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Retinopathy of prematurity (ROP) is a developmental vascular proliferative disorder that occurs in the retina of preterm infants with incomplete retinal vascularization. It is a potentially blinding disease caused by abnormal development of retinal blood vessels in premature infants.  When a baby is born prematurely, the retinal blood vessels can grow abnormally. Most ROP resolves without causing damage to the retina. When ROP is severe, it can cause the retina to pull away or detach from the wall of the eye and possibly cause blindness. Babies 1250 grams or less and are born before 31 weeks gestation are at highest risk.

Most often, retinopathy occurs simultaneously in both eyes.


Risk factors

Birth weight and gestational age are the most important risk factors for development of severe ROP. Other factors that are associated with the presence of ROP include anemia, poor weight gain, blood transfusion, respiratory distress, breathing difficulties and the overall health of the infant. Close monitoring has decreased the impact of oxygen use as a risk factor for development of ROP. Light levels do not affect severity of ROP.

Diagnosis of retinopathy of prematurity

Infants less than 1500 grams and with a gestational age less than 31 weeks undergo eye examinations to monitor for ROP. Examination of a premature baby will take place 3-4 weeks after birth.

Subsequently, it is absolutely necessary to be followed-up weekly by an ophthalmologist. For children suspected of retinopathy, ophthalmologists examine the eyes after the pupils are dilated with drops.

Keep in mind that in order to maintain your children’s visual health, diagnostic examination of vision should be as important and regular as vaccinations and visits to pediatrician. Development, integration into society and the future of the child depend on his vision.

The treatment of retinopathy of prematurity

According to medical statistics, there are many cases where improvement in the condition of children with retinopathy of grade I-II has occurred without specific treatment.

Laser photocoagulation is the preferred treatment of choice. Laser ablation is applied to the immature portion of the retina.  If laser is not available, cryotherapy may be performed.

It is important to diagnose aggressive posterior ROP and treat it immediately, as this form of ROP can rapidly progress to retinal detachment.

If laser or cryotherapy fails to prevent progression of ROP and the patient develops a retinal detachment, surgery (vitrectomy, scleral buckle) may be performed.

Eyes with retinal detachment caused by ROP generally have a poor visual prognosis.



Patients with a history of ROP have a higher incidence of astigmatism, high myopia, and retinal detachment and should be followed routinely.




  • Description
  • Cataract is a common ophthalmic disorder that causes gradual decrease in vision by loss of lens transparency.

    Cataract can be congenital or acquired. Studies have shown that about 70% of people over the age of 65 suffer from this medical condition, but sometimes cataract can also be found in younger patients.

    In advanced, untreated stages, this condition can cause serious complications. In most cases, both eyes are affected, and the decrease in vision is not accompanied by pain. The patient complains on progressive loss of vision or on clouded, blurred or dim vision.

    Congenital cataract is present at birth, either alone, or as a component of a complex malformation.

    Cataract appears as a white area in the pupil of the affected eye. It requires emergent diagnosis and treatment in the first months of life; otherwise the visual function of the eye cannot be recovered.

  • Causes
  • Cataract is generally developing with age, appearing as an aging of the lens. This disease may also have several underlying causes, such as general pathological conditions (e.g. diabetes mellitus, long-term use of steroids and other medications) or certain ocular disorders (myopia, inflammation or trauma of the eye). Among the environmental factors, the most often considered to be involved in cataract development is ultraviolet radiation.
  • Symptoms of cataracts

Common symptoms of cataracts include: progressive blurry vision, trouble seeing at night, seeing colours as faded, increased sensitivity to glare, halos surrounding lights, double vision in the affected eye.

There are also particular forms of cataracts that decrease vision especially in bright light or imply a need for frequent changes in prescription glasses.

  • Evolution of cataract
  • Cataracts can interfere with daily activities and, when left untreated, lead to completely impeding the penetration of light into the eye and blindness. Although some stop growing, they don’t get smaller on their own.

    For timely diagnosis and treatment, the patient presenting the symptoms mentioned above should be consulted by an ophthalmologist. After performing a comprehensive eye examination, cataract is relatively easy to diagnose.



The prevalence of diabetic retinopathy is 40 percent and occurs more frequently in type 1 diabetes, the threat for vision occurs in 10 percent of cases.

