Vision Birth to Three
The visual system at birth is very immature. After all, our new born has been a a dark environment since conception! Acuity develops over time as does the accuracy of eye movements.
|1 to 4||acuity is 20/200 to 20/400, follow slow moving object intermittently, basic eye movements present|
|5 to 8||developing color vision, not as good as adult yet|
|9 to 12||improving acuity, responds to faces|
|12 to 24||acuity improved to 20/50, developing eye-hand coordination, depth perception|
|24 to 36||acuity is 20/20, begins exploring environment|
|36 to 48||using vision for fine motor coordination. At 48 months, refined eye movements with decreased head movement.|
Assessment of eye movements before the age of three should focus on full range of motion understanding that the accuracy of these movements are still developing and will demonstrate poor accuracy and excess head movement.
“When should their head be still??”
This separation of head and eye movements should begin at about 4 years old with no head movement observed during assessment at age 10 and tapering in between. This going to be tied to development of the proprioceptive and vestibular system as well as development of the overall brain. These system are closely linked and delay in any of them will cause a delay in ocular motor skill development as well.
When should a baby get their first eye exam?
The first eye exam should be at 6-12 months old. Infantsee, a public health program developed by the American Optometry Association, provides this first eye exam at no charge. It is vital to detect any problem that could limit development of the visual system. The next eye exam at 3 years, then annually from ages 6-18. Just as the child is growing a changing during these years, their vision could be changing as well. With the visual demands placed on our children during these years, an annual exam makes sure they are ready to meet those demands.
Common Birth to 3 vision problems
The below table is just a few the pathologies that could limit development of the visual system.
|Common Birth to 3 Eye problems||Pathology||Acuity||Prognosis||Functional Problems||Modification|
|Coloboma||failure of the halves of the eye to join completely inutreo, may affect pupil, retina or lid||varies depending of retinal damage||stable condition||glare problems if pupil is affected and retina is functional, reduced bincular depth percpetion||sunglasses, motor practice|
|Optic Nerve Hypoplasia||decreased evelopment of the optic nerve, usually assocaied with midbrain/endocrine problems||varies from minimal affect to near blindness, possbile field cut, possble nystagmus||stable condition||Delayed motor development due to reduced visual input. Refer to TVI at 3 yrs old.||vestibular and motor facilitation tasks.|
|Retinopathy of Pre-Maturity||scarring related to excessive blood vessel growth during prolonged O2 exposure in premature infants||varies by amount of scarring||stable condition||depends on level of scarring, may be no delays related to vision||based on acuity|
|Corticol Visual Impairment||lack of vision due to visual pathway damage/failure to develop||Usually not 100% blind||stable condition||near blindness, refer to TVI,||use contrasting colors, movment and work peripheral to central to investigate amount of vision. Referal to TVI is important for school readiness.|
|Accommodative Esotropia||medial eye turn due to extreme farsightedness||20/20 with glasses in place, eye turn also corrects with glasses||improves, but child will remain in glasses throughout life||none with early correction, amblypoia without correction||glasses should be comfortable and worn at all times.|
|Infantile Esotropia||medial eye turn not related to||generally reduced due to amblyopia, may improve with correction||varies, tx by surgery vs VT vs Botox||reduced motor development||per doctors order concerning patching, facillitate motor improvement|
|Amblyopia||reduced acuity due decreased visual pathway development due to prolonged suppression or lack of stimulation to visual pathway||varies, 20/200 or worse to 20/50 depending on patching complaince and glasses wear compliance.||may improve with compliance of tx and glasses wear, binocular vision therapy||reduced motor dev., head turns, decrease binocular depth perception. Brain with compensate in time||motor dev facilitation, exercise amblyopic eye if currently patching, binocular vision activities|
|Strabismus||eye mis-alignment at rest, corrected with surgery vs VT vs Botox||varies, generally reduced due to amblyopia||varies greatly. Long term, brain adapts to suppression of the turned eye||reduced motor dev, self-esteem, self conscious of turned eye, reduced binocular depth perception||eye exercises per doctors order, facilitate motor development|