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Mechanical or surgical procedures are often indicated. For example, congenital cataracts, if significant, must be removed at the earliest possible age. Good visual acuity can be obtained if the cataract is removed before the patient reaches 1 to 2 months of age, although the prognosis is poorer in unilateral cases

By the 2-month checkup, each eye should be tested separately for its ability to fix and follow.

Measuring visual acuity in the office becomes possible with patients between the ages of 18 months and 3 years.

While looking through the ophthalmoscope, illuminate both eyes simultaneously and examine the eyes for clarity of the red reflex at a distance of 1 to 2 feet.

Dr. McCourt moderates this virtual journal club with Drs. Campbell, Moshfeghi, and Wan.

This video presents intraoperative OCT in a series of six unique and complex pediatric cataracts, as an aid to surgical planning and successful outcomes.

Parental concern may initiate the evaluation for amblyopia. Parents may note that their child’s eyes “look different”. Careful examination may reveal such serous concerns as a white pupillary light reflect (leukocoria, top) or an abnormally large cornea, indicating possible congenital glaucoma (bottom).

A vertical offset of the eyes will also result in asymmetric localization of the corneal light reflex, with the reflex in the deviating eye below the pupil center (hypertropia) or above the pupil center (hypotropia) while the reflex in the fixating eye will be centered in the pupil.

Focusing the Image. Infants and children with high refractive errors require glasses. or contact lenses to achieve good vision and avoid amblyopia. The ophthalmologist can objectively quantify an abnormal refractive error by altering the quality of the red reflex obtained with a retinoscope. Although parents are often anxious that their infant will not tolerate glasses, any infant who has a visual problem that can be corrected optically does extremely well.