Paediatric and Low Vision Care
What this domain tests
This domain tests age-appropriate assessment, amblyopia detection, referral thresholds and low-vision rehabilitation. Paediatric questions emphasise development, cycloplegic refraction and avoidable causes of permanent visual loss.
Core rules and concepts
- Children need age-appropriate tests: fixation preference, cover testing, retinoscopy, cycloplegic refraction and optotype acuity when able.
- Amblyopia risk rises with anisometropia, strabismus and media opacity; early detection improves outcomes.
- The B4 School Check in New Zealand is a screening point, not a diagnostic eye examination.
- Low vision care includes magnification, lighting, contrast, eccentric viewing and referral to Blind Low Vision NZ and other supports.
- Driving and safety advice must be individualised and discussed with the patient and family.
Worked example
A 4-year-old has 6/12 acuity in each eye and +4.00 D hyperopia on cycloplegic retinoscopy. Reasoning: the acuity is reduced for age and the hyperopia is significant. Do not rely on a single crowded adult chart. Repeat with age-appropriate optotypes, assess binocular status and consider referral for paediatric ophthalmological or orthoptic assessment and possible spectacle correction.
Traps that cost marks
Using adult acuity charts for a preschool child; skipping cycloplegia when amblyopia is suspected; assuming a screening pass excludes pathology; failing to ask about family history of strabismus or amblyopia.
Key points
- Use age-appropriate acuity and fixation tests in children.
- Cycloplegic refraction is essential when amblyopia is suspected.
- B4 School Check is screening, not diagnosis.
- Low vision care includes magnification, lighting and contrast.
- Refer early for anisometropia, strabismus or media opacity.