General Information

Dr. Burke is one of Cincinnati’s most trusted resources concerning Retinopathy of Prematurity.

What is Retinopathy of Prematurity (ROP)?

Retinopathy of prematurity (ROP) is a potentially blinding disease caused by abnormal development of retina blood vessels in premature infants. The retina is the inner layer of the eye that receives light and turns it into visual messages that are sent to the brain. 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.

How many infants have ROP?

There are approximately 3.9 million infants born in the U.S. each year. About 14,000 are affected by ROP and 90% of those affected have only mild disease. About 1,100- 1,500 develop disease severe enough to require medical treatment and 400-600 infants each year in the U.S. become legally blind from ROP.

What determines the severity of ROP?

Birth weight and gestational age are the 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.

How is ROP diagnosed?

The diagnosis of ROP is made by an ophthalmologist (Eye MD) who examines the eyes after the pupils are dilated with drops. Infants less than 1500 grams (3.3 lbs) and with a gestational age less than 30-32 weeks undergo eye examinations to monitor for ROP.

How do doctors describe ROP?

ROP is described by its location in the eye (the zone), by the severity of the disease (the stage) and by the appearance of the retinal vessels (plus disease). The first stage of ROP is a demarcation line that separates normal from premature retina. Stage 2 is a ridge which had height and width. Stage 3 is growth of fragile new abnormal blood vessels. As ROP progresses the blood vessels may engorge and become tortuous (plus disease) .

Who requires treatment?

When ROP reaches a certain level of severity, called type 1, the potential for retinal detachment (and possible permanent vision loss) becomes great enough to warrant consideration of laser treatment. Eyes that develop this disease have type 1 ROP and are usually treated.

How is ROP treated?

Typically laser ablation is applied to the immature portion of the retina via a headset. The outcome of laser treatment is usually favorable with disappearance of the abnormal blood vessels and resolution of plus disease. Despite accurate diagnosis and timely laser treatment, the ROP sometimes continues to worsen and the retina pulls away from the back of the eye. Eyes with retinal detachment caused by ROP generally have apoor visual prognosis. Retinal detachment can be treated with vitrectomy and/or scleral buckling procedure. There is active research in the use of medications to retard the growth of the abnormal blood vessels. Despite optimal treatment, some eyes with ROP progress to permanent and severe vision loss.

Why are eye exams recommended after discharge from the hospital?

It is VERY IMPORTANT to have eye exams after discharge from the hospital since ROP may not be resolved before discharge. Also, even with successful treatment of ROP, prematurity may lead to other vision abnormalities. Prematurity is a risk factor for the development ofamblyopia (lazy eye), eye misalignment (strabismus), and the need for glasses (even at a young age), and cortical visual impairment. Therefore, every premature infant needs the lifelong attention of an ophthalmologist (Eye MD).

Where is there more information about retinopathy of prematurity?

National Eye Institute
The Association for Retinopathy of Prematurity and Related Diseases (ROPARD)
More technical information can be found on the EyeWiki Site

Dr. Burke is one of Cincinnati’s most trusted resources concerning eye problems in children.

Poor visual fixation in an infant over 6 weeks of age may be indicative of poor visual development for which a pediatric ophthalmology evaluation should be considered.

White pupil – The pupil is the center hole in the colored part of the eye (iris) which under most conditions appears black and, with flash photography, the reflection often has a red or orange coloration. If the pupil appears grayish to white or if the red reflex is white or not noticeable with flash photography, this may be indicative of two serious eye problems – a cataract or a tumor in the eye. If a white pupil were observed, an urgent pediatric ophthalmology evaluation is indicated.

Excessive light sensitivity, also called photophobia, which is often associated with lots of tearing and sometimes redness to the white of the eye, may indicate a problem with the cornea such as a scratch or abrasion, foreign body, or excessive stretch caused by congenital glaucoma. If these signs were present, an emergent pediatric ophthalmology evaluation is necessary.

Droopy eyelid, referred to as ptosis, may interfere with vision if the eyelid were to cover the pupil’s visual axis and may cause an irregular astigmatism which might result in amblyopia. If one or both eyelids droop significantly after two months of age, a pediatric ophthalmology evaluation is now necessary.

Jerky or dancing eye movements may represent nystagmus. Nystagmus refers to the eyes moving in a slow to fast, typically side-to-side movement. Nystagmus may indicate retinal or optic nerve problems that could result in less than normal vision. Nystagmus is often not observed until the first or second month of age, but whenever it is noted and if it persists should stimulate a pediatric ophthalmology evaluation.

