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Pediatric Ophthalmology, Adult Strabismus and Neuro-Ophthalmology

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Dr. Klombers at Schein Ernst Mishra Eye Care has an interest in all types of eye movement disorders and sees patients of all ages. He is an expert in treating the following diseases and more, both medically, optically, and surgically:

  • Amblyopia (lazy eye)
  • Strabismus (misaligned eyes) in both children and adults
  • Nystagmus (jiggling eyes)
  • Double Vision from all causes
  • Nasolacrimal Duct Obstructions (blocked tear ducts)
  • Ptosis (Lid drooping)
  • Lid malpositions or deformities
  • Benign and malignant growths around and behind the eye
  • Retinopathy of Prematurity
  • Congenital cataracts
  • Congenital Glaucoma
  • Genetic disorders of the eye
  • Myasthenia Gravis
  • Grave's Disease
  • Temporal Arteritis
  •  Autoimmune diseases that affect the eyes
  • Optic nerve disorders from all causes (pituitary tumors, cancer, strokes, etc.)
  • Vision disorders caused by:
  • Parkinson's Disease
  • Multiple Sclerosis
  • Pseudotumor Cerebri
  • Strokes
  • Brain Tumors
  • Concussion

Facial and neck movement disorders such as:

  • Blepharospasm
  • Hemifacial Spasm
  • Meige Syndrome
  • Torticollis

Dr. Klombers is an expert in eye muscle surgery, eyelid surgery, tear duct surgery, pediatric cataract surgery, surgical treatment of retinopathy of prematurity and many other problems.He has performed over 15,000 eye muscle operations and has a unique interest in adjustable suture eye muscle surgery for the treatment of adult eye movement disorders.Dr. Klombers has utilized Botox for the treatment of facial movement disorders since 1987 and has injected well over 3,000 patients for a variety of problems.


About Pediatric Ophthalmology

Pediatric ophthalmology is a subspecialty of ophthalmology dealing with children's eye diseases. When a baby is born their eyes are not completely capable of seeing and vision can be limited to around 20/1500. (the ability to see shapes but not features) The main reason for this lack of vision is due to the fact that their brains have not learned how to process the visual images it receives. Over time children will begin to detect extremely fine details. Sometimes visual development can be hindered by a variety of eye diseases or conditions.

Common Pediatric Eye Conditions:

Amblyopia

Amblyopia refers to reduced vision in one or both eyes caused by visual deprivation in childhood. Even with appropriate eyeglasses, an eye with amblyopia does not see well. It is often reversible with the appropriate treatment protocol. Amblyopia results from actual atrophy of the visual pathways in the brain that allow an individual eye to "see." That is, because of improper stimulation of the involved eye, the portion of the brain serving that eye does not develop properly.

This eye condition causes more visual loss in the under 40 group than all the injuries and diseases combined in this age group. If not detected and treated early in life, amblyopia can cause loss of vision and depth perception.

Improvements in vision can be achieved at any age, but early detection and treatment still offer the best outcomes. Comprehensive vision examinations are needed for infants and pre-school children. A vision screening by a pediatrician or the 20/20 eye chart screening is not adequate for the detection of amblyopia (and other visual conditions related to or mistakenly called lazy eye).

How is amblyopia treated?

Treatment for amblyopia consists of forcing use of the amblyopic eye, either by patching, or by instilling topical medication (atropine) in the eye with better vision. Glasses may be required to balance the refractive differences of the eyes. Early detection and compliance with the treatment protocol are key to the success in treating this condition. Although the best outcome is achieved if treatment is started before age 5, research has shown that children older than age 10 and some adults can show improvement in the affected eye.

Patching: An opaque, adhesive patch is worn over the stronger eye for weeks to months. This therapy forces the child to use the eye with amblyopia. Patching stimulates vision in the weaker eye and helps the part of the brain that manages vision develop more completely.

Strabismus

Strabismus, also known as misaligned eyes, is a visual problem in which a misalignment of the eyes prohibits both eyes from focusing on the same point at the same time. One eye may look straight ahead, while the other eye turns inward, outward, upward, or downward. In a very young child, misalignment of the eyes may cause the child's brain to ignore one eye causing amblyopia. When that occurs, vision must be restored prior to contemplating correction of the strabismus. Usually, every attempt is made to correct strabismus with optical means. However, sometimes spectacles alone are not adequate to achieve good alignment and surgery may be required.  If eye muscle surgery is required, it is almost always performed in an outpatient ambulatory surgery setting.

Stabismus surgery is typically performed in a hospital outpatient surgical facility. During the surgery a small incision is made on the clear membrane covering the white part of one or both eyes. Through this incision, the appropriate surgery is then performed tighten, relax, or reposition eye muscles causing the misalignment. The inside of the eyeball is not entered during this type of surgery. Contemporary strabismus surgical techniques involve "hidden" incisions, leaving virtually no visible scarring of the eye surface as a result of this surgery. Though this incision, appropriate surgery is performed to loosen, tighten or reposition one or more eye muscles to allow proper alignment of the eyes to occur.

Children's Vision and Exams

Some experts estimate that approximately 5 to 10% of pre-school aged kids and 25 percent of school-aged children have vision problems. Children should have early, regular screening eye examinations performed by the pediatrician and/or school. Unless hereditary or developmental problems exist, a formal eye examination is usually not of high yield. However, if any eye misalignment or abnormal visual behavior is witnessed (such as squinting, pulling objects close, closing one eye, etc.), then that child should have a prompt, formal eye examination (including dilation of the eyes) by an eye care professional trained in managing pediatric eye disease.

NOTE : Children with existing vision problems or risk factors should have their eyes examined more frequently.

Common risk factors for children's vision problems include:

  • premature birth
  • developmental delays
  • turned or crossed eyes
  • family history of eye disease
  • history of eye injury
  • other physical illness or disease

State-of-the-Art Eye Care


in a

State-of-the-Art Facility

Harrisburg

10 Capital Drive, Harrisburg PA 17110

(717) 233-EYES

Lemoyne

717 Market Street, Suite 112, Lemoyne, PA 17043

(717) 703-3937