Amelie was born 6 weeks premature.  She was born with a congenital condition known as choanal atresia.  The back of the nasal passage is blocked with abnormal soft tissue or bone which is formed during fetal development.  This can be a very serious condition disrupting oxygen to the baby in the critical time after birth.  Affected babies may require post delivery resuscitation, a temporary catheter to open the airway, or emergency surgery to correct the defect.

Of significance in the infant vision assessment are infant attentiveness (cognitive function), eye motor development, eye alignment, eye and motor function integration, and eye heath issues, specifically coloboma which frequently accompanies this condition.

Amelie was one of the best experiences we have ever had examing young infants.  She was a happy baby, curious and exploring everything - with hands and feet!  She was engaged in every test we performed.

Visual acuity:  Amelie maintained fixation and eye contact on the examiner, she was able to fix and follow equally with each eye, there was no objection to occlusion, and she did equally well with each eye with prefential looking paddles.

Ocular motility:  Eye rotations were full and smooth in each eye.

Eye alignment:  Eyes were aligned with normal Hirschberg reflexes, absence of Bruckner's reflex, a normal cover test and proper nearpoint convergence.  There was no reliable data on the 10 prism dioptor vertical prism test.

Visual field:  The visual fields were normal in each eye by gross confrontation testing.

Pupillary reactions:  Pupils were of equal size with equal responses to light and accommodation.

Refractive status:  Distance retinoscopy, nearpoint retinoscopy, and cycloplegic retinoscopy all yielded an astigmatic prescription. 

OD  PL - 1.50 X 045  OS  PL - 1.50 X 135

 External eye health was normal.  Absence of iris coloboma.

Internal eye health:  (dilated fundus exam with 1% Tropicamide):  Clear mediae, healthy optic nerve heads with good pink color, healthy normal vessels, healthy dry maculae, no peripheral retinal disease, absence of coloboma.

Conclusion:  Amelie shows no ill-affects of the potential effects of oxygen deprivation that can occur post birth with choanal atresia.  She is still at high risk and does exhibit a significant refractive error, so after the usual discussion of interacting with the baby to help vision skills development, we recommended that Amelie be seen again as a follow up in six months or sooner if any concerns arise.

Normal Hirschberg reflexes, absence of Bruckner's reflex in each eye, and absence of refractive crescents in each eye.  The left photo is axis 180, the right image is axis 090.

These photos yield the same results as the non-dilated eyes.  The left photo is axis 180 and the left is axis 090, both dilated/cyclopleged wioth 1% Tropicamide.