The Smart System PC-Plus by M&S Technologies holds a young child’s attention, making testing much easier.

Follow these steps to make the biggest impact on your smallest patients during their exam.

I’ll never forget the time I opened the door to the exam room to see a 2-year-old fall on the floor in her effort to back away from me. She was an aphake and therefore had reason to be nervous around doctors. Such a response, however, did not instill confidence in me””a resident just two weeks into her pediatric specialization. To avoid these situations, and to promote a happy and productive experience for the child, the parent, and the ECP, there are a few steps you can take.


  • Introduce yourself to the child first, then ask who is accompanying her to the appointment. This gives the youngster a feeling of control and also allows you to identify the people in the room without making an embarrassing mistake. Who among us hasn’t confused Mom with Grandma?
  • Explain each step of the exam, demonstrating on the accompanying adult if the child seems nervous.
  • Ask the child if she has any questions about her eyes. This brings the focus of the exam back to her and gives Mom or Dad a chance to collect their thoughts before asking them the same question.


  • When performing near tests choose targets that are detailed and appealing. I like Lang fixation cubes (available from multiple companies) because it’s easy to switch the picture if the child becomes disengaged. Finger puppets also work as they are easy to hold a child’s interest.
  • When performing distance tests, I use video clips on the Smart System PC-Plus from M&S Technologies. If a younger child is distracted, I’ll have a staff member hold an interesting toy or make faces.
  • When performing cycloplegic retinoscopy (critical for determining refractive error), I’ll often talk to the child so he’ll focus on my face, or sing a song. You can also have a staff member stand behind you with a toy that makes noise or flashes.
  • For acuity testing, it’s worth investing in age-appropriate tests such as LEA or HOTV and lap cards for matching (preloaded onto the M&S system or via Good-Lite). I’m a fan of the M&S Technologies system as it provides unlimited randomized acuity lines””important for amblyopes who quickly memorize lines on a standard projector chart. Lap cards can allow for acuity testing in children as young as age 2, and it’s much easier to convince parents to follow through with patching if you can demonstrate concrete acuity improvement.
  • Trial lens sets and child-sized trial frames help keep a child engaged during best-corrected acuity testing. This is particularly important when you’re going for initial acuity on an amblyope young enough to get lost behind the phoropter.


  • Identify the testing that is most critical for each case and consider doing these tests first. When working with children, time and cooperation are often finite resources and you don’t want them to run out before you check alignment in a patient presenting for strabismus evaluation.
  • If the exam takes a turn for the worse or starts out poorly, remember to relax. You can always have the child come back for additional testing.

The right tools and attitude are sure to make pediatric eyecare a rewarding part of your practice and provide quality service to these special little patients.

Amanda Huston is an optometrist specializing in pediatric and family eye care at Children’s Eye Physicians/Stapleton Family Eye Center in Denver, CO.


Good-Lite •847-841-1145 •good-lite.com

M&S Technologies, Inc •877-225-6101 •mstech-eyes.com


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