After the eyes have dilated, retinoscopy is performed outside of the phoropter with a retinoscopy rack (Figure 4). The patient can be shown a movie at a distance while the refraction is performed. Or I sing a tune or whistle for younger patients to capture their attention. Externals are assessed with a penlight or even the binocular indirect ophthalmoscopy (BIO) if the patient is under age 3 and cannot fit into the slit lamp.
Lastly, the dilated fundus exam is performed with a 20 D lens and a BIO. I again use my light-up toys as a target for patient gaze and quickly glance at the internals (Figures 5 and 6).
In the optical
Your optical should include smaller frames for children from in kid-friendly colors on your frame board. Be sure to include several choices in blue and several choices in pink because in my experience children choose those colors.
If your practice does not feature an optical or your dispensary area is too small to comfortably fit a wide selection of children’s frames, refer your younger patients to pediatric-friendly colleagues with a children’s optical.
Benefits of pediatric exams
I have found that bringing more children into my schedule makes my day go faster and brings more excitement into my chair.
With a successful eye exam of a young patient, you can then add siblings and parents to your patient list and perform eye exams for the whole family. Be sure to inform your community you can perform eye examinations for babies, toddlers, and any member of the family. When you are with your patient, ask the accompanying adult if any family members or children need an eye exam as well.
A pediatric exam will certainly keep you on your toes because you never know what the young patient might do or say. Completing a thorough exam is important, but so is creating a positive experience through a child’s eyes.