Case #1 The Infant Assessment
This initial case study is of a routine Infant Vision Assessment. Slightly less than 90% of all infant vision assessments exhibit a flow and findings similar to this one.
Gayle had a family history of an uncle with albinism. He had to "wear a patch" which is suggestive of possible amblyopia (lazy eye). Eye health and identifying risk factors for amblyopia are two of the most important goals of the Infant Vision Assessment.
Her personal history was unremarkable. She was a full term baby, she was born C-section but no complications were involved, and she was of a normal birth weight.
Gayle presented as a happy, fully cooperative baby - with beautiful hair! She had a big smile and enjoyed her vision exam.
Visual acuity: Gayle made consistent eye contact with the examiner. She was able to fix and follow targets of various sizes and colors. She exhibited no objection to occluding either eye. She was able to follow preferential looking paddles with either eye.
Ocular motility: Gayle accurately followed a finger puppet fully in all directions of gaze. She maintained interest and consistent fixation.
Eye alignment: Gayle's eyes were properly aligned by both the Hirschberg Reflex and the absence of Bruckner's Reflex (see photos below). She maintained fixation and alignment on the convergence nearpoint test. She exhibited a positive reaction to the 10 prism dioptor vertical prism test by alternating fixation up and down on the diplopic targets created.
Visual field: Full in each eye by gross confrontation.
Pupillary reactions: Equal and brisk.
Refractive status: Distance retinoscopy indicated equal reflexes with a refraction in the +0.25 to +0.50 range. Nearpoint retinoscopy was consistent and equal with against motion appearing at about 9 inches and release of focusing at about 11 inches. Cycloplegic retinoscopy indicated +0.75 sphere in each eye.
External eye health: Normal - see photo
Internal eye health (dilated fundus exam with 1% troicamide OU): Clear mediae, healthy, well defined optic nerve heads, well pigmented fundus with a healthy, dry maculae with foveal reflexes noted in each eye, normal vessels, and no peripheral retinal disease.
As a conclusion to this visit we offer material on how involved parents are key to continued development of their baby's vision skills to ensure preparedness for future education and vocational success. OEP's Help Your Baby to See Better and AOA's Your Baby's Eyes are given to the parents. We also inform the family when the next comprehensive eye health and vision examination should be done - in this case at age three.
This is the easy one. Watch for the next on-line case to increase your knowledge and skill
The photo to the left is taken axis 180, the photo to the right is taked axis 090. Each photo shows a Hirschberg reflex slightly nasal to central indicating normal eye alignment. There is also no Bruckner reflex.
The above photorefractive pictures are post dilation/cycloplegia with 1% Tropicamide in each eye. Note the larger pupils. Also note the thin yellow cresent in the bottom of the first, axis 180 picture. This represents a low, +0.50 to +0.75 hyperopia (farsightedness). The thin yellow crescent in the second image represents the same hyperopic condition in axis 090.
We use these images for case presentation of each infant and toddler seen in our office. Parents can see their children's vision problems just as the examining doctor can.