PEDIATRIC LOW VISION

INTRODUCTION

The presence of visual impairment impacts every aspect of development with a profound effect on early relationships and communicative functions.  The earlier the detection of a visual problem, the earlier intervention can be implemented. This will have a beneficial effect not only motoric and sensory development, but enhances social interaction.

THE LOW VISION CREDO

Low Vision services are not based solely on a clear-cut science, but this care for children in need should be part of comprehensive eye care services. Low Vision services should be part of a multidisciplinary team including the ophthalmologist and low vision specialist, plus educational and rehabilitation services. Each child's evaluation needs to be individualized. The visual assessment, history, and examination is age and ability dependent.
The goal of low vision services is to help each child achieve his/her maximum potential. Visual impairment or blindness does not mean the child cannot learn, just that they must learn differently. This is our challenge as providers. All children are born with low vision. Each child's unique environment as well as neurological make-up teaches (allows) him/her to see and learn. Visual impairment in the first years of life demands urgent attention, just as any other developmental delay. Visual acuity is not the only factor determining which child needs low vision services. Functional vision is the most important issue. How does this functional vision affect development and quality of life? No two children with" low vision "experience "low vision" the same.

TAKING THE HISTORY
            

OCULAR HISTORY 

Age at onset of symptoms?

Eye poking present?

Response to light? Night blindness may indicate retinal dystrophy Photophobia and light gazing may indicate cortical visual impairment Response to parent's face, to toys, objects (Parents of children with low vision frequently report that the child is interested in "small" specks on the floor or that the child is interested in bright shafts of light or shadows. While parents tend to be encouraged, these are actually "blindisms".) Tracking favorite color

 MEDICAL HISTORY

1. PERINATAL HISTORY

    a. MOTHER:
      Estimated date of confinement, general health of mother during pregnancy, general nutritional status
      Drugs, alcohol, medications used during pregnancy
      Trauma, multiple births
      Infections such as CMV, AIDS, toxoplasmosis, maternal rubella
      Steroid use, hypertension, preeclampsia

   b. BABY:
      APGAR score, gestational age at birth, birth weight, did the baby move in utero?  
      How was the birth, resuscitation required? other congenital anomalies?

2. POSTNATAL HISTORY

    a. NURSERY STAY

• Retinopathy of prematurity risk factors especially low birth weight and exacerbated by several factors including, sepsis, transfusions, unstable course
• Cortical Visual Impairment: risk factors including above, and history of intraventricular hemorrhage

    b. CURRENT MEDICAL PROBLEMS

• Seizures, trauma, other congenital anomalies, "birth marks",  ADHD, hearing, speech, hospitalization, frequent visits to the doctor, surgeries, other diagnosis
• Medications:  seizure meds, meds for ADHD, chronic antibiotics        

3. FAMILY HISTORY

• Eye diseases (strabismus, amblyopia, refraction, ask if any one wore an eye patch or thick glasses as a child)
• Medical problems or disabilities in the family
• Consider examination of family members

4. DEVELOPMENTAL HISTORY

• when did infant raise his/her head -this is a normal response, and will be delayed if the child cannot see
• crawling age
• walking age
• reaching/grasping objects, when

5. EDUCATIONAL ISSUES

• how is the child  performing in school
• type of school attended

6. OTHER INTERVENTIONS  
      
        Receiving occupational therapy, physical therapy, speech therapy

Linda M. Lawrence, M.D.