Misalignment eyes or strabismus that persists after 3-4 months of age warrants a timely pediatric ophthalmology evaluation.

Overflow of tears with or without accumulating discharge is suggestive of a tear duct obstruction. External eyelid and eyelash cleaning and occasionally eye medications are necessary to limit the discharge. If these problems persist till 9 months old, evaluation and treatment by a pediatric ophthalmologist is indicated.

Dr. Burke is one of Cincinnati’s most trusted resources concerning eye problems in children.

Vision concerns

  • cannot see well
  • poor eye contact
  • unable to see distant things clearly
  • stumbling over small objects
  • blinking more than usual
  • squinting eyelids together or frowning
  • eyes flutter quickly from side-to-side
  • drooping lid

Eye alignment concerns

  • crossed eyes
  • wandering eye
  • shutting or covering one eye
  • blurred or double vision
  • tilting or turning of the head

External eye disease concerns

  • rubbing eyes excessively
  • red-rimmed, encrusted, or swollen eyelids
  • inflamed or watery eyes
  • recurring styes or chalazions
  • itching, burning or scratchy eyes
  • excesive sensitivity to light
  • chronic tearing or wetness with or without discharge
  • eye pain

Dr. Burke is one of Cincinnati’s most trusted resources for detection of eye problems in children.

What are some signs of Eye Trouble?

  • Squinting eyelids together
  • Tilting or turning of the head in an awkward position
  • Eyes do not appear properly aligned (straight eyes)
  • Closing or covering one eye while watching TV, video screen, or books
  • Light sensitivity
  • Red-rimmed, and crusted, or swollen eyelids
  • Itching, burning, scratchy, or otherwise painful eyes
  • Inflamed or watery eyes

Dr. Burke is one of Cincinnati’s most trusted pediatric ophthalmologists.

What is Pediatric Ophthalmology?

Pediatric ophthalmology is a subspecialty of ophthalmology concerned with eye diseases, visual development, and vision care in infant, children, and teenagers. An ophthalmologist is a medical doctor specifically trained in the medical and visual treatment as well as surgical care of the eyes. An ophthalmologist is the only type of doctor trained to perform a comprehensive medical eye examination that can examine the eyes in relation to the general health and condition of the whole body.

Pediatric ophthalmologists in the United States are physicians who have completed medical school, a one year internship, a 3 year residency in ophthalmology, and one or more years of fellowship in pediatric ophthalmology and strabismus. Individuals who have completed this training may become members of the American Association for Pediatric Ophthalmology and Strabismus.

What are Pediatric Ophthalmologists trainined for?

Pediatric ophthalmologists are specially trained in the development of the visual system and the diseases that disrupt visual development in children. Pediatric ophthalmologists are qualified to perform complex eye surgeries as well as having expertise in managing various ocular diseases that affect children including the use of glasses and medications. Pediatricians, family practioners, and even most ophthalmologists refer pediatric patients to a pediatric ophthalmologist for examination and management of ocular problems because of the children’s unique needs and special requirements. Pediatric ophthalmologists also manage adults with eye alignment disorders (strabismus).

Pediatric ophthalmologists are specially trained to manage most children’s eye disorders including strabismus, amblyopia, blocked tear ducts, abnormal vision development, refractive errors, ocular and orbital tumors and congenital malformations, external ocular diseases including conjunctivitis, blepharitis and chalazion, ptosis, pediatric cataract, pediatric glaucoma, and retinopathy of prematurity.

Additional Information:

Dr. Burke is one of Cincinnati’s most trusted resources concerning eye health in infants, children & teenagers.

When shoud Eye Screening be considered?

Monitoring ocular health should begin at birth and continue throughout childhood. Life-threatening diseases such as retinoblastoma can present at any time during infancy and early childhood.

Vision threatening conditions that require immediate attention can occur at anytime during infancy and childhood (e.g. cataract, glaucoma, and strabismus).

Serial screening of every child by their primary medical care provider is the most effective approach to accomplish early detection of ocular problems in infants and children.

The American Academy of Pediatrics, The American Association for Pediatric Ophthalmology and Strabismus, and The American Academy of Ophthalmology all advocate early and continued serial screening of children as the best approach for infants and children.

Newborns are screened by the pediatrician prior to discharge from the hospital and during subsequent outpatient well-child checks.

Suspicious cases should receive immediate referral to a PEDIATRIC OPHTHALMOGIST who is specially qualified to care for infants, children, and teenagers.

