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Vision screening in the UK
• To detect congenital ocular abnormalities, e.g. cataract, corneal opacities, microphthalmia, glaucoma and retinoblastoma.
• Ask about family history of these disorders.
• Use a (bright) ophthalmoscope to examine the eye and red reflex.
• An indistinct red reflex can be caused by cataracts/corneal opacities.
• Retinoblastoma or abnormal retina can cause a white reflex.
• The red reflex may be darker in Asian and Afro-Caribbean babies.
• Refer on if in doubt.
• At 6wks: GP asks parents about their baby’s visual behaviour. Baby should be able to fix and follow a face and large toy. Red reflexes checked with an ophthalmoscope. Squint assessment.
• At 7–8wks: health visitor observes visual behaviour. Parents advised of what to look for regarding expected future visual development.
• At 4–5yrs: orthoptist checks monocular visual acuity and ocular alignment, children achieving <6/9.5 are referred.
Orthoptic programme for children referred by par-ents, health visitors and GPs whenever a concern regarding vision or squint is raised.
• 6–8wks: baby should fix and follow a bright target and your face.
• 4mths: baby should not squint and should fix and follow toys.
• 6mths: baby should reach out for toys.
• 2–3yrs: use picture charts (e.g. Kays pictures).
• 4–5yrs: use letter charts (e.g. Snellen +/– matching letter card).
• Use a bright toy to attract attention and move in a ‘H’ shape to assess the action of each muscle.
• Cover test for squint assessment (see Fig. 24.1).
• Use ophthalmoscope set on +20 for a magnified view of the front of the eye, click in the cobalt filter for fluorescein examination.
• Instill anaesthetic drops prior to examination if the child is in pain.
• Check the diameter of the corneas are equal and that the light reflection from each is bright.
• Check the red reflex in both eyes is equally bright.
• Ask the child to look at an interesting target over your shoulder when trying to examine the optic disc.
• Dilating drops are safe to use, but will interfere with neuro-
observations for 24hrs: use 1% cyclopentolate (if <1yr old use 0.5%)
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