We see children with multiple handicaps such as having to walk with crutches or live in a wheel chair as they were born with spina bifida, a condition, which the lower part of the spine is open to the skin at the time of birth. Many of these children have no control of their bladders and require being catherized all their life to empty their bladders. There is a large incidence of strabismus in these children, as well as optic nerve atrophy.
We see children with optic nerve inflammation in both eyes called optic neuritis. We admit these children to the hospital and treat them with massive dosages of intravenous corticosteroids. Many of them improve but still have reduced vision to a level of 20/60 to 20/200; some return to 20/20 in each eye. If the vision is 20/200 or less and cannot be corrected with glasses, it is called legal blindness. Some of our children with severe retinopathy of prematurity have this reduced level of vision.
Some children who are born with underdevelopment of their optic nerves, which is called optic nerve hypoplasia, have legal blindness with a visual acuity of 20/200 or less in both eyes. Many of these children also have associated endocrine abnormalities and have to take thyroid hormone replacement as well as growth hormone replacement all of their lives.
We see visually impaired patients, which mean that their vision is not normal even with glasses. These children may have optic nerve atrophy or scars at the center of the retina (the macula), which may have been produced by pre-natal infection with toxoplasmosis. Retinopathy of prematurity may cause scarring of the macula (center of the retina) or may produce retinal detachment leaving us with a visually handicapped child that does not see well even with glasses.
We see many children with cerebral palsy that have Cortical Visual Impairment or CVI which means that they don’t see well because their cortex (part of the brain responsible for visual development and use) has not developed normally. The most difficult medical exams are those children with cerebral palsy and other mental disabilities.