Screenings can detect vision loss due to amblyopia, refractive errors, and life-threatening conditions such as retinoblastoma.

Infants, children, and teenagers benefit from eye and vision screenings

Infants, children, and teenagers benefits from serial eye and vision screenings by their primary medical care provider to detect poor vision (amblyopia), eye misalignment problems, and potentially life-threatening medical conditions.

Click the following links for more information.

Specific Age and Type of Eye Screening Recommendations
General Information On Eye Screening
Pediatric Eye Screening

Dr. Burke is one of Cincinnati’s most trusted resources concerning eye protection for children.

What are the likely causes of loss of vision in a child?

The two most likely causes of vision loss in children are amblyopia and eye injuries.

Where do eye injuries occur?

Accidents occur at anytime and in any place. About half of childhood eye injuries occur around the home and the other half occur in sports and recreational activities.

What around a house may be dangerous to the eyes?

Parents should supervise their children at play. Extreme care is necessary if you allow children to use darts, guns, or other toys that can shoot objects into the eye. Toys with sharp edges are dangerous. Pencils, pens, and scissors may easily scratch or penetrate the eye. Forks and knives, clothes hangers, and screwdrivers are of concern. Hammering, power drills and power saws, powered gardening tools, and lawnmowers all may propel rocks or other high speed particles toward the eyes. Household chemicals including cleaning products, bleach, and powerful soaps may cause significant irritation and possibly damage to the eyes. Never play with fireworks.

What are the sports with the greatest likelihood of eye injury?

Participating in sports requires that the parents and the child have a full understanding of the risks involved. Sports that have high velocity ball action or those that have high speed projectiles have the highest potential for eye injuries. These include racquetball, squash, hockey and field hockey, lacrosse, baseball, basketball, and soccer.
Academy of Ophthalmology Policy Statement

What kinds of eye protection are available?

For typical daily protection, impact resistant lenses with sturdy eyeglass frames are sufficient. The most frequently used protective lenses are made out of polycarbonate, a material that is extremely strong and shatter resistant. Sturdy eyeglass frames for daily wear are available in many attractive styles. Special protective eyewear including the sports frames are available for most sports. Contact lenses alone should not be the only protection used because they do not provide enough protection against injury.
Play Hard Don’t Blink, advice by Ohio Ophthalmological Society

What does it mean “living with one good eye”?

Once it has been determined that the vision can never be improved in one eye, taking care of the remaining good eye becomes extremely important. Protection of the good eye cannot be stressed enough. At any age, appropriate eye protection should be worn at all times whether it be play, school, sports, or hobbies. Protective eye wear should be worn for the remainder of one’s life, even if no prescription is necessary for improving the vision in the good eye. “Living with one good eye” also means not forgetting about maintaining the health of the good eye. Regular eye examinations by an ophthalmologist are very important to make sure the good eye remains healthy.

What high risk sporting activities should be avoided you have poor vision in one eye?

For those individuals “living with one good eye”, the high risk sporting activities that should be avoided are full contact martial arts, wrestling, and boxing.

Click the following links for additional information.
Academy of Pediatrics Recommendations

Dr. Burke is one of Cincinnati’s most trusted resources for Down Syndrome Eye Problems

The improved quality of medical care and educational resources provided to these children has allowed them to lead more productive lives and to have a longer life expectancy. The proper assessment and correction of their visual functioning can further enhance their quality of life.

Individuals with Down syndrome are at increased risk for a variety of eye and vision disorders. Since many of these problems have the potential to reduce vision, it is important to identify them early.

A pediatric ophthalmologist should evaluate all children with Down syndrome during the first six months of life. Because potential ophthalmic problems appear to increase with age, reevaluations are needed every year or two. Fortunately, many eye disorders common to individuals with Down syndrome can be treated if discovered at an early age.

If you have general questions about Down syndrome or would like to join a support group, contact the following organization.

Down Syndrome Association of Greater Cincinnati
644 Linn St.
Cincinnati, Ohio 45203
(513) 761-5400

Additional Sources:

Dr. Burke is one of Cincinnati’s most trusted resources concerning dyslexia and vision therapy in children.

What is a learning disability?

The term learning disability refers to difficulty understanding and using spoken or written language. Individuals with learning disabilities may have problems with reading, writing, listening, speaking, concentration or doing mathematical calculations. Approximately 80% of people with learning disabilities have dyslexia. Dyslexia is a major cause of learning disability occurring in almost one out of five children worldwide.