Diabetic proliferative retinopathy affects 5-10% of the diabetic patients. Patients with type 1 diabetes have a 60% risk of proliferative diabetic retinopathy at 30 years.


Causes of diabetic retinopathy

There are three basic components of this damaging process.

– the blood vessels can leak

– they can make a special growth substance that makes other vessels grow (VEGF = vascular endothelial growth factor)

– the vessels may eventually close and block.

The leakage causes the retina to swell up a little and become waterlogged, a bit like a sponge. This swelling then damages the retinal cells themselves. This is the main mechanism in ‘maculopathy’ and ‘macula edema’. At the same time control of the blood flow to the retina is faulty, and blood flow to the retina increases. This naturally increases the retinal leakage further.

The tiny blood vessels may eventually close and block. If the retina is badly damaged by leakage or very severe diabetes, the blood vessels may close up, and nutrients will not reach the retinal cells. This happens in ‘ischemic’ macular disease.

In diabetic proliferative retinopathy very small blood vessels grow from the surface of the retina.

As the retina is damaged by diabetes, the diseased retina releases special growth chemicals. These chemicals make tiny blood vessels grow: these are called ‘new blood vessels’.


Diabetic retinopathy – signs

  • microangiopathies
  • retinal hemorrhages
  • exudates
  • macula edema
  • focal maculopathy
  • diffuse maculopathy
  • ischemic maculopathy
  • neovascularization


Risk factors

– longstanding diabetes

– poor blood glucose control

– pregnancy

– arterial hypertension


Other risk factors: hyperlipidemia, smoking, cataract surgery, obesity, anemia



– factors of poor prognosis:

Ocular: severe ocular ischemia, exudates, diffuse macula edema, severe retinopathy at first attendance.

Systemic: uncontrolled hypertension, renal disease, poor blood glucose control, elevated HbA1 – glycosylated hemoglobin


Diagnosis of diabetic retinopathy

Diagnosis is done through examination of eye fundus by direct or indirect ophthalmoscopy.


Treatment of diabetic retinopathy

Pharmacologic therapy of diabetic retinopathy is used to reduce diabetic macular edema and neovascularization of the disc or retina. However, these medications cannot stop disease progression and are used as complementary methods.

One of the most efficient treatments is laser retinal coagulation. This involves directing a high-focused beam of light energy to create a coagulative response in the target tissue and destroy newly formed vessels with increased wall permeability, narrow areas where capillaries are blocked. During the treatment, the patient should be monitored by the ophthalmologist.

When laser photocoagulation in PDR is precluded in the presence of an opaque media, such as in cases of cataracts or vitreous hemorrhage, cryotherapy may be applied instead.

In selected patients surgical treatment is indicated.

Sursa foto:


Glaucoma is a group of chronic eye conditions that damage the optic nerve, which is vital to good vision. This damage is often caused by an abnormally high pressure in the eye.

Glaucoma is one of the leading causes of blindness in the world. Vision loss due to glaucoma can’t be recovered.

So it’s important to have regular eye exams that include measurements of eye pressure. If glaucoma is recognized early, vision loss can be slowed or prevented. The treatment in this condition is generally needed for the rest of the life.

Unfortunately, glaucoma is a widespread condition.  It can occur at any age but is more common in adults over the age of 40. Glaucoma can also affect young people (juvenile glaucoma) and even neonates (congenital glaucoma).

If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.


Causes of glaucoma

Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout the eye. This fluid normally drains into the front of the eye (anterior chamber) through tissue (trabecular meshwork) at the angle where the iris and cornea meet. When fluid is overproduced or the drainage system doesn’t work properly, the fluid can’t flow out at its normal rate and pressure builds up.

Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage.

People who have close relatives diagnosed with glaucoma are at greater risk of developing this disease.

Symptoms of glaucoma

Glaucoma can be asymptomatic for a long time. The most common form of glaucoma has no warning signs. The effect is so gradual that one may not notice a change in vision until the condition is at an advanced stage.

Rarely, in advanced phases of glaucoma, headaches, and pressure in the eye area and when the optic nerve is almost completely destroyed, there is also a decrease in vision.

The signs and symptoms of glaucoma vary depending on the type and stage of the condition. Patients may experience:

– Patchy blind spots in their side (peripheral) or central vision, frequently in both eyes

– Tunnel vision in the advanced stages

– Severe headache

– Eye pain

– Nausea and vomiting

– Blurred vision

– Halos around lights

– Eye redness

Evolution of glaucoma

Glaucoma is the result of damage to the optic nerve. As this nerve gradually deteriorates, blind spots develop in the visual field.

