What Makes Testing Children’s Vision So Challenging When a Child Has Retinoblastoma?
Firstly, the infant or child needs to be happy. Not hungry, thirsty, bored, or frightened. If a vision test takes place before an EUA, the child will be hungry due to pre-surgery fasting. An older child is probably already thinking about the eye drops that are yet to come as part of the eye exam.
Realistically though, in experienced hands, testing vision in a child under that age of 2 years is relatively straightforward. An examiner will always be able to get some sense of the vision regardless of whether a formal test like the Cardiff Acuity Cards is used, or simply observing the child’s visual behaviour.
Once children reach 2 years, things can become a little tricky as their personalities start to emerge. They may be too shy to speak or engage with the examiner, who can then only observe their visual behaviour.
Being fearful of a new environment or new people, or knowing they will have eye drops soon can also make it difficult to obtain a reliable result. The child may not like either eye being covered, so the examiner can only assess the vision with both eyes open. In this case, they cannot be certain whether each eye would achieve that level of vision separately. However, this observation can confirm what the better-seeing eye can see, which is an important start.
How Can I Help My Child Prepare For A Vision Test?
There are several ways you can prepare your child in the comfort of your home.
Playing games where either eye is covered in turn is a very useful way to help them not be overwhelmed when this happens during their vision test. ”Peek-a-boo” can be a great way to introduce this.
The examiner may be able to provide you with a sheet of the pictures or shapes that will be used at the next vision test. There are no extra points for knowing the alphabet letters. In fact, when children “kind of know the letters” then give an incorrect letter name during the vision test, it can be difficult to know whether they can’t see the letter, or they got the name wrong.
Talk to your child about their vision test as being a game, rather than a test. Young children like to please. They don’t want to disappoint or get things wrong. If they realize their letter or picture responses are incorrect, they will very quickly stop wanting to play. Encouraging your child during the testing process is the best thing you can do.
Finally, the visual behaviour you observe at home can be very helpful to the examiner. Especially when your child does not enjoy having their vision examined or is not having a good test day. Use your smartphones to take a video of your child doing everyday activities that illustrate what they can see, such as picking up small objects, or pointing out small pictures in a book. You might also like to have someone video their reaction when you cover either eye with your hand while they are trying to look at a book or pick up a small toy. Try to take any video without your child being aware of the camera.
What If My Child Does Not Co-Operate With The Testing?
The examiner will be used to this – and it is a perfectly appropriate and normal behaviour. Seeing the same examiner each time helps, as this builds rapport, and the concept of ‘playing’ is reinforced. Sometimes it will take a few visits to gain a child’s confidence and obtain all the information needed – and that is ok.
Supporting children to play and practice at home can make a big difference to their coping and confidence. Part 3 of this guide is written directly to children and includes a video following a young boy throgh his vision test and eye exam. We recommend reading and watching together with your child to support their preparation.
