There can be no doubt about the importance of surveillance for visual defects in children. Controversial points concern the age at which surveillance is required. Particular attention is paid to vision surveillance where there has been a risk factor –
- A relevant family history
- A virus infection in pregnancy
- Ophthalmia in the newborn or the finding of hydrocephalus
- Mental backwardness
- Cerebral palsy
- Major congenital abnormalities
The eyes of the newborn are inspected for an opacity (which may be due to cataract or retinoblastoma), a fixed squint (which could be due to retinoblastoma, which is treatable) and for nystagmus, which usually denotes a defect of vision.
Simple tests include blinking when a bright light shines in to the eye, eye fixation and eye-following of a bright object or a flashing light. More sophisticated tests include that for optokinetic nystagmus when the baby watches the rotating striped drum and after 2 months, visual evoked potential.
After the newborn period surveillance, there always is inspection for strabismus, using the cover test, symmetry of reflection of a light on the eye and a test for eye movements. Whenever a parent suspects a squint, whether it is thought to be intermittent or continuous and especially if there is a family history of a squint, the eyes should be examined immediately. It is most important that a squint should be treated early to prevent suppression of vision in the squinted eye.
When there is a relevant history or suspicion of a visual defect, the ophthalmologist is consulted. They will examine for amblyopia and for refraction defects causing astigmatism, myopia or hyperopia.
However, it is difficult to test accurately for visual acuity under the age of three. But, medical intervention should never be compromised and the child should be taken for seeking immediate assistance.
Written By: Dr. Harman
Edited By: C. Soni