Vision Screening and Ophthalmic Evaluation

Since the eye structures and ophthalmic needs of children differ greatly from those of adult, early diagnosis and treatment are of great importance. Untreated eye problems may cause impairment of the child’s normal development, school performance and social interactions and affect entire life of the child. Most of the eye development occurs in early childhood. The refractive state of the eye changes as the eye’s axial length increases and lens and cornea flatten with aging. These processes called emmetropization. Retinal vascularization begins at the optic nerve head at 16 weeks of gestational age and reaches the temporal ora serrata by 40 weeks of gestational age. For this reason, in premature newborns, the retina is not fully vascularized at the time of birth and there are peripheral avascular areas depending on the gestational age. Because it helps identify possible causes of the problem, the child’s visual, prenatal, prematurity history and systemic abnormalities should be checked. Infants with family history of strabismus, congenital glaucoma, congenital cataract and known risk factors for retinopathy of prematurity should be referred to an eye care specialist. Pupils are usually miotic in newborns and the pupillary light reflex is not reliable until 30th gestational age. Relative afferent pupillary defect (RAPD) may be seen in some retinal disorders and optic nerve lesions like glaucoma, optic neuritis, anterior ischemic optic neuropathy. The child’s vision assessment can be made by evaluating fixation and follow behavior, preferential looking tests and visual acuity chart. Searching eye movements, eyepoking, nystagmus and poor light reflexes may demonstrate poor visual development of an infant.