American Academy of Pediatrics, the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus all recommend examination of the eyes of a newborn. Vision testing of newborns is heartily endorsed by these organizations. Up to Date reminds us that newborns and infants see a very different world than toddlers and older children because the retina, optic nerves and visual cortex are immature at birth. Vision assessment must be geared to the infant's developing abilities.
Recommendations
The American Academy of Pediatricians recommends that pediatricians learn the ocular history of the parents so as to be aware of any potential problem. The doctor should assess the newborn's vision and perform an external inspection of the baby's eyes and eyelids. Additional tests should be performed as the baby gets older.
Technique
Vision assessment in children under three is difficult because conventional eye tests such as a letter chart are not appropriate for this age group. The American Academy of Pediatrics recommends looking to the baby's ability to focus upon an object and track it. This is a three-step assessment: The baby should be able to focus on an object, maintain the focus and follow the object when it is moved. The baby should be able to do this with each eye, and with both eyes together.
Issues
If the baby cannot focus and track an object using both eyes by three months of age, the American Academy of Pediatrics suggests that there may be "significant visual impairment," possibly involving an eye or brain abnormality. They recommend that pediatricians refer such children to a pediatric ophthalmologist.
Technological Advances
The April 10, 2009, issue of "Science Daily" reports on a technique for assessing infant vision. Brain waves of infants are monitored while the baby is shown a series of moving lines. The brain activity of healthy babies shows a predictable pattern when the baby's eyes focus upon the moving lines. Developed at the Smith-Kettlewell Eye Research Institute in San Francisco, this technique is good for detecting amblyopia--also known as "lazy eye"--that often develops in babies that have broken blood vessels in their eyelids.
Child Abuse
Infant vision testing is important because it can reveal child abuse. Shaken baby syndrome produces external eye trauma and retinal trauma. According to the American Optometric Association, violent shaking causes retinal hemorrhage.
References
- American Academy of Pediatrics: Eye Examination in Infants, Children, and Young Adults by Pediatricians
- American Optometric Association: Pediatric Eye And Vision Examination
- Science Daily: Test Allows Early Detection Of Vision Problems In Infants With Hemangiomas Of Eyelids
- Up to Date: Visual Impairment