What is dyslexia?

The definition of dyslexia is “difficulty in learning to read despite normal intelligence, strong motivation, and adequate instruction.” It is characterized by difficulties with accurate and/or fluent sight word recognition and decoding abilities. Dyslexia may affect not only how a person reads but, surprisingly, a range of other important functions as well, including the ability to spell words, to retrieve words, to articulate words, and to remember certain facts. These difficulties are unexpected in relation to the child’s other cognitive skills. This disability may also damage a child’s developing self-image and cause emotional problems such as withdrawal, anxiety, depression, or aggression. Dyslexia has been identified as having a strong genetic basis with up to 40% having extended family individuals demonstrating dyslexic tendencies.

Do children with dyslexia have more eye problems than average?

Children with learning disabilities and dyslexia have no greater incidence of eye problems than the rest of the population.

What is the most up-to-date information on dyslexia?

The scientific and education communities know that dyslexia is common (up to 20% of all humans), persistent, and chronic. It is now known that this complex reading problem has its roots in the very basic brain systems that allow humans to understand and express language. The accepted model of dyslexia is based upon phonological processing – processing the distinctive sound elements of language. In dyslexic children, it is this glitch within the language that impairs the child’s phonemic awareness. As a result of this weakness, children have difficulty breaking the reading code. Reading represents a code, specifically, an alphabetic code. Seventy to 80% of children (American and those all over the world) learn how to transform printed symbols into a phonetic code without much difficulty. For the remainder, however, written symbols remain a mystery. These children are dyslexics. Although vision is fundamental for reading, the brain must interpret the incoming visual images. Historically, many theories have implicated defects in the visual system as a cause of dyslexia. We now know these theories to be untrue.

National Center for Learning Disabilities
381 Park Ave. South, Suite 1401
New York, NY 10016

Is there any treatment for dyslexia?

The greatest stumbling block preventing a dyslexic child from realizing his/her potential and following his/her dreams is the widespread ignorance about the true nature of dyslexia.

Dyslexia and learning disabilities are complex problems that have no simple solutions. A prestigious national panel of scientists and educators have agreed upon what we now believe are the optimal methods of teaching children to read. Their report was released April 13, 2000, and is titled “Report of the National Reading Panel, Teaching Children to Read: An Evidence–Based Assessment of the Scientific Research Literature on Reading and Its Implications for Reading Instruction.” Much of that report has been synthesized by one of the panel participants, Sally Shaywitz, M.D., into a wonderfully understandable book titled Overcoming Dyslexia, Random House, New York, 2003. In this book, Dr. Shaywitz explains how to help a child become a reader and what methods accomplish the task of turning struggling readers into proficient readers — namely, “overcoming dyslexia.”

The American Academy of Pediatrics, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists all strongly support these recommendations for early diagnosis and educational intervention. With early recognition and individualized, interdisciplinary management strategies, children with learning disabilities can enjoy successful academic experiences.

What about other treatments?

The new science of reading has direct application to identifying and treating reading difficulties. The treatment must be educationally directed. There is no credible evidence to show that simple solutions, such as visual training, eye muscle exercises, perceptual or hand-eye coordination exercises, weak magnifying glasses, colored overlays, diet, megavitamins, or sugar restriction, can significantly affect a child’s learning disability. These approaches can give parents a false sense of security and may delay proper educational assistance.

There appears to be much controversy about vision therapy, why is that?
Because learning disabilities and dyslexia are difficult for the public to understand and for educators to treat (that was in the past before the newer scientific evidence was available), the attempt to help these struggling learners gave rise to a wide variety of controversial and scientifically unsupported alternative treatments, including one that is now called “vision therapy”, also referred to as vision training or eye exercises.

Optometrists who advocate vision therapy persist in claiming that many problem learners have undiagnosed vision problems contributing to their difficulties. However, optometrists concede vision therapy does not directly treat learning disability or dyslexia. Advocates claim vision therapy is a treatment to improve visual efficiency and visual processing which thereby allows the child to be more responsive to educational instruction. Despite the significant lack of corroborating research findings with statistical validity, vision therapy is popular and persuasive.

As advocates for their patients, physicians use scientific evidence of effectiveness as the basis for treatment recommendations. Treatments that have inadequate scientific proof of efficacy should be and are discouraged. Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child’s learning difficulties are being addressed, may waste family and/or school resources, and may delay proper educational instruction or remediation.

