For a baby, the eye exam starts the moment the doctor walks into the room: The clinician pays close attention to the baby, watching the child as they look at the doctor, look at their parents, shift their gaze around the room, etc. Even at three months of age, a baby should be able to track an object up to 10 inches from them; if not, there may be an indication of a neurological deficiency. The best time to do an infant eye exam is first thing in the morning, when the baby is wide awake, fed and ready for their day.
Visual attention is an important cue and the baby should be able to follow an object or person moving around the room. In our class, the babies were six months and six weeks of age, and I can imagine that their attention was difficult to monitor with all the faces in the class looking at them. Watching the baby track an object, such as a bottle or rattle, is very important. Because a baby is a non-verbal patient at this point, the parents will become the key source of information and will usually notice if something seems not quite right; most commonly they’ll notice either an eye turn, or that the eyes aren’t tracking objects well.
How a baby’s vision quality is assessed
The traditional procedures for determining visual acuity can’t be used on a baby for obvious reasons–they can’t exactly tell you which one is better? One or two? An interesting way the profession has gotten around this is through the use of Teller acuity cards. The card has two sections: One section has a striped pattern, known as gratings, that varies from card to card; the other section is a uniform gray. Between the sections is a peephole that the clinician can use to view the baby’s response to the card, while keeping their face hidden. If the baby spends more time looking at the gratings than the uniform gray, that means they can visually detect the pattern presented to them.
Once it’s determined the baby is looking at the gratings, the clinician will move on to a finer grating, to determine the limits of acuity. As soon as the baby chooses to look at the uniform gray instead of the gratings, we know it has gone beyond the limits of their detection. A similar technique for measuring acuity in infants is using LEA paddles, which work the same way as the Teller cards; the difference is that Teller cards hide your face. A baby will always choose to look at a face over anything else because it is much more interesting to them–it’s one of the obstacles in doing infant eye exams.Read More