VisionPlus India

eye coordination and gross spatial recognition become evident. Delays in these milestones can indicate visual impairment. Signs of possible visual impairment according to age include: • Birth-4 months: Decreased sensitivity to bright light, absent or delayed blink reflex, slowed development of a social smile, and nystagmus. • 5-8 months: Delayed or absent eye contact, failure to fixate on objects or familiar faces, and strabismus. • 9-24 months: Lack of awareness of own hands, absence of goal-directed hand movements. • >24 months: Clumsiness with crawling, difficulty reaching toys, holding objects close to the face, problems navigating curbs or steps. • School-age: Difficulty with reading, complaints of headaches. As children grow, signs of low vision become more apparent. They may struggle with reading, experience eye strain, or have frequent headaches. These symptoms often lead to misdiagnosis of learning disabilities, emphasising the need for comprehensive eye exams. EVALUATION Early referral for low vision assessment is essential. The paediatric low vision exam aims to gather detailed information about the child's visual function and identify the cause of the impairment. The evaluation process includes a thorough history, visual acuity measurement, visual field assessment, contrast sensitivity testing, colour vision testing, and refraction assessment. A detailed history includes the onset, severity, and progression of symptoms. Family history of visual impairment, impact on daily activities, prior use of low vision aids, and difficulties with near tasks and mobility are crucial components. Visual Acuity testing must consider the child's age and cognitive ability. Gold standard tests include near and distance logMAR testing using age-appropriate optotypes. Testing methods vary by age group: • 0-36 months: Teller Acuity Cards. • 4-7 years: LEA symbols, Landolt C, or HOTV optotypes. • 8-13 years: LogMAR chart. Visual Fields testing in young children involves confrontation visual fields or kinetic perimetry, with standard automated perimetry for older, cooperative children. Contrast Sensitivity tests like the Hiding Heidi Low Contrast Face Test and Pelli- Robson test provide insights into discrepancies between GENETIC AND SYSTEMIC CONDITIONS ARE MAJOR CONTRIBUTORS TO PAEDIATRIC LOW VISION 43 VISION PLUS INDIA EDITION