Oooh Baby, baaby…
Oooh Baby baaaby…baby, baaaby….Push it. Push it good. Oooh…Baby baaaby. Yup, got my grove on (in my mind). Who remembers the group Salt N Pepa? Yes, I’m going back to the 80’s…girls with big hair, Miami Vice, OP shorts, Member Only jackets…glad that era is over. Almost as bad as the disco 70’s. But I digress.
Babies. Just how do we check babies and those little kids eyes?
Well, it’s not easy. It helps to be quick, creative and sometimes a goof ball to get their attention and help them not be scared.
When we check little children’s eyes, we are looking for three main things:
1. Clear vision in each eye
2. The eyes are aligned straight ahead
3. The ocular health is normal.
While we often can’t be as detailed in the exam data as an adult, we get what information we can.
To determine if the child is seeing clearly, we shine a light streak at the pupils which gives us a red reflection, much like that of a bad photograph where someone’s pupil has got a red reflex. By moving the light streak in different directions, we can use that red reflex to determine the refractive power of the eye and thus what power of glasses they would need. If they are old enough to sit for it, a computerized machine called an auto-refractor can read the approximate power of the eye within seconds. This gives us a second opinion from the manual method. So if the child is handicapped, won’t speak or too young to respond to questions, we can determine very closely what the refractive status of the eyes are without them saying a word. When the two readings are close, especially with the help of eye drops that make the focusing system of the eye relax, we can be assured the refractive status of the eye is determined accurately. That is how we know often times if a child is trying to fake a vision problem.
We usually use pictures instead of letters if they are old enough to speak to help determine what their visual acuity is on the eye chart. A spinning hand held drum with alternating black and white lines can be used also to get a gross screening of what an infant is capable of seeing.
To determine if the eyes are straight, we cover and uncover the eyes back and forth to see if the covered eye moves to look at a target when the eye is uncovered. This is called the “Cover Test.” We also can shine a flashlight toward the eyes and look at the reflection off of the corneal surface and compare it to the pupil location and with the other eye reflection to look for symmetry. If the reflection differs in one eye, it usually because one is turned a certain direction. We also use a 3D picture the child looks at with special polarized glasses that makes the picture seem to be floating in the air if they have good stereopsis or depth perception. If there is an eye turn, usually their depth perception is weak.
Finally, to determine the eye health, we look inside the eye as much as possible. We try to utilize eye drops that make the pupil dilate and increases the view inside with our special equipment. At the very least, a good bright red reflection should be coming out of the child’s pupils from the light. If there is not a good red reflection or especially a white color coming from the pupil, that could indicate a serious eye problem that should be checked immediately by an eye doctor.
I recommend an Optomap Retinal scan be performed on everyone, every year to help see a more complete view of the retina inside the eye. Even retinal specialists can overlook small things that an Optomap can bring attention to. It was developed by a Scottish engineer whose 5 year old son had a retinal detachment that was not seen by regular means until it was too late. Many kids even as young as 2 or 3 years old can often have an Optomap picture taken to see almost the entire back of the eye at one time.
If there is a suspicious finding and the child is just too young or too uncooperative, they can be sedated slightly with medicine that makes them sleepy and just not care or even totally sedated if needed for a more thoroughly internal eye examination.
Since the nerves from the eye to the brain quit developing by age 7-8 years, we want to make sure children are seeing clearly well before that age. Ideally, children should have an early childhood, wellness eye exam to look for any abnormalities that could affect the eyes development by ages 3-4. Now with Obamacare, children under the age of 18 are mandated to be covered by a yearly vision exam as a routine procedure. Check with your insurance provider for specifics.
Don’t assume those big, bright baby eyes are seeing perfectly. Often the problems are subtle and hard to tell they have a problem. The child certainly doesn’t know any difference. We need to correct those problems as early in life as possible so they can develop clear, comfortable, binocular vision at all distances they are looking at by age 7 or 8. Especially when they look at your old high school yearbook and laugh at your big hair and Madonna outfit.
Don’t gamble with your children’s eyes. Start checking their eyes by 3-4 years old. Schedule your kids for an eye exam today.
Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry. Serving the Dumas, Texas, Moore County and upper Texas Panhandle area for 23 years. Call (806) 935-2020 for appointment or visit our optical gallery without an appointment. Visit our website www.visionsource-dumas.com for more information. Like our Facebook business page: Dumas Vision Source and you can also connect on Twitter @eyedocdumas
Tory Moore, OD – “A Hometown Eye Doctor You Know and Can Trust!”