Visual System Assessment in Infants, Children, and Young Adults by Pediatricians

Abstract

Appropriate visual assessments help identify children who may benefit from early interventions to correct or improve vision. Examination of the eyes and visual system should begin in the nursery and continue throughout both childhood and adolescence during routine well-child visits in the medical home. Newborn infants should be examined using inspection and red reflex testing to detect structural ocular abnormalities, such as cataract, corneal opacity, and ptosis. Instrument-based screening, if available, should be first attempted between 12 months and 3 years of age and at annual well-child visits until acuity can be tested directly. Direct testing of visual acuity can often begin by 4 years of age, using age-appropriate symbols (optotypes). Children found to have an ocular abnormality or who fail a vision assessment should be referred to a pediatric ophthalmologist or an eye care specialist appropriately trained to treat pediatric patients.

Pediatric eye screening – Why, when, and how

“…[ 7 ] However, a Joint Policy Statement by the American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Association of Certified Orthoptists emphasises that vision assessments and screening eye examinations are critical for the detection of conditions that result in visual impairment, lead to problems with school performance, harbinger serious systemic disease, and, in some cases, threaten the child's life. [ 8 9 ] The incidence and prevalence of conditions causing visual morbidity varies widely across the world [ Table 1 ]. [ 10 ] Unfortunately, the available data on pediatric vision impairment and blindness in India are not broad-based or robust enough to generalize and make firm recommendations.…”

“…Current guidelines are based on the available evidence and preferred practice recommendations of expert committees. [ 8 9 10 ] Primary care providers (pediatricians) should perform a basic eye screening of newborns. [ 8 9 10 ] Risk-based screening for retinopathy of prematurity, congenital anomalies, and retinoblastoma in the immediate post-natal period should be conducted by an ophthalmologist.…”

“…[ 8 9 10 ] Primary care providers (pediatricians) should perform a basic eye screening of newborns. [ 8 9 10 ] Risk-based screening for retinopathy of prematurity, congenital anomalies, and retinoblastoma in the immediate post-natal period should be conducted by an ophthalmologist. [ 8 9 10 ] Pre-screening history should include the following questions: (1) Do your child's eyes appear unusual, (2) Does your child seem to see well, (3) Does your child exhibit difficulty with near or distance vision, (4) Do your child's eyes appear straight or do they seem to cross, (5) Do your child's eyelids droop or does one eyelid tend to close, and (6) Has your child ever had an eye injury.…”

“…[ 8 9 10 ] Risk-based screening for retinopathy of prematurity, congenital anomalies, and retinoblastoma in the immediate post-natal period should be conducted by an ophthalmologist. [ 8 9 10 ] Pre-screening history should include the following questions: (1) Do your child's eyes appear unusual, (2) Does your child seem to see well, (3) Does your child exhibit difficulty with near or distance vision, (4) Do your child's eyes appear straight or do they seem to cross, (5) Do your child's eyelids droop or does one eyelid tend to close, and (6) Has your child ever had an eye injury. [ 8 9 10 ] Screening of infants under 6 months of age comprises of red reflex testing to detect abnormalities of the ocular media, external inspection of ocular and periocular structures, pupillary examination, and assessment of fixation and following behavior.…”

“…[ 8 9 10 ] Pre-screening history should include the following questions: (1) Do your child's eyes appear unusual, (2) Does your child seem to see well, (3) Does your child exhibit difficulty with near or distance vision, (4) Do your child's eyes appear straight or do they seem to cross, (5) Do your child's eyelids droop or does one eyelid tend to close, and (6) Has your child ever had an eye injury. [ 8 9 10 ] Screening of infants under 6 months of age comprises of red reflex testing to detect abnormalities of the ocular media, external inspection of ocular and periocular structures, pupillary examination, and assessment of fixation and following behavior. [ 10 11 ] Findings that would warrant referral of children to an ophthalmologist for a detailed eye examination following screening are listed in Table 2 .…”