My classmate performs a fixation preference test with a prism over our patient’s eye to determine her binocular fixation pattern.
Sometimes, when looking at my clinic’s schedule of the day, I experience a hesitant feeling when I see anyone under the age of eight on the schedule. It feels ridiculous, to be nervous of a patient so young and innocent. But then I wonder what the chief complaint could be and hope that patient compliance won’t be an issue. I wonder what the appointment is for. Is it a follow-up to a failed school eye screening? Is the child in pain? Will the patient cooperate with me today?
There are a few classes at NECO that are catered towards students learning about diagnoses we will come across in pediatric patients. In the fall semester this year, I was enrolled in Development, Strabismus, and Amblyopia to understand abnormal visual development. This semester, we have the Pediatric Optometry class to learn about different ocular and vision conditions in the pediatric population. Dr. Nicole Quinn, the instructor, along with other professors, teach the students about child development, individuals with disabilities, and visual problems we may see in a primary care practice, as well as examination techniques for the pediatric patients.
I believe a major concern about conducting a pediatric examination is that the mood of a child can change in an instant, and sometimes what we do affects this. A child may enter an exam room with excitement and if we don’t keep their attention, it’s difficult to get back and refocus the exam. Or the child may start off shy and quiet, but as you interact with them, they relax over time. It may seem odd to be so concerned about these factors, but aside from keeping the child’s attention or trying not to scare them, we’re also thinking about identifying any visual issues. We think about what problems might be presenting and whether it is a visual problem or if there is another issue at play. We feel a great responsibility and want to feel confident that we have the correct diagnosis so that normal visual development can occur.
Thankfully, our preceptors double check everything and teach us what to look for as we do the exam and offer tips on how to keep a child from running around the office. Our Pediatric Optometry class also demonstrates useful techniques to use in clinic as well. The class has several seminars outside of lecture where we practice various examination techniques like the Teller Acuity cards, Stereo Smile test, and visual processing tests on our classmates to prepare for our seminar with infant and toddler volunteers.
Our patient in today’s seminar wanted us to wear occluder glasses with her before her color vision test, so our classmate volunteered to match with her!
Part of the the pediatric optometry seminar involves letting us practice our skills with real pediatric patients. Parents bring in infants and young children to allow our students to practice an undilated pediatric eye examination using the techniques we learned in class and our previous seminars. Students are placed into small groups to work with one patient and we rotate as primary examiner to give the child some space and feel more comfortable as a patient. Not everyone sees many young children in clinic, so this seminar gives students a chance to overcome that hesitation of interacting with a young patient in the chair and feel more comfortable conversing with parents about how their child is doing.
This seminar was probably our most adorable lab to date. Although I was under the weather and opted to participate via observing so as not to get anybody ill, it was great to see the energy of the room and the different techniques classmates used to keep an infant’s or toddler’s attention. It was a great way to put everything we have learned in Pediatric Optometry to and receiving valuable feedback from the course instructors!