Glaucoma treatments can be highly effective if used early on in the development of the disease. If diagnosed early enough, there are several treatments that can slow or even stop the disease altogether. That’s why it’s important for everyone over 40 to see an eye specialist for regular check-ups, especially if they come from families with glaucoma.


Regular comprehensive eye exams can help detect glaucoma in its early stages before irreversible damage occurs. As a general rule, one should have comprehensive eye exams every four years beginning at age 40 and every two years from age 65.

Glaucoma is suspected when a routine eye control reveals an intraocular pressure that exceeds 21 mmHg.

Diagnosis of glaucoma is confirmed by other investigations that can reveal optic nerve damage:

–  funduscopy (including optic nerve look)

–  Checking for areas of vision loss (visual field test)

– Testing for optic nerve damage by means of Optical coherence tomography scanning

– Measuring corneal thickness (pachymetry) – this is important because intraocular pressure measurement is made by applying pressure on to the cornea; the results of these measurements can be influenced by cornea thickness

–  Inspecting the drainage angle (gonioscopy)

The Optisan clinic is equipped with state-of-the-art equipment that enables to carry out all investigations necessary for accurate and timely diagnosis of glaucoma.

Treatment of glaucoma

The damage caused by glaucoma can’t be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially when started in early stage of the disease.

The goal of glaucoma treatment is to lower intraocular pressure. Depending on the situation, the options may include eye drops, laser treatment or surgery.

Glaucoma treatment often starts with prescription eye drops. These can help decrease eye pressure by improving how fluid drains from the eye or by decreasing the amount of fluid the eye makes.

If needed, two or even three drugs may be associated, acting by different mechanisms, and potentiating the hipotensive effect.

After confirming the diagnosis of glaucoma, regular checkups by an ophthalmologist from six to six months to follow the prescribed treatment are needed. The ophthalmologist will take the intraocular pressure, will see the eye fundus and decide whether computerized visual field test or optic nerve tomography should be repeated. Also, only the ophthalmologist can decide to modify the treatment protocol.



It is probably the least understood disorder among the general population. Like myopia or hypermetropia, astigmatism is a refractive error. Astigmatism is caused by an error in the shape of the cornea. With astigmatism cornea, which is the front surface of the eye, has an irregular curve (cornea has a curve of a rugby ball), and the vision will be blurred, fuzzy, or distorted both at near and at distance, as the way light passes, or refracts, to retina is changed.

The symptoms of astigmatism may differ from person to person. Some people don’t have any symptoms at all. The symptoms of astigmatism include: blurry, distorted, or fuzzy vision at all distances (up close and far away), difficulty seeing at night, eyestrain, squinting, eye irritation, headaches.

It is estimated that 30% of children suffer from astigmatism and therefore it is important to consult an ophthalmologist at the smallest sign indicating a problem in a child’s vision. Otherwise, the child will not only have a decrease in quality of life, but also will face problems at school (at writing, reading, mathematics, etc.).

Astigmatism may be associated with other refractive errors (myopia, hypermetropia, or presbyopia). Astigmatism may be asymmetric (in one eye or both), and also can change over time.

The most common method of correcting astigmatism is permanent eyeglasses because the blurred vision is present both at distance and at near. They have special, cylindrical shaped lenses to compensate deformation of cornea. This shape will give an uneven thickness of the lens edge, but is not very visible to give an esthetical discomfort. At first wear of cylindrical lens glasses, the patient may experience a deformation of the surfaces, the bulging of the floor; he complains on dizziness, instability downhill stairs and sidewalks. All of these symptoms disappear fast through exercise and the patient shouldn’t give up on wearing glasses.

In some cases, astigmatism can only be corrected with the aid of contact lenses, which compensate the faulty curvature of the cornea. For high degree astigmatism, special rigid contact lenses that compress the cornea are used.

Laser surgery is recommended in selected patients. This type of surgery involves using lasers to reshape the cornea. Laser surgery can permanently correct astigmatism, but eliminating it totally is difficult to achieve.


Astigmatism in a child

About one fourth of the planet inhabitants have a so-called “physiological astigmatism” whose degree does not exceed 0.5 diopters.

