I remember (not so very long ago!) being asked several times by my clinic manager if as an Optometrist I would fit in an extra appointment to see a child as “They don't take very long”.
It is an interesting thought. Why would it not take as long to test a child as an adult? A child has small eyes but still has two of them. A child still suffers from headaches and all the other symptoms that an adult may have. A child still has to be able to see in the distance and actually more importantly, see clearly and binocularly close up. Surely a child`s eye examination should take exactly the same time as an adult`s?
What can you skip in a child`s eye examination to make it faster?
I feel as a profession we let down a lot of children by not giving each child a thorough binocular vision assessment at near each and every time we see them. The point being that as they grow and mature the state of their ability to cope with a binocular vision issue at near changes. I also do not believe that a quick cover test at near is enough to tick the box for having completed a comprehensive binocular vision examination. It is merely the start…..
What would I like to see being performed for a near vision assessment for a child?
Firstly, give them a reading chart and see how they get on with both eyes initially and then cover each eye in turn to see if it makes it easier.
Next (and in no particular order), perform cover test, near point of convergence, accommodative ability both monocular as well as binocular, stereopsis, near Mallett test, dynamic retinoscopy, Brock string.
Look up Brock string on You Tube video below. Watch right to the end of the video. Yes, you can train eyes but it is a really good way to look at near binocular vision in the real world without visors. First, check that they only see one close up bead, it is amazing how much near diplopia this uncovers, far more than a normal push up convergence test. Then ask how many strings they can see, again, I am amazed how much suppression goes on undetected. Ask if the strings are equally clear, if not it indicates a mild suppression. Ask if the strings are level, one higher indicates a hyperphoria. Ask if the strings cross at the bead they are looking at. If the strings cross in front there is an esophoria present, if the strings cross behind there is an exophoria present. What fantastic binocular vision tests from a piece of string and three beads!
My main point, do not rush through a child`s eye examination. They deserve as much attention to detail as the grown ups!