Children's eye examination lasts two hours and includes:
- assessmentof visual acuity at near and far distance
- tests for strabismus and stereopsis
- dilatation of pupils and assessmentof objective diopter
- full examination of the anterior and posterior ocular segment.
Methods for assessing visual acuity are different depending on the age of the patient. When assessing baby’s special cards with patterns are used with which one can determine what size of the sample raises the baby's attention and the result is compared with the expected results prescribed for a certain age.
For preschool children little symbols (Lea symbols) are used which are regulated by the same geometrical progression as characters for adults. In order to get more accurate resultsit is necessary to examine the child's ability to recognize the little symbols at near and far distance. The same tables of letters are used for school-age children and adults.
Download here Lea symbols for printing and exercise
Taking the orthoptic status (examination for strabismus) is also a necessary part of the child’s examination, and is necessarily performed for adults who have strabismus. It serves to assess thepresent situation and adequate mobility as well as cooperation between both eyes. In this partof the examination, we measure the deviation angle, determine the type of strabismus and disorders of binocular vision (whether the child has the ability to use both eyes together while watching), amblyopia (lazy eye), and nystagmus (wobbly eyes). The development of stereopsis (3D vision) is established using stereo tests (Titmus test, Lang test). In children or adults who have nystagmus (wobbly eyes) in this part of the examination additional measurements are carried out.
The procedure of assessingthe objective refractionof the child is somewhat different than in adults because of strong adaptability (accommodation) of the children's eye that sometimes easily conceals even greater diopters. To exclude this adjustment, it is necessary to widen the pupil, which is achieved by putting in eyedropsseveral times, and the entire procedure takes about an hour. It is advisable to prepare children at home for the fact that drops will be putinto their eyes and that they will have a blurry visionafter the examination (lasting for a few hours to a full day). After the pupils have fully dilatedthe objective assessmentof the diopter is done - retinoscopy, extremely important for assessingpossible hidden diopters or other visual disturbances. Althoughthe cooperation of the child is necessary to determine visual acuity, objective diopter can be determined even for the smallest child because it does not require itscooperation.
To assessthe objective diopters in children we use specially adapted children's refractometer Plusoptix.
The anterior eyesegment is examined on a split lamp with a microscope to rule out signs of inflammation, allergies and any anatomical abnormalities. The examination of the the posterior eyesegment (retina) is done in order to thoroughly examine the eye.