We spoke with Professor Dr. Wolf Alexander Lagrèze –  the Head of Neuroophthalmology, Pediatric Ophthalmology and Strabismus Treatment at the Eye Center of the Medical Center – University of Freiburg to explore the latest developments in children’s eye health. From the most common vision challenges to cutting-edge research in myopia prevention, this interview sheds light on how early detection, specialized care, and long-term follow-up can make a lifelong difference for young patients.

What are the most common vision problems in children today, and how have they changed over time?

Even in early childhood, serious organic diseases of the eyes or the visual pathways in the brain can occur, sometimes with profound consequences for quality of life and long-term development. Fortunately, such conditions are relatively rare.

By far the most common vision problems in children are amblyopia (often referred to as “lazy eye”), strabismus (misalignment of the eyes), and—an increasingly important issue in recent years—myopia (short-sightedness). Today, up to one in three children develops myopia before reaching puberty.

Amblyopia and strabismus typically emerge in preschool years, while myopia most often develops during primary school age. In many countries, basic vision checks are integrated into routine pediatric health visits. While these programs are valuable and identify many children in need of care, they cannot detect every vision disorder. This is critical, as visual development in childhood follows time-sensitive stages—missed diagnoses may mean missed opportunities for optimal treatment.

At what age should children have their eyes examined, and what signs should parents take seriously?

Routine pediatric check-ups usually provide a solid foundation for early detection. Parents who want additional reassurance, however, may consider a comprehensive eye examination by a pediatric ophthalmology specialist around the age of two to three years, ideally in a center equipped with child-specific diagnostic tools.

One clear warning sign should never be ignored: persistent eye misalignment at any point during the first year of life requires immediate specialist evaluation.

What distinguishes pediatric ophthalmology in Freiburg from other centers worldwide?

In Freiburg, we offer the full spectrum of pediatric eye care — from conservative management to highly specialized surgery—at the highest international standard. A key principle of our work is the understanding that children’s eyes are not simply smaller versions of adult eyes. They differ fundamentally in tissue properties, development, and healing responses, and they present a distinct spectrum of surgical risks and long-term considerations.

Conditions such as congenital or early-onset cataract and childhood glaucoma illustrate this complexity. These disorders require not only technical expertise but also long-term strategic planning.

Equally important is our close and well-established collaboration with neighboring medical specialties. These interdisciplinary pathways have been refined over many years and translate into tangible benefits for young patients. Crucially, especially after surgery, seamless and long-term follow-up by our integrated team of physicians and orthoptists is guaranteed — an essential factor for achieving durable functional outcomes.

Which current advances or innovations in pediatric ophthalmology do you find most promising?

A major focus of our work lies in the early detection of visual disorders and the continuous improvement of screening methods. In particular, we are internationally recognized for our research into the prevention of myopia and have led multicenter clinical trials in this field.

For children with congenital cataract or glaucoma, we now have clinical data with follow-up periods extending beyond 20 years. These long-term insights have enabled us to refine surgical techniques and treatment pathways, significantly improving outcomes. Our findings have been published in leading international peer-reviewed journals and continue to shape best practices in pediatric ophthalmology worldwide.