Such a refractive error is not recognized by the person and does not need correction. If the degree of astigmatism is above 1.0 diopter, it usually affects visual function significantly. Astigmatism can manifest itself at any age, not necessarily in childhood. However, astigmatism could be diagnosed in children through a comprehensive eye examination beginning with the age of 2 years. At this age, the doctor can already predict the further development of the child’s visual system.

The Optisan Clinic has the equipment suitable for examination of children starting with the age of several months. With the PlusoptiX binocular autorefractometer, the primary examination of the children is very simple, without the pupil being dilated.


PlusoptiX is a very valuable visual screening device because:

  • detects vision deficiencies in children from the age of 6 months. Standard tests can be used relatively late, from the age of 5 years, when the child is able to cooperate with the doctor;
  • detects the risk of developing amblyopia by revealing anisometropia (differences in diopters of the two eyes) in children over 6 months;
  • allows early diagnosis of strabismus;
  • reveals vitreous disorders;
  • alows monitoring of children with nystagmus;
  • detects anisocoria, by measuring the pupil of both eyes simultaneously.


How can astigmatism be recognized?

In case your child complains on poor vision, headaches, discomfort in the supraorbital area, fast tiredness, these may indicate the presence of astigmatism. Medical examination is required not only for diagnosis, but also for prescribing glasses or contact lenses. If astigmatism is confirmed, eyeglasses or contact lenses are prescribed according to individual tolerability and age of the patient. Usually, children with astigmatism are prescribed glasses with cylindrical lenses for permanent wearing. Surgical treatment of astigmatism is recommended only after the age of 18-20 years, when the visual system is already fully developed.

Children with astigmatism should have an ophthalmologic exam twice a year. If your child wears glasses, it is important to monitor the eye growth and to change the glasses if needed.

It is important to diagnose astigmatism in time in a child, in order to take corrective measures as soon as possible and to minimize the likelihood of irreversible decrease in visual acuity, and development of strabismus and amblyopia.



Myopia is a refractive error of the eye characterized by formation of the image seen by the eye in front of the retina. People with myopia have well near vision but poor distance vision. It is, in most cases, an acquired condition that occurs as the child grows up. Most children are hypermetropic, so, in order to get a clear picture on the retina, they tend to draw, read, watch TV at rather small distances, thus fixing their eyes for a longer time on nearby objects and forcing accommodation. Myopia develops as a result of overuse and decompensation of accommodative mechanisms.

Due to the elongated shape of the eyeball, the image is no longer projected onto the retina, but in front of it, the objects become blurred and the child complains that he does not distinguish things in the distance.

In an attempt to see better, the effort to accommodate the eye is permanent. Therefore, eyestrain, headache and a feeling of visual fatigue may occur. People with myopia have well near vision but poor distance vision.

How can myopia be suspected?

Myopia is a widespread condition among schoolchildren.

The following symptoms can suggest myopia:

–  Frequent headaches

– The child complains that he does not clearly see in the distance (for example on the blackboard or does not see the bus number clearly, etc.)

– The child dims his eyes to make the image clearer

How is myopia diagnosed?

An eye care professional can diagnose myopia during a comprehensive eye exam.

After consultation, the doctor will prescribe the glasses needed to correct myopia and will recommend a correct treatment strategy.

Myopia is a refractive error that tends to grow, along with the growth of the child and, respectively, its eye. That is why an individualized plan of medical visits is required for repeated assessments of visual acuity and changes in the eye fundus (retina) due to disease progression.

A delicate and personalized approach, a careful choice of glasses, and repetitive consultation at six months can keep your child’s health condition under control.

The evolution of myopia in children and teenagers is considered to be favourable if the reduction in vision acuity does not exceed 0.5 diopters per year. In this case, it is treated by conservative methods: wearing of glasses or contact lenses, giving rest to the eyes, exercises for enhancing vision, enough sleep, balanced nutrition and adherence to the rules of visual hygiene.

At the Optisan Clinic, after a complete diagnosis, a suitable correction method is chosen for the child and the treatment is done using a variety of therapeutic techniques. Additionally, there is a program of individual home sessions, parents are explained how to test vision acuity at home. The doctor monitors the performances and, if necessary, changes the program.

The treatment schedule is drawn up individually for each child, taking into account its age, health condition and general psycho-emotional status.

