Comprehensive Vision Examination

Goals of the Pediatric Eye Examinations

Birth to 18 years of age

• Evaluate the functional status of the eyes and visual system
• Assess ocular health and related systemic health conditions
• Counsel and educate the parents and patient regarding the status of the visual system and possible associations with overall health and development.

Components of the Eye Examination

Although children may not be able to communicate at an adult level, there are many procedures that can be used to determine how well their visual system is functioning. Game-like activities using special figures allow the pediatric optometrist to observe visual reflexes and even communicate with infants and young children. There are also several procedures that are simple measurements of the eye and vision that do not require input from the patient.

Patient History - Information about the child's and parent's general health can provide clues about the potential risk for vision anomalies. If there is a strong history of a particular vision problem that runs in the family, more frequent examinations or special procedures may be required.

Visual Acuity - Determines how well the child sees. There are several ways to estimate the child's visual abilities. Although they are not precise for infants they are very good at determining if there is significant vision loss, especially a difference between the two eyes.

Refraction - Measures the focusing power of the eyes. There is a small range of incorrect focusing power that is acceptable and this can easily be identified with several procedures. Again, a difference between the two eyes is more important than a small amount of near- or far-sightedness. Eye drops are often used to make this procedure even more precise.

Eye Movements, Binocular Coordination, and Accommodation - There are 14 different muscles that the child must learn to control in order to see the world single, clear and comfortably. For infants, it is common to have minor, occasional lapses in control. Careful observation by the pediatric optometrist can determine if the child is developing appropriate eye movement control for their age.

Ocular and Systemic Health Screening - Bright lights and magnifying instruments are used to view the different structures of the eyes and supporting tissues. Usually dilating drops are used to temporarily enlarge the pupil so the internal eye structures can be viewed. The lights and drops do not cause any damage but are occasionally uncomfortable and resisted by children. Most of the time a little persistence and consoling will provide the examiner enough time and cooperation to complete the procedure.

Perceptual Testing - Visual Perception is a broad term that describes how the brain organizes and interprets the information sent by the eyes and other sense organs. This is a very important skill for young learners. Information from the history or examination may indicate the need to examine the child's visual perceptual skills. A screening procedure may be administered during the eye examination or a comprehensive developmental assessment can be scheduled for another day.

Things for parents to consider to make the exam go efficiently.

• Set a good example, get your eyes tested and allow the child to observe that there is nothing to fear.
• Bring props, favorite blanket, comfort toy, extra snacks/bottle.
• Try to schedule the appointment soon after their typical nap time.
• Don't bribe, children quickly learn to associate unpleasant activities with, "If you do ______, we will go to McDonalds". Their natural "stranger anxiety" often becomes heightened.
• An extra set of hands is often very helpful. Having to care for another child may limit your ability to aid and comfort the child being examined and often serves as a distraction to the task at hand.