Our practice provides full-spectrum eye care for children from birth to age 18. Dr. Plotsky is experienced in examination, medical treatment, and surgery for the wide variety of ophthalmologic problems that occur in patients in this age group. In addition, we treat adults who have ocular misalignment (strabismus).
Vision Evaluation For Glasses
Many of the children Dr. Plotsky sees are referred to the practice because they have unclear vision or have failed a vision screening exam at school or in the pediatrician's office. Examination of children at any age allows us to determine if nearsightedness (myopia), farsightedness (hyperopia), or astigmatism is present. Dr. Plotsky will also verify that more serious causes of blurred vision are not present. If it is determined that a child needs eyeglasses, he will provide a prescription for the glasses and instructions for their use. We require that all lenses be fabricated from polycarbonate plastic which is very shatter resistant.
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In general, children are capable of wearing contact lenses beginning at twelve years of age, depending on the individual's motivation and level of maturity. Some children can start a little earlier while others must wait longer. We have a large group of successful contact lens wearers in the practice and are happy to fit your children with contacts when appropriate. We use soft disposable, soft toric (for astigmatism), rigid gas permeable, and occasional bifocal soft contact lenses.
Contact lens fitting is a process that involves measuring the prescription, trying on lenses, evaluating the fit and vision, and teaching their proper use and care. This can often be done in one visit but may require additional evaluations depending on the patient. Once the patient has begun to wear lenses, Dr. Plotsky requires rechecks within the first six months to ensure proper fit and vision.
Because the correct fitting and evaluation of contact lenses can be time consuming we ask that you let our receptionist know that you are interested in this service when you schedule your child's appointment. If your child is wearing contacts that have been fitted elsewhere, please bring a copy of the current contact lens prescription and have your child wear (or bring) the contacts to the office visit so that we can properly evaluate the lenses.
Contact Lens prescriptions are valid for 1 year only. Please schedule your child’s annual exam and contact lens evaluation prior to the expiration of the contact lens prescription.
Expired prescriptions cannot be renewed without the requisite examination.
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Pediatric strabismus or ocular misalignment is a commonly seen problem in our practice. Eyes may cross (esotropia), eyes may drift apart or diverge (exotropia), and eyes may be misaligned in their vertical plane (hypertropia). Strabismus may occur in early infancy (congenital or infantile) or may appear later (acquired). Misalignment that resolves spontaneously prior to age six months may be normal, particularly in premature babies. Misalignment beginning after six months of age is not usually normal.
Strabismus may be an isolated finding or may be associated with other general medical conditions, like Down Syndrome.
Children with strabismus may complain of ocular discomfort, headache, blurred vision, or, less commonly, double vision. Parents may notice misaligned eyes, closure of one eye in bright sunlight, abnormal head posture (torticollis), or reading aversion.
Treatment of pediatric strabismus varies depending on the particular circumstances of each patient. Glasses, surgery, or in rare situations, eye exercises may be required to improve ocular alignment. Combinations of these therapies are often employed. Patching is NOT a treatment for strabismus (see amblyopia below).
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Adults may have strabismus as a consequence of untreated or recurrent childhood misalignment. Adult onset strabismus may occur without known cause but much more commonly there are identifiable causes. Some conditions that can cause strabismus are hyperthyroidism, diabetes, myasthenia gravis, stroke, and head trauma (most commonly after motor vehicle accident.) Adults with strabismus often have bothersome double vision (diplopia). Ocular realignment with elimination of symptoms is the goal of treatment. Glasses, with or without prism, and surgery are the most commonly used therapeutic modes.
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Surgery to realign eyes is often needed in children and adults. To accomplish this type of surgery a small incision is made into the clear tissue (conjunctiva) covering the white of the eye. Through the incision, the muscles are detached, repositioned, and re-attached with sutures. The direction and degree of misalignment determine which muscles are operated on and how far they are moved. Surgery may be needed on one or both eyes. In certain circumstances in adults "adjustable sutures" are used. These sutures are tied in such a way that they can be repositioned in the office the day after surgery if needed. Absorbable sutures are used so that stitches do not need to be removed.
Most patients recover quickly from strabismus surgery and are able to return to normal activities within a few days. Post-operative care usually requires that cold compresses and antibiotic ointment be used for a few days.
Eye muscle surgery usually requires general anesthesia and is done at a hospital or surgicenter. Currently, Dr. Plotsky operates at Children's Hospital, Georgetown University Hospital , and the Washington Hospital Center in Washington , D.C. . He also works at the Children's Hospital Outpatient Surgery Center in Rockville , Md. and the Suburban Hospital Outpatient Surgery center in Bethesda , Md.
Patient and Parent Guide to Strabismus Surgery
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Amblyopia is decreased visual acuity in an eye. It is the result of deficient visual development in that eye in children under age eight. Amblyopia is most commonly caused by ocular misalignment or by unequal eyeglasses requirements for the two eyes. For example, if the right eye is slightly farsighted and the left eye is very nearsighted, the right eye will be preferred. If this happens in early childhood, the visual development of the left eye will lag behind, sometimes to a very dramatic degree, resulting in very poor vision in that eye.
Treatment consists of allowing both eyes to be used simultaneously and forcing the non-preferred eye to be used preferentially until vision normalizes. If the glasses requirements are unequal (anisometropia), proper eyeglasses are prescribed for full-time wear. Similarly, if the patient previously has not worn glasses but glasses are needed to improve ocular alignment, they will be prescribed at this time. Once glasses are being worn, "penalization" treatment is begun. Covering or blurring the preferred eye is done on a part- or full-time basis. Occlusion by patching is most common and seems to work more quickly but blurring with daily Atropine eyedrops can also be very effective. Although prescribed treatment usually improves the vision, poor compliance can be a significant roadblock to long term success.
