the sclera of the eye is soft and stretches so that the eye enlarges when intraocular pressure is increased. Till the age of 3 the increase of eye pressure causes the eye to stretch, this resembles the eye of an ox so it was termed ox-eye or “buphthalmos”>Parents bring the child saying that the eyeball looks bigger.

Infants with congenital glaucoma present with photophobia (avoids light), epiphora (tearing) and blepharospasm (blinking or squeezing the eyelids). The main sign is an enlarged cornea, often in both eyes. As the disorder advances, the cornea becomes oedematous and appears cloudy. The infant may become irritable to the point of burying its head in a pillow to avoid the pain caused by bright lights. The appearance of an enlarged cloudy cornea in an infant essentially makes the diagnosis of congenital glaucoma and is obvious to casual penlight examination. These cases must be operated immediately.

Treatment is surgical and often successful, although more than one operation may be necessary. The aim of pediatric glaucoma surgery is to reduce IOP (pressure of the eye )either by increasing the outflow of fluid from the eye.

Best surgeries for Paediatric /congenital glaucoma

• Goniotomy.
• Non Penetrating deep Sclerectomy-Pioneer in India (2001).
• Canaloplasty linked 360’ trabeculectomy -Pioneer in India (2009).
• Trabeculectomy/Trabeculectomy.

Pictures of a child with buphthalmos

The misalignment of two eyes is called a Squint 

Treatment of this misalignment by,

• Squint eye exercises.
• Squint eye surgery.
• Spectacles for squint correction.
• BOTOX eye muscle injection technique.

The squint or strabismus in children is most often caused by a faulty connection in the brain; This can also cause a lazy eye. The squint in the child leads to following defects in their vision This squint must be addressed immediately.

• Loss of binocular vision (inability to use both eyes together).
• Loss of stereoacuity (loss of 3-dimensional vision).
• Decreased vision in the squinting eye -Lazy amblyopia.
• Poor motor development/hand-eye coordination.
• Abnormal head posture (head tilt or face turn).
• Psychological and emotional impact.

Most of the 6 problems listed above can be fixed if we correct the squint as early as possible.

Convergent Squint

Squint called Accommodative Esotropia can be treated with just making the child wear a plus number spectacle.

In patients with an intermittent divergent squint, an over minus glass number for correction of squint can work.

Occlusion of the better eye / Blurring the vision of the better eye using atropine penalization helps to improve vision and fusion of the squinting eye and can improve the success of squint surgery.

Amblyz Goggles for Lazy eye treatment

Squint correction with eye exercises aim at regaining a child’s ability to use both eyes together (fusion), to restore 3-dimensional vision, to prevent or treat lazy eye / Amblyopia,  The objective or squint eye exercises is to delay the need of surgery or increase the success of squint surgery acuity remain intact.

Nowadays these exercises can be performed on the computer at home itself.

The squint surgery is a small surgery on eye muscles that is safe and effective.

Mostly nowadays we do squint surgery by the latest technique called fornix incision, adjustable suture technique. The entire surgery is performed through a small hole that allows quick recovery and comfort. Sometimes depending on the case, we use a limbus based incision.

For a few patients, the squint can be corrected by one or more injections of Botulinum toxin A. Botox is made by Allergan.

The Squint or Strabismus in adults is most often caused by

• A defective connection in the brain.
• Eye injuries like fractures of the orbit or eye socket.
• Paralysis of a nerve supplying the eye muscle for example in high diabetes or stroke or aneurysm.
• Eye muscle diseases like ocular myasthenia.

• Social embarrassment, marriage prospects can be affected.
• Difficulty in professional life and some careers cannot be chosen.
• Poor eye to eye contact, so important in business.
• Loss of binocular vision (inability to use both eyes together).
• Loss of stereoacuity (loss of 3-dimensional vision).
• Double vision or seeing two images of one object.
• Decreased vision in the squinting eye (also called amblyopia /lazy eye).
• Poor hand-eye coordination.
• Abnormal head posture (head tilt or face turn).

The unique feature of squint correction is that almost all the defects mentioned above can be reversed provided the restoration of eye alignment is achieved as soon as possible.

• Prismatic glasses for treatment of squint:
• Squint Surgery:

The squint surgery is a minor surgery on eye muscles that is quite safe and effective. Nowadays squint surgery is performed by the latest technique called fornix incision, adjustable suture technique. The entire surgery is performed through a small hole that allows quick recovery and comfort.

In some situations, squint can also be treated with a Botox injection.

Definition: When a child has poor vision in one or both eyes due to the uncorrected number or squint or due to the inability of the light to reach the interior of the eye, it is called as Lazy eye or Amblyopia.

Problems due to lazy eyes are

1. Lazy eye is the commonest cause of monocular blindness, loss of binocular vision stereopsis fusion, and squint.
2. The eye then remains weak lifelong if this not corrected at the correct time(as early as possible).

Treatment of lazy eye begins with early detection. The latest treatment with eye patching and eye exercises at the earliest age offers the best chances for maximum improvement in children with lazy eyes.

This condition can be treated with

1. Patching/occlusion therapy.
2. Atropine eye drops.
3. Dichoptic therapy.

• Patching /Occlusion is the most recommended form of treatment as it is safe and effective.
• It involves covering the good eye with an eye patch, forcing the lazy eye to work harder.
• Research has shown, allowing the child to perform fine activities like drawing, playing games, and watching cartoons on mobile, iPad, and TV improves vision.
• The duration of treatment depends on improvement in visual acuity shown on the follow-up visit.

• This treatment is advised for a patient who is refusing to patching.
• An Atropine eye drop (cycloplegic eye drop) is used to temporarily paralyze the accommodative action of the eye and dilate pupils. The effect gradually weans off in 3 weeks’ time.
• Atropine drop temporarily induces a blur in the good eye.
• Research shows Penalization being as effective as patching/occlusion for improvement in visual acuity.

• We can use a method called DICHOPTIC training for children with poor compliance for patching and weekend atropine.
• MfBf exercise needs your child to wear Red Blue goggles and play a game called STEREO BLOCK which is available free in play store on Android smartphones.

• We can use new technology in the treatment of Amblyopia, AMBLYZ glasses.

• Lazy eye surgery means treatment of underlying cause that leads the eye to be lazy.
• For example, Cataract in childhood deprives a child eye of a clear pathway for light to get focused on the retina.
• Congenital convergent or divergent squint.
• Shaking of the eye (Nystagmus).

• This includes a combination of one or two of the above-mentioned treatments for the correction of the lazy eye to achieve a better outcome.

Laser treatment of adult Amblyopia first time in India

Relex-SMILE for laser treatment of Amblyopia first time in India

Many a time a lazy eye is due to “anisometropic amblyopia”. This means that if there is a difference in a number of the two eyes more than – or + 3 the eye with the higher number becomes lazy. This is because the brain cannot fuse the 2 images from the 2 eyes as they are of different sizes. Wearing spectacles does not work. Wearing a contact lens on the weaker eye may sometimes work.

The best option- Use a laser and remove the number either by TransPRK smart surf or by Relex SMILE. These will quickly in under a minute reduce the glass number of the lazy eye. We have seen that in children less than 10-11 the vision improves dramatically in most cases. Previously it was thought that we could not improve the vision in children over the age of 11. We did a series of cases on children over 11 and even in young adults. They do improve!