An interview with Dr Carole Cherfan
- Who is Dr Carole Cherfan?
I am an ophthalmologist with a subspecialty degree in Pediatric Ophthalmology and Strabismus (both in children and adults). I studied medicine and general ophthalmology at the American University of Beirut Medical Center (AUB-MC) followed by a fellowship in Pediatric Ophthalmology and Strabismus at the Mayo Clinic, Rochester, MN, USA.
- Why did you choose Pediatric Ophthalmology and Strabismus as a specialty?
There are several reasons why I chose this subspecialty. Firstly, was the chance to work with children with eye problems. I find it very rewarding to be able to help and make a difference in improving a child’s sight or eye muscle imbalance is cases of strabismus. Working with children is highly rewarding and brings about a huge feeling of self-satisfaction.
Another reason was the fact that I believed that an ophthalmologist specialized in children was in great need. Children are not little adults. They require special care, attention and personal time. As a pediatric ophthalmologist, we are trained on how to approach children, gain their trust and finally examine them.
Last but not least, not one single child should be deprived of good eyesight. I take it upon my duty to make sure this is fulfilled to the best of my ability.
- Can you tell us more about it?
A pediatric ophthalmologist has the training and qualifications to treat children. We can diagnose, treat and manage children with eye problems. Pediatric ophthalmologists perform full eye exams, surgery (for eye muscles, strabismus, blocked tear ducts and cataracts), prescribe eyeglasses and contact lenses and diagnose eye problems resulting from systemic diseases such as diabetes and juvenile rheumatoid arthritis.
As previously mentioned, children are not small adults. They may not be able to express what is bothering them, answer medical questions and may not always be cooperative during the exam! Pediatric ophthalmologists have been properly trained on how to examine and treat both normal children and those with special needs. Their clinics and instruments are designed with children in mind to create a comfortable and stress-free environment. We provide the best care for dealing with children and in treating their eye disorders!
- What is strabismus? And how are you treating it?
Strabismus is any misalignment of the eyes. The actual cause of strabismus is poorly understood. However, most types are the result of an abnormality of neuromuscular control of eye movement (initiating from the brain) rather than an actual eye muscle problem. The 3 cranial nerves (III, IV, VI) responsible for eye movement can be weak or palsied and cause strabismus.
There are many different types of strabismus. Examples of horizontal strabismus include ‘Esotropia’, which is an inward turning of the eyes (crossed eyes), and ‘Exotropia’, which is outward turning of the eyes (wall-eyed). Examples of vertical strabismus include ‘Hypertropia’ in which the abnormal eye is higher than the normal eye and ‘Hypotropia’ in which the abnormal eye is lower than the normal eye.
Strabismus may occur in both children and adults. In case of children, the child may be completely normal and develop strabismus. On the other hand, children with disorders that affect the brain are more likely to develop strabismus. In adults, strabismus may be the result of an untreated childhood strabismus, stroke, trauma or neurological problems.
The purpose of treatment of strabismus is to attain ‘binocular vision’, which means to improve eye alignment, allowing the eyes to better work together. Treatment includes eyeglasses, muscle exercises and eye muscle surgery depending on the type and cause of strabismus. It is important to emphasize the fact that there are solutions to correct the strabismus in both children and adults!
5- What are the major developments in pediatric ophthalmology?
Hot topics in pediatric ophthalmology and strabismus today include: nonsurgical treatment for the progression of pediatric myopia, treatment of amblyopia at a later age-group, iPad treatment for amblyopic children, vision screening for risk factors related to strabismus and amblyopia, low-vision rehabilitation methods in children, new surgical techniques in strabismus surgery, advances in the management of retinopathy of prematurity and retinal imaging
- When do you recommend kids should visit an ophthalmologist for the first time?
According to the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) vision screening is an efficient method to identify children with an eye condition that may lead to visual impairment. Once identified, referral to a pediatric ophthalmologist should be made for further evaluation and treatment.
Vision screening is usually performed by pediatricians and in schools by qualified nurses. The main goal is to identify children who are at risk to develop eye problems such as anblyopia, strabismus, refractive errors, congenital cataracts and congenital glaucoma as well as more serious conditions.
I personally would recommend a full eye exam at the age of 3-4 years with a pediatric ophthalmologist to make sure nothing is missed. In the case of a family history of eye problems or in the case of signs and symptoms suspicious of an eye problem, some children may require an exam at an earlier age. There are many methods available used to screen a child’s vision so even a newborn can be adequately examined.
- What are frequent eye problems encountered in children?
The most frequent eye problems encountered in children are as follows:
- Amblyopia or lazy eye: defined as the loss of vision in one or both eyes during the period of visual development. Causes include refractive error, strabismus, and deprivation such as the presence of a cataract. Treated with glasses and/or patching
- Strabismus (discussed above)
- Myopia: refractive error whereby vision is better at near than at distance. Treated with glasses
- Hyperopia: refractive error whereby vision is better at distance than at near, a common cause of strabismus
- Astigmatism: refractive error whereby vision at distance and near are both affected. Treated with glasses
- Conjunctivitis: also known as ‘pink eye’ caused by bacteria, viruses or allergies. The eyes tend to look pink or red and symptoms may include eye rubbing, itching, burning and discharge. Treated with topical eye drops
- Chalazion: an eyelid lesion caused by blockage of small glands lining the edge of the eyelids resulting in a small bump. At times, the surrounding skin may become swollen and painful. Treated with lid hygiene and sometimes topical eye drops
- Nasolacrimal duct obstruction: Occurs in 5% of infants, 90% of which resolve by the first year of life. Results from an obstruction of the tear duct preventing tears from draining through the nasolacrimal duct system properly. Signs and symptoms include excessive tearing and overflow onto the eyelashes, eyelids and cheeks. Occasionally, secretions and discharge are present. Treated with massage but may need surgery if not resolved by age 1year
- Less common conditions include: congenital cataracts, congenital glaucoma and tumors
- In Lebanon, are children with eye problems morally supported?
Unfortunately, vision screening is not available in all schools and pediatrician clinics in Lebanon. As a result, many preventable/treatable conditions are missed. However, in those children whereby their eye problem is diagnosed and treated the most important step is to educate parents and teachers about the specific condition. Children with glasses or strabismus are not less ‘intelligent’ or less ‘talented’ then those without eye conditions. A girl with glasses is not less attractive than a girl without. Time should be spent with the parents to explain their child’s eye condition to them and to allow them to accept it along with the proposed treatment plan.
- You worked in the states and you are working now in Lebanon. Can you tell us the differences you encountered between the two countries and what are the main problems people here are facing to do any intervention for their eyes?
As always, a cultural difference exists between two different countries. In Lebanon for example, physical appearance plays a major role and parents are less willing to accept that their child needs glasses especially with the girls. This is more a concern in the Middle East than in the western countries such as the USA. Accepting the fact that the child needs surgery for his/her condition is also a challenge in Lebanon. Parents tend to avoid or fear surgery in this part of the world more often than in the west. With regards to the children, I have noticed them to be more independent and less fearful in the USA than here in Lebanon. We Lebanese tend to be more protective and fear for the safety of our children a lot more than in other countries and this sometimes makes examining a child more challenging! However, once the eye condition is well understood and all questions have been answered everything rolls very smoothly.