At birth most babies can fix and
follow horizontally. Initially, the eyes move independently and infant may
appear to ‘squint’. Visual acuity is about 6/200. Retina is well developed, but
the fovea is immature. Development of visual acuity is dependent on the
production of well-formed images on the retina. A cataract will affect normal
development of the optic pathway and visual cortex. Lack of normal development
leads to amblyopia.
6wks: both eyes move together and will
follow a light source.
3mths: visual acuity is 6/60. A baby
should watch their hands and notice toys.
6mths: a baby reaches for toys and passes
them from one hand to the other.
Assessment for visual problems
should be performed on all children at the newborn examination, the 6–8wks
review, and the pre-school (or school-entry) vision check.
General observation: eye movements
Red reflex—dark spots in the red reflex can
be due to cataracts, corneal
abnormalities, or opacities in the vitreous. The red reflex may be absent with
a dense cataract
White reflex—present with cataracts,
retinoblastoma, or retinopathy of
prematurity 6–8wks Optokinetics (e.g.
nystagmus demonstrated by looking at a mov-ing, striped target)
Identification of pictures
Letter matching on the single
letter chart, e.g. Sheridan Gardiner chart
Identification of letters on the
If the following are evident at
the age of 6mths, it should arouse sus-picions:
of eye contact/visual inattention
Persistent nystagmus or squint