This is performed by assessing the following three components: 1) Is the corneal light reflex central (C) and symmetrical in both eyes? 2) Is fixation steady under monocular conditions i.e. In preverbal or nonverbal children VA can be assessed using the central, steady, maintained (CSM) method ( 6). Other parts of the ocular exam, however, can be performed such as red reflex and external ocular exam. Assessment of VA cannot begin prior to 3 to 4 months of age as the fovea has not completely matured ( 3). Vision assessment in children will vary based on age ( 1). To begin, questions on history such as ‘Is your child able to reach out to or grab objects?’ or ‘Does your child bump into walls?’ can help assess any concerns with vision or stereopsis. Any abnormal finding(s) should be referred. Look for asymmetry, identify any surface irregularities such as lumps and bumps, and help diagnose any sight-threatening disorders such as congenital glaucoma (i.e., corneal clouding, epiphora, buphthalmos ) and amblyopia (caused by sensory deprivation, i.e., ptosis or cataract). Use a light source to examine various parts of the eye including eyelids, orbit, sclera, conjunctiva, iris and cornea.
The ocular exam should be performed in reverse order of the mnemonic (as listed below) to have the components of the exam with light sources directly aimed at the eye performed last (i.e., external ocular examination first and pupils last). Note: The mnemonic is simply an aid to remember the essential components of a paediatric screening exam. For instance, if a toy is being used as the fixation target, make a story related to it (i.e., “Look it’s Dora, where is she going?”). Ensure they are in the room and able to comfort the child.īe creative, playful, and make the exam fun. The chances of finishing the screening will be less once the child starts crying. Thus, it is important to finish the exam efficiently. Generally, large, bright toys or videos of the child’s favourite show on a phone or tablet work well.īe quick! Children have short attention spans. Children are often uncooperative and have a difficult time fixating. Please refer to the online version of this document for a video explaining the five steps to paediatric vision screening. It is intended for residents and staff physicians in various settings (i.e., emergency department, family medicine clinic, paediatrician’s office) to identify any vision threatening conditions, and make appropriate and timely referrals. The objective of this article is to provide a quick and straightforward approach to paediatric vision screening with practical tips that are easy to remember using the mnemonic PROVE. Further, evidence suggests that medical graduates do not feel adequately trained or comfortable performing ocular examinations ( 4, 5). Recent studies suggest that the prevalence of poor vision in the Canadian elementary school population is at least 16.1% ( 3). Untreated visual abnormalities in childhood cause permanently reduced visual acuity (VA) (amblyopia) ( 2). Over 80% of a child’s learning is based on vision, and good vision is crucial for both physical and emotional development ( 1). Paediatric vision screening is an important component of well-child visits to detect and refer vision threatening conditions.
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