The practice provides screening and follow-up of vision in children and adolescents, myopia progression control, and the management of strabismus and binocular vision disorders, in children as well as adults. The eye consultation and the orthoptic assessment are carried out together.
Screening in children and adolescents
Key ages for vision screening
Vision develops during the first years of life. Certain abnormalities, including strabismus, a large difference in prescription between the two eyes or amblyopia, can go unnoticed in young children. Early screening allows them to be treated while vision is still developing.
From birth and during the first years
Vision, fixation, eye alignment and the pupillary reflex are checked during routine paediatric examinations. Any abnormality found during this period warrants an early eye assessment.
Between 3 and 5 years
This is a particularly important period for screening for amblyopia, strabismus and refractive errors. Vision screening is recommended at least once during this period, even if there are no complaints.
From 5–6 years and throughout the school years
Vision should continue to be checked regularly, especially when starting school and then during growth. After the age of 5, screening every 1 to 2 years is a reasonable guideline, to be adapted according to medical history, symptoms and any visual disorders already known.
During adolescence, particular attention is paid to the onset or progression of myopia, which may require specific follow-up.
When to consult?
An eye examination is recommended in case of:
Persistent or recent-onset strabismus
Involuntary eye movements (nystagmus)
Lack of visual tracking in infants, particularly after about 3 months
Drooping eyelid partially covering the eye
A child who regularly closes one eye or adopts an unusual head position to look
Tendency to look at objects, books or screens from very close up
Visual difficulties at school, eye strain or recurrent headaches
Reduced vision reported by the child, or a difference in vision between the two eyes
A white reflection in the pupil, seen directly or in a photograph, requires an eye assessment without delay.
In case of risk factors
An eye assessment may be indicated earlier in case of prematurity, a particular personal history, or a family history of childhood eye disease, strabismus, amblyopia or significant refractive error.
The frequency and content of follow-up are then tailored individually to the child’s age and the results of the examination.
Myopia
Screening and progression control
In children and adolescents, myopia that appears early is more likely to progress during growth. Early screening makes it possible to identify children at risk and, when indicated, to put in place a strategy aimed at slowing its progression.
Assessment and follow-up
The assessment is based on a comprehensive evaluation, including in particular:
Precise measurement of refraction, usually under cycloplegia
Identification of risk factors for progression
Measurement of the eye’s axial length by biometry, which allows its growth to be monitored objectively
In myopic children, follow-up is generally carried out every 6 months, with the frequency adjusted according to age, speed of progression and the treatment in place.
Myopia control strategies
Various myopia control strategies can be offered, alone or in combination.
Principle
Certain lifestyle habits help reduce the risk of developing myopia and support its management when it is already present. Particular attention is paid to time spent outdoors and to prolonged near-vision activities.
Encourage time spent outdoors, ideally around 2 hours a day
Keep a reading and near-work distance of at least 30 to 40 cm
Take regular breaks during prolonged near-vision activities
Limit recreational screen time: as a guideline, around 1 hour a day for 6–10-year-olds and less than 2 hours after the age of 10, not including use required for schoolwork
Who is it for?
These measures are recommended for all children, and especially for children who are myopic or at increased risk of developing myopia.
Follow-up
Visual habits are reviewed during follow-up consultations.
Good to know
In a child whose myopia is progressing, these measures are essential but are generally not sufficient on their own, and may be combined with a specific treatment.
Principle
These lenses provide full vision correction while creating peripheral optical defocus intended to slow the elongation of the eye.
Who is it for?
They are often a first-line option in children because they are simple to use, non-invasive and have an excellent safety profile.
Follow-up
Vision, refraction and axial length are checked regularly to assess the effectiveness of the treatment.
Good to know
Effectiveness depends in particular on precise lens centring and regular wear throughout the day. Myopia must be fully corrected: deliberate under-correction does not slow its progression.
Principle
Contact lenses designed for myopia control modify the peripheral focus of the image in order to slow the elongation of the eye.
Two approaches can be offered:
Soft defocus lenses, worn during the day
Orthokeratology, based on rigid lenses worn at night that temporarily reshape the cornea
Who is it for?
These techniques are intended for children and adolescents who are independent enough to handle and care for their lenses, with the support of their family. The choice depends on age, maturity, type of myopia, and the child’s activities and preferences.
