Scott Webb (Host): Today, we're going to learn what a certified orthoptist does and how they help children and some adults in the diagnosis and treatment of eye conditions and the importance of regular eye exams, especially for children from May Chan Ho. She's a certified orthoptist with the Jamaica Hospital Medical Center.

Host: This is Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. May, thanks so much for joining me today. We're going to learn a little bit about you and about what you do and eye exams and the importance of them and so on. But before we get too far along here, tell us a little bit about yourself and what is a certified orthoptist. I was mentioning to you I don't think I've heard that word before. What does that mean? What do you do?

May Chan Ho: Our field is very small. It's a field where we evaluate and work with patient of all ages, particularly children and adults with strabismus, which is a misalignment of their eyes. We follow their treatment for amblyopia, which is a reduced visual acuity in the eyes. And we just basically treat and follow their progression as they grow older. And so in terms of strabismus, we measure for preoperative numbers, so doctors can decide on what kind of eye muscle surgery the patient may get.

Host: All right. Yeah. And you said you mostly work with children, not exclusively, but mostly. And we're kind of framing this today about children and eye exams and why they're so important. So, why are eye exams, especially those routine eye exams, so important for children?

May Chan Ho: Yeah. So, it provides the earliest opportunity for us to detect any eye problems and vision loss in children, including newborns. And vision problems can impact a child's development, their academic progression, their performance in sports, other activities, and even their safety. And a child's vision can change often and unexpectedly as they grow older.

Host: Yeah, it definitely can. And so, I guess I'm wondering as a parent whose kids are older, and maybe I did this "wrong," but when is it appropriate to bring our children in? Like, when is it too early or when's a good time to, you know, start with the routine eye exams?

May Chan Ho: So, you should bring your child in when referrals are made for a failed vision screening, whether it's done at school or at a pediatrician's office. Other reasons your pediatrician may refer your child over for an eye exam is if they've noticed that their eyes are not tracking well after three months of age, if they noticed any abnormal red reflexes, any history of retinoblastoma in the parent or a sibling, if they've noticed any misalignment in their eyes, infants with chronic tearing or discharge and those who failed the photo screening at their well visits.

Host: Yeah. And are there some things that we can do? It's always an interesting thing. I remember when my kids were little about preparing them to go to the doctor's office, right? So, is there anything we can do to help prepare them for that first eye exam?

May Chan Ho: It's really important to let them know that the eye exam is nothing scary. There are no needles, there are no booboos involved. The parents can let the child know that we get to wear a lot of fun and goofy glasses. We look at toys, we look at colorful lights. We get to play games. And at the end, we do get stickers as well. And for the more anxious kiddos, we can have the parents demonstrate putting artificial tears in their eyes and then practice on the child as well, if they're willing and then, make it a fun game. Try to encourage them, like, "Can you blink your eyes a hundred times after you put the artificial tears in?" And then, make it fun for them. So, it's nothing scary.

Host: Yeah, make it fun for sure. So, what can we expect in terms of the tests and procedures? What goes on in that exam?

May Chan Ho: So, we first start off with a very detailed review of the medical history, the family ocular history, and the reason for today's visit. If the child is old enough, I will ask them some vision-related questions as well. And then when we move on to the exam, we take a measurement of their approximate prescription with our machine. It's called the autorefractor. And then next, I'll test how the two eyes work together. There's a depth perception test, a fusion test. I will look for any misalignment of their eyes. And if there is, I will measure that with my prism bars. From there, I will check how well the eye muscles are moving. And then, I'll move on to testing their vision one eye at a time with an age-appropriate testing, and look for any abnormal visual responses. From there, if they allow me, I'll check their peripheral vision, their color vision. I'll check their eye pressure as well to check for any glaucoma, either by palpation or with a tool called the iCare. And it uses a small little probe that touches the surface of the cornea. You barely feel anything. It's like a tickle to the eyelashes. And I make that into a game as well. I ask the child, "How many eyelashes do you think you have?" And then, we'll press the button and then a number will pop up.

If it is the child's first eye exam or their routine eye exam, we do have to dilate their eyes with a minimum of two eyedrops. And the eyedrops can take anywhere from 30 to 60 minutes for the eyes to fully dilate. Your child will notice some blurriness up close. But at a distance, it won't be affected. And there will be some light sensitivity as well, all of which are normal. The eyedrops help relax the eye's ability to focus, so the doctors can see if they need a prescription for glasses, and also check the back of the eye, the optic nerve to check for general eye health as well. If the ophthalmologist wants, they may order an additional testing or pictures of the eyes prior to checking out.

Host_1: Yeah. And so when we think about the common signs or problems that you've tested for that may be diagnosed in those eye exams, maybe you can just take on at least the most common ones. How are those conditions treated?

May Chan Ho: Yeah. So, some of the more common eye problems that we find are the misalignment of the eyes, decreased visual acuity that isn't appropriate for their age, such as amblyopia or lazy eye, which is an impairment or reduced vision without any detectable, anatomical damage in the eye or the visual pathway. It is treatable. But if it is left untreated, it can result in permanent vision loss and that affects 1-4% of the children in the US. And treatment for that depends on how we can help strengthen that eye, whether it is to prescribe glasses, if they have any refractive error, patching the stronger eye, eyedrops to help blur the vision in the stronger eye temporarily, or even eyeglasses that blur the vision in the stronger eye. Our first line of treatment is generally to prescribe glasses if it's needed, and then patching afterwards if necessary.

Another common finding that we have is the misalignment of the eyes, which is called strabismus. And in cases where it's mild, we will treat that by prescribing glasses or patching. For the more severe cases of strabismus, the ophthalmologist may suggest surgery.

And the last one is an increase in myopia, which is nearsightedness. That is seen in our younger population. And there is an increase in that that we've seen in our clinic as well. So, we focus a lot on myopia control using a low-dose atropine treatment, which is an eye drop that they will use daily and it'll help control the progression of their prescription.

Host: Really awesome and really helpful today. I'm sure listeners agree. Wondering, if we go for the first eye exam or we are there for the routine eye exams, you know, how often should we schedule a followup? Basically, how often should our children or kiddos get those routine eye exams?

May Chan Ho: So, children who have no vision conditions and do not require glasses should continue to receive eye exams every two years. Those needing glasses should have a yearly eye exam or an exam at an interval that is suggested by the eye doctor. Patients with amblyopia or strabismus should be followed more closely for vision checks and alignment checks.

Host: That's perfect. We hope that listeners benefit from your expertise today and your compassion. So, thanks so much. You stay well.

May Chan Ho: Thank you. You too.

Host: And to schedule an appointment with the Pediatric Ophthalmology Center at Jamaica Hospital, please call 718-206-5900. That's 718-206-5900.

And if you found this podcast helpful, please be sure to share on social media and check out the rest of our library at jamaicahospital.org/podcasts. Thanks for listening to Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. Stay well.

All the content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast.