Considerations and Challenges for the Paediatric Optometrist: Literature Review and Case Series

Abstract

Introduction: Ophthalmic examination of infants and young children is important to ensure normal visual development and to reduce risk of permanent vision loss from conditions such as strabismus and amblyopia. The role of the optometrist includes identification of amblyopia risk factors, detection and treatment of amblyopia and detection of ocular pathology. Knowledge of normal refractive error development is important to determine when treatment is indicated. Literature Review: This summarises the changes in refractive error that occur during infancy and childhood and the prevalence of refractive error in children worldwide. It outlines screening methods used in the detection of refractive error in infants and children and provides evidence-based guidelines for prescribing for refractive errors in this group. Case Presentations: These case presentations illustrate a range of common conditions seen by paediatric optometrists. Case 1 illustrates treatment of amblyopia in a child older than seven years of age. It highlights the lack of evidence surrounding when to stop amblyopia treatment in children with residual amblyopia and/or poor compliance. Case 2 is a case series of patients in which strabismus was the presenting complaint. However, each patient had an underlying condition as the primary cause highlighting the need for full assessment including dilated fundus examination. Case 3 demonstrates the treatment of vernal keratoconjunctivitis, a potentially sight threatening allergic eye condition of childhood that may be treated effectively by optometrists in its mild and moderate forms. Conclusion: Treatment of refractive error and amblyopia in children and infants can prevent permanent visual impairment, although this may depend on a number of factors including patient compliance. Early detection of ocular pathology can result in better treatment outcomes and in some cases can be lifesaving.