Visual development and vision assessment in infants and children
- David K Coats, MD
David K Coats, MD
- Professor of Ophthalmology
- Baylor College of Medicine
Vision assessment is an important part of the medical care of children (table 1). Eye abnormalities that are not treated in the first few months (eg, cataracts, pronounced ptosis) or years (asymmetric refractive errors) of life can lead to irreversible vision loss [1,2]. Visual loss also may be an early indication of serious or life-threatening diseases, such as retinoblastoma, lipid storage disorders, or peroxisomal disorders (table 2) [3,4]. (See "Retinoblastoma: Clinical presentation, evaluation, and diagnosis" and "Inborn errors of metabolism: Epidemiology, pathogenesis, and clinical features".)
The development of the visual system and vision assessment in infants and children will be reviewed here. Specific ophthalmologic problems (eg, cataract, glaucoma, strabismus, refractive error, amblyopia, retinoblastoma) are discussed separately. (See appropriate topic reviews).
The visual system (retina, optic nerves, and visual cortex) is immature at birth. It begins to mature during the first weeks of life . Myelination of the optic nerves, development of the visual cortex, and growth of the lateral geniculate body occur over the first two years . The fovea, the most visually sensitive part of the retina, reaches maturity at approximately four years of age.
The period of visual maturation is a critical period during which the visual system is affected by outside influences. Visual stimuli are critical to the development of normal vision. Development of the visual pathways in the central nervous system requires that the brain receive equally clear, focused images from both eyes. Ocular processes (eg, refractive error, strabismus, cataract) that interfere with or inhibit the development of the visual pathways may result in amblyopia [1,2]. (See "Refractive errors in children" and "Amblyopia in children: Classification, screening, and evaluation", section on 'Definition' and "Evaluation and management of strabismus in children", section on 'Complications' and "Cataract in children", section on 'Complications'.)
Visual behavior and performance evolve with maturation of the visual system (table 3).
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- VISUAL DEVELOPMENT
- OVERVIEW OF VISION ASSESSMENT
- - Referral indications
- Optimal conditions
- VISUAL HISTORY
- VISUAL ACUITY
- Infants and children <3 years
- - Observation
- - Fixation reflex
- - Preferential looking
- Children 3 years and older
- - Optotype tests
- Crowding phenomenon
- - Administration
- - Interpretation
- - Testing artifacts
- INSTRUMENT-BASED SCREENING
- NEAR VISION TESTING
- COLOR VISION TESTING
- VISION ASSESSMENT IN CHILDREN WITH NYSTAGMUS
- Manifest nystagmus
- Latent nystagmus
- VISION ASSESSMENT IN CHILDREN WITH SPECIAL NEEDS
- Vision tests
- - Vestibuloocular reflex
- - Optokinetic drum
- VISUAL EVOKED POTENTIAL
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS