An introduction to Paediatric Optometry

1. Paediatric optometry

Optometrists play a pivotal role in the assessment, diagnosis and management of paediatric vision and eye health in Australia. Early detection is key to the prevention of vision impairment associated with refractive error or ocular disease.

According to the national Eye Health report (2008), about one in six 10-14 year olds wear glasses or contact lenses to correct sight. Furthermore, Optometry Australia reports that one in five children in Australia suffer from an undetected vision problem or require ongoing assessment. This stresses the importance of regular, routine eye exams for children. In line with this view, Optometry Australia recommends having a full eye exam before starting school and regularly as they progress through school.


An important dogma in the field of health is understanding that healthcare is deeply driven by the ethics of shared responsibility of care, thus emphasising the need for appropriate referrals to and collaboration with other professionals, within the field of health (allied health) and beyond. 

2. Paediatric Examination 

The information herein is current as at the time of publication. Readers and students should refer to the most recent evidence-based publications and research as a guideline for clinical practice and management.

Careful consideration of a child’s age and development plays a major role in determining the appropriate test selection. The following is a standard testing protocol according to Optometry Australia’s clinical practice guide outline (2016):
-       
            a) History
-          b) Visual acuity
-          c) Refraction
-          d) Binocular vision testing
-          e) Stereopsis
-          f) Colour vision assessment
-          g) Ocular Health assessment

A note on 'History':
A thorough history is pertinent to understanding the needs of the patient which will ultimately drive testing and mangement. Typically (but not exclusively), this will involve: establishing and exploring the presenting complaint, patient ocular history, family ocular history, general health and developmental history.

A questionnaire filled out by the patient’s parent &/or guardian can facilitate for a more thorough assessment. An example of a typical questionnaire is provided at the end of this page.

Important Developmental Milestones
·         2mo: can hold head up (05-2m), begins to follow things with eyes
·         4mo: brings hands together in midline (2.5 months, 4 months), begins to smile at people (0-3m), enjoys eye contact (0-3m)
·         6mo: looks towards person talking to them (3-6m), laughs (3-6m), bangs objects together (3-6m)
·         9mo: rolls both ways (6m, 8.5m), sits well (6.5m, 8m) explores caregiver’s face, searches for hidden toy
·         12mo: crawls (9m, 11m), babbles (6-10m), can play peek-a-boo (9-12m), capable of imitating/clapping/representational behaviour (bye-bye) (9-12m)

 Reference: (Dosman, Andrews, & Goulden, 2012)


The following tables (from Optometry Australia, Paediatric clinical guideline) lists the tests available to each age group.







Resources

 The following are useful links & resources regarding the examination of children:


Paediatric History Questionnaire

Example Questionnaire. For educational purposes only, not designed for comprehensive assessment
All questions contained in this questionnaire are strictly confidential and will become part of your medical record.




References

Australian Institute of Health and Welfare website https://www.aihw.gov.au/reports/children-youth/eye-health-australian-children/contents/summary / Accessed April 2020
Dosman, C. F., Andrews, D., & Goulden, K. J. (2012). Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health, 17(10), 561-568. doi:10.1093/pch/17.10.561
Optometry Australia website https://www.optometry.org.au/ Accessed April 2020