The significance of eye screening for newborns is to detect certain treatable pediatric eye diseases, such as retinopathy of prematurity, retinoblastoma, congenital glaucoma, congenital cataract, ptosis, strabismus, and other eye diseases. Early detection, early diagnosis, early treatment and intervention are necessary for such eye diseases. For those congenital eye abnormalities that do not affect vision much and are temporarily untreatable, they are classified as informative eye diseases and parents can be notified.
Among infants and preschoolers, 5% to 10% have vision problems. Strabismus and amblyopia account for 2% to 5% of children from infancy to 7 years of age. Early detection of visual impairment provides the best opportunity for effective and less costly treatment. Also infants and children have immature visual systems and if visual impairment is not detected early and treated promptly, the eye will not provide clear images to the brain and permanent vision loss will result.
We provide timely and effective interventions for cases with clear diagnosis after initial screening; we conduct targeted reexaminations on a regular basis for suspected cases, diagnosed cases, and cases that cannot be confirmed through initial screening. For those with high risk factors for neonatal ophthalmology (e.g., low birth weight infants with high oxygen inhalation), even if there are no obvious positive signs at the time of screening, active follow-up is required and parents are instructed to learn observation methods to detect problems in a timely manner. For complicated cases and children who need surgical treatment, they need to be transferred to professional ophthalmology treatment in time.
1. Time of initial screening:
Premature infants: birth weight less than 2kg should be examined at 32 weeks of corrected gestational age for fundus examination
Newborn: examination within 42 days
Infants: 1 week of age for a comprehensive physical examination and 3 months for a re-examination
Infants: routine checkup for admission to school
Preschool children: Entrance physical examination
2.Screening methods.
External eye examination (deformity, eyelid, cornea, anterior chamber, pupil, lens, etc.)
Response to light stimulation
Red light reflex (refractive interstitial, refractive influence)
Visual acuity examination (PL, OKN, graphic visual acuity chart, international standard visual acuity chart, etc.)
Refractive examinations (“Welland” examination, photographic optometry, computerized optometry, fundoscopy, measurement of eye axis and corneal curvature)
Astigmatism fundus examination.
3. Characteristics and clinical manifestations of common eye diseases.
Congenital anomalies (peculiar facial features, eyelid defects, microphthalmia, microcornea, anophthalmia, etc.)
Retinopathy of prematurity (ROP)
Neonatal conjunctivitis, the
congenital tear duct obstruction, the
Retinoblastoma (RB)
Congenital glaucoma, the
congenital cataract, congenital cataract
congenital ptosis, congenital ptosis
strabismus, the
amblyopia, and
Nystagmus
Some congenital fundus diseases and differentiation (FEVR, PHPV, macular defect, petunia syndrome, etc.)
4. Associated risk factors.
Premature birth
oxygenation
History of trauma
Family history and genetic factors
Degree of eye habits, etc.
5. Relevant special examinations.
Visual electrophysiology (VEP, etc.)
Fundus photography (RetCam II or III system)
B ultrasound
CT
MRI
OCT
Optical biometry (IOLmaster)
6. Completeness of screening and focus on
Medical history
Symptoms
physical signs
Special examination
Children should be screened and seen as soon as possible for abnormalities such as photophobia, easy falling, preference for head tilting, strabismus, and involuntary eye fluttering.
7. Some examination techniques.
Infant fixation methods
Use of lid openers and eyelid hooks
Method of turning the eyelid
Use of spotlight torch and magnifying glass
Use of Waylon
Use of fundoscope
8. Determination of some examination results.
Determination of Weiland results
Refraction of aphakic eyes
Interpretation of some special examination reports
Identification and referral of suspicious eye diseases