CET feedback: Paediatric examination interactive

The development of the visual system is well underway, and in some ways near finished, by the age of three. Post-natal testing usually focuses on checking for a red reflex and usefully detects leukocoria that may signify a disease requiring immediate intervention, such as cataract, retinopathy of prematurity scar tissue, residual foetal remnants or a large detachment as might be caused by a neoplasm such as retinoblastoma. Over the first few months, once ocular movements start to coordinate and stabilise, obvious strabismus or nystagmus should be apparent to anyone in contact with the infant. Small angle strabismus, refractive errors (including anisometropia) and strabismus linked with accommodation may be less apparent, however, and may have had a negative impact upon the vision by the time suspicions are aroused. This might be several years later. For this reason, I would argue, a pre-school assessment of the eyes and vision is appropriate.