Visual Development in Childhood

Question 1

Growth of eyeballs

Answer 1

75% adult size at birth
Most growth in the 1st year
Full size at 13 years

Question 2

When should you start measuring vision?

Answer 2

In infancy
By the time of first well baby check and definitely the first immunization at 2 months you should be convinced the baby can see
Formal exam at 3.5 years

Question 3

3 tests to do during an eye exam in young kids

Answer 3

Red reflex
Corneal reflex
Cover test

Question 4

Cover test

Answer 4

Testing for strabismus
Cover normal eye, the abnormal one will move back into a normal position
Seeing this shift means there is strabismus

Question 5

What does the
1. Numerator
2. Denominator
mean in 20/20

Answer 5

1. What the patient sees

2. What the average person sees

Question 6

What is

1. Myopia
2. Hyperopia
3. Astigmatism

Answer 6

1. Nearsighted
2. Farsighted
3. Different focal points because eye is shaped like a football

Question 7

2 things to reduce the progression of myopia

Answer 7

Outdoor play

Lose dose atropine

Question 8

Strabismus

Answer 8

Misaligned eyes
Loss of binocularity
Loss of depth (stereopsis)

Question 9

Pseudoesotropia/ pseudoexotropia

Answer 9

Looks like eso/exotropia but when you do the corneal light reflex the light is straight so it is normal
Refer if in doubt

Question 10

Infantile esotropia

Answer 10

Documented by 6 months
More common if there is a neuro history
Cross fixation
Alternate which eye is focused on an object
Can get nystagmus
Usually a larger deviation
Treat with early surgery

Question 11

Accommodative esotropia

Answer 11

Presents between 6mo-7 years
Intermittent esotropia initially
Treat with glasses
Surgery if there is still residual deviation

Question 12

Intermittent exotropia

Answer 12

< 5 years old
Is worse with fatigue, more in the distance, eyes close in the sun
Don’t always need to treat
But treat with glasses, surgery, patching

Question 13

Amblyopia

Answer 13

“Lazy eye”
One eye has worse vision than the other
Causes: strabismus, anisometropia, ametropic, visual deprivation
Little functional disability
Treatment can be stressful
But there is a risk of vision loss in good eye and reduced stereo
Usually preventable or reversible with timely detection and intervention

Question 14

Treatment of amblyopia

Answer 14

Make the amblyopic eye work harder
Fix any defect
Patching
Blurring with drops or lenses