Treatment of myopia

Optical correction:

– Eyeglasses for distance vision are absolutely necessary to compensate this refractive error of the eye.

– Contact lenses are an alternative method of optical correction.

Refractive surgery:

– Refractive surgery is an option once the optic error of the eye has stabilized, usually after the age of 18s. The most common types of refractive surgery are laser-assisted interventions.

How to establish myopia in a child?

It is well known that many diseases respond better to treatment if detected in the early stages; this statement also applies to myopia. A child can not complain that he sees badly, because he just does not know the difference between “seeing badly” and “seeing well”. Therefore, if you notice in your child signs of fast fatigue during reading, bending over a book or notebook, periodically complaining of headaches, often blinking and rubbing his eyes, attend an ophthalmologist immediately!

Keep in mind that only a specialist can diagnose the disease in a proper time and may designate an appropriate treatment!

Preventing inappropriate visual skills

First of all, parents should deal with the prevention of wrong visual skills in their children.

Teach them to stay correctly at a desk. Make sure the light falls evenly on the book or notebook during working, while the head and face remain in the shade. The best is the use of an office lamp in addition to general lighting; this is especially important during the night. It is necessary to avoid bending the child’s head close to the work object; the optimal distance for visual activity is 30-35 cm.

During work, it is recommended to eliminate reflective surfaces from the child’s field of vision. The bad habit to read abed can be a triggering factor of myopia. It is necessary to take a break after every 30-35 minutes of visual work (for younger pupils 20-25 minutes), during which the child can eat, perform eye exercises, other types of exercises or simply rest.

Congenital myopia

What is congenital myopia?

Congenital myopia is caused by a disturbance of the intrauterine development of the eyeball. It is often due to premature delivery, hypoxia, and various diseases of the mother during the first three months of pregnancy.

Normally children are born hypermetrops. The eyeball in the child is shortened and the light rays, which pass through the refractive media of the eye, do not focus on the retina but behind it. In young children, a slight degree of hypermetropia is considered to be a natural age-specific feature, which over time (six to seven years) resolves due to the increase of the child’s eyeball and the shift of the optic focus on the retina. In case of congenital myopia, the child is born with an elongated eyeball, which means that the light rays do not reach the retina. This is rather dangerous because it interferes with the proper development of the visual analyzer and, subsequently, with the general development of the child.

The risk group includes children whose parents (one or both) have myopia. Congenital and hereditary myopia are different things. Hereditary myopia is a predisposition of the visual system to the appearance of this disease; it usually develops later in childhood, under the influence of negative factors. In opposite, congenital myopia is produced in the stage of intrauterine development of the foetus and is more dangerous for the formation of visual functions.

Congenital myopia may be associated with premature delivery, genetics, or may be caused by some pathological processes. Noteworthy, in most cases, congenital myopia is characterized by minor changes in the eye fundus.

Typically, congenital myopia is stable, although in some cases it can progress. Of course, children with congenital myopia require close supervision from the ophthalmologist. In order to prevent the possible development of amblyopia it is necessary to start the optical correction as soon as possible.

Why is early diagnosis important?

The primary objective is early recognition of congenital myopia. If this condition is not detected in a proper time and no immediate measures are taken, more serious problems may arise. Late detection of congenital myopia and lack of optimal optical correction (glasses, contact lenses) can lead to occurrence of refractive amblyopia and convergent strabismus (crosseye) even in the first year of life. Solving the latter requires much more time and effort.

In order to detect congenital myopia, the first examination of the newborn is carried out at the maternity centre by the ophthalmologist, but this examination is not enough.

It is important to carry out a comprehensive diagnosis of the child’s visual system using modern equipment.

Optisan Ophthalmology Specialists consult children as young as five-six months!

The rationale of early detection of congenital myopia is to designate an appropriate correction for the harmonious development of the child. Modern glasses and contact lenses allow making this at an early age.

Evolution of congenital myopia

The next step is systematic observation of the child’s vision. The regularity of examinations is determined by the ophthalmologist. Depending on the results of the examinations, prognosis and subsequent preventive treatment are established.

As a rule, congenital myopia is of a high degree. Formerly, congenital myopia was thought to not progress or progress very rarely, but stereotypes have changed at the end of the last century. Unfortunately, ophthalmologists are increasingly experiencing progressive congenital myopia.

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