I’m definitely of the mind set that the more prepared you can make your child for doctor’s appointments, the better they turn out. So, I thought I’d post about the details of what I do all day, in the hopes that maybe this will help calm the fears of our littlest patients. I’ve had some parents tell me that they show their kids picture of my Honolulu magazine cover before the appointment and just that simple thing, makes my patients much more comfortable with me.
First up in an any eye exam is to check vision. Vision should be checked with an actual eye chart for any kid over the age of 3. Your pediatrician (or his/her nurse) should be doing this at the well child visit. They may either use an old fashioned wall chart or any one of the number of new vision screeners out there that pediatricians are currently using. I’ve actually found that the Plus Optix screener that couple pediatricians use in the area is very accurate. When your child comes into our office, we try to immediately escort them into our pediatric waiting room. This way they don’t have to feel antsy about sitting in a grown up chairs in an adult waiting room. Here, they can play and read until they are called for their appointment. Then, they are called into the exam room by one of technicians. The child will sit in the chair (on a parent’s lap if necessary) and we will check vision. We have the children wear special glasses that have a hole on one side to check vision. We have a pair which has the hole on the other side to check the other eye.Older kids can check vision like adults, using the paddle.
Then we use a vision testing system which is a computer program. It’s nice because we can isolate the chart to a single letter and can change the letters on any given line (for any of you guys who try to memorize the chart!). It also has the advantage of having different types of tests to use based on the age of the kid. This is why we can usually test any child older than 3 years of age. Sometimes, we’ve even been able to do 2.5 year olds!
And, if the kids are too young to know their letters, then we do these shapes or the HOTV letters.
Some pediatricians still use the chart below to test kids who don’t know their letters. They are called Allen symbols, but most pediatric ophthalmologists don’t like them because each picture is so unique in shape, that they’re easy to guess.
Then, we use special polarized glasses to do a test of 3D vision.
Then, if the child is older than 12 or 13 years old, I will refract them – that means checking to see if they need a glasses prescription. That’s the whole “1 or 2 ” test.
If the kids are younger than 12 years old, then I don’t do this for them. It’s tough enough for most adults to figure out which is clearer – 1 or 2. For some reason, this simple question seems to provoke a lot of anxiety. I check the glasses prescription for younger kids only after dilating their eyes. Click here to read more about how I can figure out if babies need glasses.
If a child is old enough (at least 4 years old), I will try to examine the front part of the eye at the slit lamp biomicroscope. You’ve probably had this done if you’ve gone to the optometrist or ophthalmologist. This basically gives me a closer look at the eyelids, conjunctiva, cornea, iris and lens.
Then, on to the dilating drops. This is probably what gives children the most anxiety. I try to minimize this by combing all of the various drops into one spray bottle. This way, the child doesn’t need to have 3 different drops (even though they may need 3 doses even of the spray). And, the convenience of the spray is that I can apply it to the child’s eyelashes when their eyes are closed and if I really soak them, then whey they open their eyes, the drops get into their eyes.
It’s actually quite rare for kids to scream and cry for the drops. OK, maybe rare is an overstatement – my own oldest son cried when I put drops in his eyes to do his eye exam and that was me putting them in. This is when the teachers at his preschool kept insisting that he needed glasses because he tilted his head to the side when watching TV or thinking. And, they knew I was a pediatric ophthalmologist! “Yeah, I’m pretty sure I’ve checked my son”, I condescendingly thought. However, add 2 more kids to the crazy mix of our life and I will abashedly admit that I’ve never checked their eyes. So I guess it wasn’t totally out of the range of possibility that I could miss my kid’s need for glasses. But, that’s a tangent.
Once the eyes are dilated, I use this crazy thing on my head, called the indirect ophthalmoscope to examine the inside of the eye. For young kids, I use toys to distract them so I can get a good view inside. For older kids, I have movies playing to hold their attention (best money I have ever spent when setting up my practice!)
For the young kids, this is when I check the refraction. I do this both with an automatic machine (pictured below).
And then I double check everything by using a retinoscope as well.
And, that’s about it. Of course, they get to choose a toy from our treasure chest on their way out. I have a lot of kids who don’t want to leave our office. We have the nicest techs and they are just wonderful with children. We try to make the experience as pleasant as possible!
And, no I don’t usually have a professional photographer following me around the clinic. Almost all of these pictures were taken a freshman in college, right before he graduated from college. His pics are amazing, for any local moms who want to use him when he comes home for summers and breaks.