Vision
Vision screening and eye examination should be a component of all routine health care visits. The American Academy of Pediatrics recommends that the evaluation begin in the newborn period and then at all subsequent visits, with the goal of identifying conditions that might result in visual impairments or represent serious systemic diseases (37).
In the child with a disability, this is especially important, given the frequent association of visual disorders with neurologic diseases. The eye evaluation from birth to 3 years should include a vision assessment, which is accomplished by having the infant or young child fix on an object. The examiner assesses the child's ability to maintain the fixation and follow the object into different gaze positions, a skill that by 3 months of age is developmentally appropriate. Further evaluations of the young child should also include external inspection of the eye and lids, pupillary and red reflex examination, and ocular alignment. Assessment of the child older than 3 years should also include age-appropriate visual acuity measurements and an attempt at ophthalmoscopy.Ophthalmologic disorders frequently seen in children with cerebral palsy require very close follow-up with an ophthalmologist (38). Annual evaluation for cataracts should be completed in children with myotonic dystrophy or those on chronic corticosteroids, such as boys with Duchenne muscular dystrophy or a child with a juvenile rheumatoid arthritis (13,39). Detailed and accurate documentation of the ophthalmologic examination of a child with spina bifida can be helpful when assessing possible ventriculoperitoneal (VP) shunt malfunctions. For example, a malfunctioning VP shunt may cause papilledema or changes in extraocular movements. These are early indications that may manifest prior to more obvious signs, such as headaches or lethargy.
The eye examination of a child with a disability is best performed by a pediatric ophthalmologist due to the child's high risk for ophthalmologic problems. The ophthalmologists have the skill needed to obtain a thorough assessment. A referral to a pediatric ophthalmologist for specialized tests, such as an electro- retinogram (ERG), may be useful in assisting with the diagnosis of rare neurologic conditions, such as mitochondrial diseases.