Examining children, particularly young children, demands a different approach to collecting data than you would take with an adult.
You need to do as much objective testing as possible when it comes to children.
Although we typically test visual acuity using the Snellen chart, if a child is too young to know letters, it’s time to try something different.
For a child ages 3 and up, you may have better luck using charts with LEA symbols from Good-Lite Company. LEA symbols, the standard of care for this age group, are available in several formats. These include distance LEA charts that you can hang on the wall or have an assistant hold. There are pocket near cards and near charts that are larger and have a working distance measuring cord attached. The LEA sets come with matching cards that children can point to so that they do not have to verbalize anything if they choose not to.
Another useful test is the Broken Wheel Test from Bernell. On this forced choice test, Landolt “C”s represent the tires of a car. You hold the cards at 10 feet from the patient, who must choose which car has the “broken wheel.” Because there are only two choices, the child can choose rapidly, and you can quickly go to cards that represent lower acuity values. This test can be useful even for children as young as age 2.
For younger children, you may use the more portable version of the research standard of Teller Acuity cards, with options such as Patti Stripes Square Wave Grating Paddles from Precision Vision or LEA Grating Paddles. The premise of these tests is that children will choose to look at a striped pattern if they can see it rather than a gray background.
Most options for testing stereo acuity in children are portable. These include the Stereo Acuity Fly or Stereo Acuity Butterfly, Stereo Smile Cards or Stereo Optical’s Randot Preschool Stereotest. For children who do not want to put the stereo glasses on, the Lang-Stereotest is a favorite.
No test is more important for a pediatric exam than retinoscopy. Loose trial lenses can be used, or Sciascopy Bars Lens Racks are a great way to unobtrusively perform retinoscopy quickly and accurately.
I would stay away from handheld autorefractors for this age group, but if you are considering using one, the Retinomax handheld autorefractor seems to work well at least for collecting the correct axis for astigmatism.
There are two good options for checking intraocular pressure in children. You may use the Tonopen, which requires the use of anesthetic, or the ICare Tonometer, which does not.
For assessing the anterior segment, you probably want to use a handheld slit lamp. You also can get great magnification and a cobalt filter with the much less expensive option of using a Burton Woods Lamp. Traditional binocular indirect ophthalmoscopy with a 20.00D lens is always portable, but if you need magnification, your portable ophthalmoscope will give you all you need.
Christine Allison, OD, FAAO, FCOVD, Diplomate American Academy of Optometry, FNAP, is a professor and coordinator of the Pediatric Residency Program at Illinois College of Optometry.
WHERE TO FIND IT:
800.348.2225 | Bernell.com
800.362.3860 | Good-Lite.com
888.422.7313 | Icare-USA.com
815.975.3999 | Precision-Vision.com
800.344.9500 | StereoOptical.com