Follow-up
Close check-ups are needed during fitting, followed by regular follow-up to monitor the cornea, vision and the progression of myopia.
Good to know
Wearing contact lenses carries a risk of corneal infection (microbial keratitis), higher than with treatments that do not require lenses. Rigorous hand and lens hygiene, strict adherence to care instructions and good compliance are therefore essential.
In case of a red, painful or light-sensitive eye, or reduced vision, the lenses must be removed and an eye examination carried out promptly.
Principle
Low-dose atropine is given as eye drops, usually in the evening. It slows the progression of myopia and the axial elongation of the eye through a pharmacological mechanism that is not yet fully understood.
Who is it for?
It may be offered to children with progressive myopia, alone or combined with an optical strategy depending on the progression profile.
Follow-up
Refraction, axial length and tolerance of the treatment are checked regularly.
Good to know
Increased sensitivity to light or discomfort in near vision may occur. Stopping treatment must be carefully considered and monitored because of the possibility of a rebound in myopia progression.
Combined treatments and personalised care
When myopia continues to progress despite a correctly followed strategy, several treatments can be combined to improve control of its progression.
The decision is based on changes in refraction and axial length, but also on the child’s age, tolerance of the treatment and everyday needs.
There is no single method suitable for all children. The choice of strategy depends on the age at which myopia began, its degree and speed of progression, the axial growth of the eye, family history and the child’s lifestyle.
The effectiveness of the treatment is reassessed regularly in order to adapt care as the child grows.
Strabismus & orthoptics
Strabismus and amblyopia can impair the quality of vision and the coordinated functioning of both eyes. Screening for them is particularly important in children, to allow early treatment. Strabismus can also persist or appear in adulthood.
Strabismus
Strabismus is a misalignment of the eyes, either constant or intermittent. One eye may turn inwards, outwards, upwards or downwards.
In children, it can disrupt the development of binocular vision and lead to amblyopia. Early treatment is therefore essential.
In adults, strabismus may be long-standing or appear later on. When it occurs suddenly, particularly with double vision, an assessment is needed to identify the cause.
Depending on the type of strabismus, treatment may combine:
Optical correction
Prisms
Orthoptic therapy when indicated
Treatment of any amblyopia in children
Surgery on the eye muscles, in children as well as adults, when necessary
Amblyopia
Amblyopia is insufficient development of vision during childhood. It may be linked in particular to strabismus, a large difference in prescription between the two eyes, or an obstacle to visual development.
Treatment is mainly based on:
Appropriate optical correction
Treatment of the cause when it can be identified
If necessary, occlusion (patching) or penalisation of the dominant eye to stimulate the amblyopic eye
The earlier amblyopia is diagnosed, the better the chances of visual recovery. In adulthood, it is most often the after-effect of amblyopia that developed during childhood.
Assessment at the practice
The assessment is adapted to the patient’s age and clinical situation. It may include:
Measurement of visual acuity and refraction, under cycloplegia when necessary
A complete orthoptic assessment carried out by our qualified orthoptist
Additional tests depending on the situation
The aim is to clarify the diagnosis, assess the functional impact and offer care suited to each patient.
Our qualified orthoptist carries out complete orthoptic assessments for children, adolescents and adults, in collaboration with the practice’s ophthalmologists.
Orthoptic assessment
The orthoptic assessment evaluates how both eyes work together and examines in particular:
Eye alignment and motility
Binocular vision, fusion and depth perception
Convergence and accommodation
The presence and extent of strabismus or an eye-muscle imbalance
When is it indicated?
An orthoptic assessment may be indicated in particular in case of:
Strabismus in children or adults
Double vision
Eye strain, headaches or discomfort during prolonged close work, particularly with a convergence or accommodation disorder
Visual difficulties at school
Amblyopia and monitoring of its treatment
Orthoptic therapy
When indicated, orthoptic therapy combines personalised sessions at the practice with exercises that can be continued at home. It aims to improve certain visual functions, in particular the coordination of both eyes, fusion, convergence or accommodation.
The programme is adapted to the disorder identified and how it evolves.
Not all visual disorders call for orthoptic therapy. Depending on the situation, treatment may combine optical correction, prisms, orthoptic therapy or surgery, in consultation with the ophthalmologist.
