Paediatric ophthalmology is unique amongst the sub-specialties of ophthalmology in that its boundaries are defined primarily by the age of the patient rather than by groups of clinical conditions that it treats.
The separation of the care of children and young people from that of adults helps to ensure that they are treated by appropriately experienced doctors in an environment which is child and family-friendly. The separation of paediatric and adult care may take place either in space (separate paediatric departments or hospitals) or time (dedicated operating lists or clinics within a department that also treats adults).
The practice of ophthalmologists who have a sub-specialty interest in paediatric ophthalmology varies widely. Many (particularly in smaller eye departments) will not undertake paediatric ophthalmology exclusively, but will also have an adult general ophthalmology commitment and a general ophthalmology on-call commitment. It is particularly common for ophthalmologists with an interest in strabismus to have a practice which treats both adults and children. Ophthalmologists whose work consists entirely of paediatric ophthalmology are likely to be found in tertiary referral centres. Within the largest paediatric ophthalmology services, there may be some further sub-specialisation, and such departments may also use the services of ophthalmologists from other sub-specialties (eg vitreoretinal surgery, glaucoma, orbital surgery) for the treatment of conditions that occur very rarely in children.
In some situations, there are tensions between the desirability of separating adult and paediatric care, and the need to provide a clinical service which is safe and accessible for children and their families. This may for instance be the case in rural areas or in services which treat very rare conditions, or in emergency situations, where it may not always be possible to segregate the care of children and adults entirely.
Many children with eye problems have other health problems or developmental issues which may be related or incidental. Paediatric ophthalmologists may be called upon to examine a child to confirm or exclude ocular signs of a multi-system disorder, or to look for signs of eye disease in a sibling of an affected child. It is therefore important that the paediatric ophthalmologist is in close communication with paediatricians and a range of colleagues from other disciplines who treat children. Paediatric ophthalmologists may contribute to multi-disciplinary teams for the care of children with multi-system disorders, and will need to maintain close liaison with specialist sensory disability teams for the care of children with visual impairment.