Pediatric myopia affects more and more children in Asia, USA and other countries. There is no standard protocol for the therapy but pediatric ophthalmologists try to decrease myopia progression using different methods. Myopia in children is more and more frequent and the onset age has decreased over time, leading to a greater chance to progression into high diopters for spectacles or contact lenses and also other ocular complications. Regarding this issue, the aim of this paper was to underline the new therapeutic regimens for correcting and slowing pediatric myopia progression.

The aim of the study was to highlight the medical and legal difficulties in framing lowvision patients for certification. We performed a retrospective observational study conducted from January 2013 to January 2016, on 63 patients with the mean age of 16.37±3.34 years, evaluated at the Ophthalmology Clinic from "Sf. Spiridon" Hospital, Iași, in order to release a medical certificate required at the Expertise Board. The clinical parameters observed were visual acuity (VA) with correction, objective refraction (in Spherical Equivalent -SEq), intraocular pressure, slit lamp examination of the anterior pole, fundus examination, orthoptic eye exam, and ocular ultrasonography (in selected cases). The main causes for the decreased visual acuity found are refractive or strabic amblyopia determined by: high myopia (28.57%), esotropia (19.04%), astigmatism (17.46); congenital diseases -congenital nystagmus (12.69%), congenital cataract (7.93%), microphthalmia (7.93%); acquired diseases -retinopathy of prematurity (9.52%), optic nerve atrophy (7.93%), bandelette keratopathy (6.34); ocular trauma (7.93%). In 52.38% of the cases for the RE and 53.96% of the cases for the LE, decreased visual acuity was caused by an irreversible condition and could not be improved. Patients come every year for reevaluation in order to receive the medical certificate required at the Expertise Board. Evaluating the patient for a certificate for visual impairment is a time consuming process due to the high number of investigations necessary and, sometimes, difficult collaboration with the patient with associated general pathology. It also requires knowledge of frequently changing legislation to complete legal forms for patients with visual impairment. A medical certificate may now be issued with a validity of up to four years, given that certain diseases are irreversible and visual functional status does not change over time.

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