Testing Visual Acuity

Several diagnostic tests are used to detect strabismus, amblyopia, ocular disease, and refractive errors. These include visual acuity and fixation preference tests, corneal light reflex test, cover test, simultaneous red reflexes test, fundus examination, stereoscopic tests, and photorefractive techniques.

The best way to screen for possible visual loss caused by amblyopia is to measure the visual acuity or fixation preference of each eye separately. The covered eye should be firmly occluded during the assessment to avoid any peeking. When there is no apparent sign of amblyopia, the only clue to poor vision may be the child's objection to having the better eye occluded. Additionally, the child may demonstrate a fixation preference of the better-seeing eye, with an inability to fixate on distance objects in the amblyopic eye. Both are common signs of amblyopia that may be caused by a refractive error, media opacities, retinal or optic nerve abnormality, or cortical processing problem.

Equipment required for testing children older than 42 months consists of standard wall charts containing Snellen letters, Snellen numbers, tumbling Es, and HOTV monitors, as well as some means of occluding the nontested eye, ideally, occluder patches (Opticlude, Coverlet).

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