Pediatric and Geriatric Optometry; Low Vision and Vision Rehabilitation
Pediatric, geriatric, and low vision items combine developmental and functional reasoning: what a child can report, what an older adult needs, and how to restore function when acuity cannot be improved.
Pediatrics
Vision screening uses fixation preference, photoscreening, and Lea symbols. Any leukocoria needs urgent retinoblastoma workup. Amblyopia treatment is refractive correction first, then patching two to six hours daily or atropine penalization. Accommodative esotropia responds to full hyperopic correction. Perform cycloplegic retinoscopy in children - non-cycloplegic findings underestimate hyperopia. Screen premature infants for retinopathy of prematurity.
Geriatrics
Cataract, glaucoma, AMD, and dry eye dominate. Review medications for anticholinergic and hypotensive effects, address fall risk and lighting, and counsel on driving standards.
Low vision
Magnification is predicted by the equivalent power: a +12 D lens gives about 3×, and required magnification is desired acuity divided by present acuity. Telescopes help distance, magnifiers and CCTV help near, prisms expand field, and eccentric viewing training uses the preferred retinal locus. Emphasize contrast, glare control, task lighting, and referral to rehabilitation.
Worked example
A five-year-old has 20/100 acuity in both eyes, +5.00 D retinoscopy under cycloplegia, and no strabismus. Reasoning: refractive amblyopia from uncorrected hyperopia. Prescribe the full cycloplegic refraction, review in six to eight weeks, and add patching if acuity does not improve. In contrast, a 78-year-old with 20/200 from dry AMD needs magnification, Amsler monitoring, and low vision rehabilitation rather than a stronger spectacle prescription.
Traps
Skipping cycloplegia in a child; under-prescribing hyperopia in accommodative esotropia; missing leukocoria; and selecting a magnifier without considering working distance and field of view.