Orthoptics Awareness Week is taking place between 1-5 June with the theme ‘Seeing the future’. This third article in a five-part series, authored by Queensland paediatric orthoptist FAREN WILLETT, discusses unique ways to test children’s vision.
“I don’t know what my child can see. How do I know?” is a question many orthoptists have encountered before.
Fortunately, for us, it’s child’s play – but the difficulty lies in that no two kids are the same, so how is this overcome? Some attention to detail, a lot of adaptability and endless patience. Imagination is another key factor, hence why it is one of four core values at the Queensland Children’s Hospital.
Children learn through play, and now we are testing through play.
The first step is creating the vibe. The space needs to be upbeat and light. The children’s eye clinic in any Australian hospital is abundant with bright colours, stickers on doors, toys in the waiting room and art on the wall.
Once they are in the door, interaction is imperative. This is where adaptability is essential. From a young age each child develops their own personality and it is important to constantly take notice of what seems to interest them and scares them. It quickly becomes clear which children the professional will have limited time to assess, and those who need time to break down the wall.
An orthoptist’s experience and attention to detail are crucial because, with the smallest mistake, one can lose the child’s cooperation. However, the smallest eye movement can provide all the necessary information. It’s a constant balance between speed to maintain interest and rechecking to ensure the deducted information is accurate.
There are a variety of ways to test children’s depending on what we want to know and what level the child is at.
Does a baby react to light, or is it focusing on mum’s face? Is it following large toys or small toys? Can they find little sprinkles in your hand? As the age increases, it’s important to reduce the stimulus size. It needs to be age appropriate, keeping in mind children’s vision develops until age seven.
Eye preference and preferential looking is the next step and orthoptists have a heavy artillery here – but the concepts behind them are simple. We should be happy to use each eye equally and instinctively look towards a picture that is more interesting to us.
Eyes should see equally well. If this isn’t the case, the professional can tell by covering an eye. If a good eye is covered, leaving the child with a poorly seeing eye, a child will understandably be upset.
Occlusion itself tells a lot about vision but it’s also important when it comes to documenting more exact vision in older kids. There are many ways of occluding an eye. Perhaps mum has glasses so little Sophie wants to wear the occlusion glasses too. Johnny tries to peek but loves pirates so let’s use a pirate patch. But Jimmy is always ripping it off, so we try the stick-on patch. Little Suzie however will only stop crying if we use mum’s hand but Sarah is independent and wants to cover her eye all by herself. But jeepers creepers, watch out for those peekers!
Matching games are the next step. By displaying a picture at a distance and having the child verbalise or match, it will let you know if they can see it. This is how we quantify children’s vision in the clinic, but this can be done from home. It’s a great way to get kids comfortable before coming to clinic. The picture is moved further away and checked with each eye independently.
These games can be turned into competitions. A wand’ can be used as a pointer. And what can you win? Stamps! That big dinosaur sticker! And on occasion we see parents offering almost anything, once I even heard a pony was up for grabs (although we do not endorse this).
Many granddads also show the pinhole trick. By making a fist with their hand and peaking through the hole, their vision improves. This is science, not magic – and something we utilise frequently because of the insight it gives into the visual potential.
There is more than meets the eye when testing children’s vision. And we haven’t even entertained other modalities we check on a routine paediatric eye exam, how well the eyes work together, depth and colour perception, eye movements, the need for glasses and the back of the eye check.
Orthoptists are the ideal profession for this because they have these skills and experience to perform the tests and the understanding of visual responses to determine what it really means, what is relevant and what is simply being a kid.
ABOUT THE AUTHOR: Faren Willett BSc, MOrthop, is a paediatric orthoptist who works at the Queensland Children’s Hospital.