What major organizations are against vision therapy in the treatment of dyslexia?

Given that the most widely accepted scientific view that dyslexia is a language-based disorder, the American Academy of Pediatrics, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Council on Child and Adolescent Health, and the National Education Association all agree with the evidence that vision therapy does not benefit children with learning disabilities or dyslexia. And all are united in discouraging parents from having their children participate in such unsubstantiated and expensive vision training programs, saving the parents’ valuable time and family resources and allowing the child to use their time and effort utilizing proper educational intervention.

What resources are available?

Locally and nationally, information and support can be obtained from:

The Attention Deficit Disorder

Council of Greater Cincinnati

6941 Jerry Dr

West Chester, OH 45069-4040

International Dyslexia Association
Ohio Valley Branch
Cincinnati, Ohio 45208
(513) 651-4747

International Dyslexia Association
40 York Rd., 4th Floor

Baltimore, MD 21204

Voice: (410) 296-0232

Fax: (410) 321-5069

Learning Disabilities Association of America

4156 Library Rd., Pittsburgh, PA 15234-1349

Voice: (412) 341-1515

Fax: (412) 344-0224

National Center for Learning Disabilities
381 Park Ave. South, Suite 1401

New York, NY 10016
Voice: (212) 545-7510

Fax: (212) 545-9665

Toll-free: (888) 575-7373

The national reading information website is:

Overcoming Dyslexia, Sally Shaywitz, M.D.,
Random House, New York, 2003.
(I have borrowed freely from this book to help answer some of these questions and this is my acknowledgement thereto.)

The following are scientific references discouraging the use of vision therapy:

Evidence shows vision therapy does not benefit children with dyslexia, Sheryl M. Handler, M.D., AAP News, volume 31 (number 5): 19, May 2010.
(I have borrowed freely from this article to help answer some of these questions and this is my acknowledgement thereto.)

A critical evaluation of the evidence supporting the practice of behavioural vision therapy, by Brendan T. Barrett, Ophthalmic and Physiological Optics. 2009, 29: 4–25.

Learning disabilities, dyslexia and vision: Policy statement,
jointly supported by the American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists

Complementary Therapy Assessment: Vision therapy for learning disabilities, American Academy of Ophthalmology, September 2001.

Dr. Burke is one of Cincinnati’s most trusted resources concerning eye care for children.

Is the eye just like a camera?

Although often compared to a camera, the eye is far more complicated and complex. It not only focuses and takes “pictures” but it also tracks and follows the target then processes this information seamlessly with the brain which ultimately allows us to be conscious of what we “see”.

Why do we say that our eyes are so complex?

Our eyes are indeed a very complex sensory organ that is an extremely important part of what we call the visual system. In order for us to “see”, first there must be light rays emitted from or be reflected off of a target. As these light rays enter and pass through the eye, an image is focused by the cornea and lens (and glasses if worn) and projected onto the retina. The retina is at the back of eye and consists of millions of light receptive cells that convert these focused light rays into electrical signals that are transmitted through a multilayered system into our brain. Once the brain receives and processes these signals, we perceive an image. It is at that moment that vision has occurred and we say “I see”.

What does that mean to have your visual acuity measured?

Visual acuity testing is a measurement of a person’s ability to see in sharp, clear, and fine detail. Visual acuity expressed as “20/20” is what is referred to as normal vision.

What are the four ways one commonly evaluates our visual abilities?

The 4 parts of the visual system that are commonly evaluated are central vision, peripheral vision,
3-D vision or depth perception, and color vision.

What is central vision?

Central vision is the ability to clearly see objects at which one is looking.

What is peripheral vision?

Peripheral vision is the ability to see shapes and forms that surround the central vision target. Peripheral vision does not give us a detailed vision.

What is 3-D vision?

3-D vision or depth perception is the ability of our two eyes to view one object from slightly different angles which the brain blends these two views giving us a perception of dimension and position in space of the object at which we are looking.

What is color vision?

There are light receptive cells in our retina that are called cones. In the normal eye there are 3 different kinds of cones, each perceiving or responding to different wave lengths of light. Typically we refer to these as red, green, and blue cones. It is through the variable stimulation of these cones that allow the human to differentiate over a million shades of color.
Additional Information

Why does the eye have its own field of medicine?

With so many vital components of the eye and so many aspects to visual ability, it is no wonder that so much effort and so many different kinds of professionals are involved in preserving eyesight and maintaining eye health.

Anatomy information may be obtained through these links: