Karen E. Love
by Karen E. Love, OD
One of the reasons eye exams are recommended for infants between 6 and 12 months old is that this is a time when babies’ interactions with people and visual stimuli are critical to healthy sensory development.
Early detection of problems may point to vision or neurological problems that are best addressed early.
As someone who specializes in childhood visual disorders, I can say that it is thankfully very rare to diagnose a brain tumor in a baby. But it is not so rare to encounter a baby with sensory development delays, possibly due to an injury at or near the time of birth. Additionally, reduced time looking at people and faces is one of the earliest signs of autism spectrum disorder, according to Falck-Ytter and colleagues.
Here are six warning signs related to vision and neurological development in infants:
--Does not intentionally direct eye movements towards a stimulus (eg, a light target, parent’s voice or interesting toy);
--Attends to a target on one side only;
--Can’t track or follow a stimulus (at all, or in part of the visual field);
--Doesn’t make an effort to touch or reach for an interesting target;
--Can’t make eye contact or maintain it (for at least a few seconds); and
--Abnormal pupil response.
Of course, with any infant exam, it is important to make sure that any symptoms you are noticing are due to a real problem and not just sleepiness or hunger. Encourage parents to schedule the exam at a time when the baby is likely to be well-rested, fed and not distracted by siblings in the room. Additionally, examiners should use exaggerated facial expressions, an engaging tone of voice and brief but novel stimuli that are appealing to babies.
If you notice any of the above warning signs, the first step should be to ask the parents more questions about how the baby normally interacts with people and his/her environment. If the parents aren’t sure, I give them some “homework,” asking them to purposefully engage in short visual development activities over the next 2 to 4 weeks and take note of the baby’s reactions.
If there is a high level of suspicion of neurological problems or increased concern when the parents return for the follow-up visit, it is a good idea to refer to a neuro-optometric rehabilitation optometrist or see if your state has a regional center or other early childhood intervention center.
InfantSee, a public health program managed by Optometry Cares – the AOA Foundation, is designed to ensure that eye and vision care becomes an essential part of infant wellness care to improve a child’s quality of life. Under this program, participating optometrists provide a comprehensive infant eye assessment between 6 and 12 months of age as a no-cost public service. For more information about participating optometrists, visit www.infantsee.org. For a directory of neuro-optometric rehabilitation specialists, visit www.noravisionrehab.org. The Optometric Extension Program Foundation also offers a helpful list of visual development activities to share with parents.
Falck-Ytter T, et al. J Neurodev Disord 2013;doi:10.1186/1866-1955-5-28.
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Karen E. Love, OD, is a fellow of the Neuro-Optometric Rehabilitation Association and a fellow of the College of Optometrists in Vision Development. She practices at Escondido Premier Eyecare Optometric Center, a Vision Source practice in Escondido, Calif.
Disclosure: Love reports no relevant financial disclosures.