If medical conditions such as ptosis (droopy eyelid), cataract, or strabismus not responsive to glasses, underlies the amblyopia, surgical correction of these problem is essential to achieving and maintaining good vision.
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Nasolacrimal Duct Obstruction
Nasolacrimal Duct Obstruction (Blocked tear duct) is a very common problem in early infancy. Ordinarily, tears are produced beneath the upper eyelids, wash across the eye and drain into small openings in the nasal portion of the upper and lower eyelids. Beneath the surface there is a plumbing system that carries the tears into the back of the nose. The main part of this system is the nasolacrimal duct. Frequently, the bottom of the duct does not open completely at the time of birth. When this occurs, tears can back up and run down the cheeks instead of draining as they should. In addition, tears sitting in the nasolacrimal duct are an excellent medium for the growth of bacteria. When this happens, a yellow or green discharge can be seen in the tears or collecting on the eyelids.
In about 50% of children born with partial nasolacrimal duct obstruction the problem clears spontaneously by one year of age. If there is no significant improvement in the symptoms by this age, consideration of probing and irrigation, a brief surgical procedure, should be considered. Sometimes, particularly in older children, more complex surgical procedures may be needed. While waiting for the problem to resolve, the intermittent use of antibiotic drops or ointments can reduce the volume of discharge, making parents and babies happier.
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Retinopathy of Prematurity
Retinopathy of Prematurity (ROP) is a disease of the retina seen in premature, low birth weight infants. Low birth weight, gestational age at birth, and oxygen exposure are risk factors for the development of ROP but the precise cause is unknown. In most cases, ROP is mild and resolves without treatment. Occasionally the disease progresses and laser treatment is needed to prevent severe complications, including loss of vision. Babies are usually examined in the neonatal intensive care unit (NICU) for ROP and are rechecked after discharge if their particular situations warrant such care.
Babies born prematurely, including those with mild, resolved ROP, have a higher risk of needing glasses as children and of developing strabismus than comparable full-term babies.
Dr. Plotsky currently examines babies in the NICU at George Washington University Hospital and at the Washington Hospital Center . If additional care is needed, he sees these babies in the office after their discharge from the hospital.
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A cataract is a cloudiness in the normally clear lens of the eye. Cataract is normal in the aging eye. Congenital cataracts and acquired cataracts of childhood are uncommon; however they do occur. Depending on a variety of factors. sometimes early surgery is required. On occasion the cataracts are mild and only need to be watched carefully. If surgery is required to remove cataracts, glasses, contact lenses, or intraocular lenses will be necessary to correct the postoperative vision. Recent experience has shown that many young children who have cataract surgery do well with intraocular lenses and can avoid the often difficult use of cataract glasses or contact lenses.
Pediatric cataracts may be associated with systemic metabolic or genetic disorders or may be isolated findings in otherwise healthy children.
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Ptosis is the droopiness of one or both upper eyelids caused by a weakness in the muscle that raises the lid. Children who have ptosis are usually born with the condition. The droopiness may be very subtle or may dramatically cover the eye so that vision is severely impaired, if not completely blocked. Sometimes the eyelid droops enough to cover the pupil while allowing part of the eye to be visible. Visual development will be affected adversely and treatment is needed. Ptosis can be managed with patching or with glasses to improve or maintain vision but its correction requires surgery. Surgery is often recommended in early infancy but may be delayed until later in childhood if the visual development is judged to be adequate. Mild degrees of ptosis which are not visually significant can be treated with restorative surgery after five years of age.
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Congenital glaucoma is an uncommon disease characterized by elevated pressure in one or both eyes at birth. Uncontrolled pressure can damage the optic nerve and retina, leading to decreased vision or blindness, in the worst case. Congenital glaucoma is usually manifest by a cloudiness and enlargement of the cornea. This is often accompanied by tearing and light sensitivity.
The treatment of congenital glaucoma requires surgery as soon as possible. The goal of treatment is to normalize the eye pressure and often is accomplished through a combination of surgery and medications.
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Dyslexia is a specific type of learning disorder that manifests as difficulty in reading by children with otherwise normal intelligence and sociocultural opportunity. Reading is a complex function that involves integrating multiple factors related to an individual's experience, ability, and physical makeup. Although some children do not read well because they have trouble seeing, research has shown that most children with reading difficulties experience a variety of language defects that stem from complex brain function. Reading difficulty is not due to altered visual function per se.
Parents, teachers, and pediatricians are often the first to identify dyslexia or learning disabilities in children. Dr. Plotsky sees many children who are so identified. Evaluation by the pediatric ophthalmologist is important to detect and treat any refractive errors (requirements for glasses) or eye muscle imbalance which could add to the child's educational difficulties.
Eye defects, subtle or severe, do not cause reversal of letters, words, or numbers. No scientific evidence supports claims that the academic abilities of dyslexic or learning disabled children can be improved with treatment based on vision therapy, "neurological organizational training", or tinted and colored eyeglass lenses.
Early remediation of reading difficulties based on intensive one-to-one tutoring and a balanced reading program seems to work best. Training in reading should be supplemented with enrichment activities to foster language development. The consensus among scientific investigators is that there is no substitute for direct remedial instruction in reading.
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