Do you feel anxious when a patient asks you to examine their 2-year-old’s eyes?

[Michael McQuillan]

Do you feel anxious when a patient asks you to examine their 2-year-old’s eyes? Would you like to feel confident handling pediatric eye exams at any age?

I am considering giving a course to provide that level of confidence. Seeing if there is any interest.

 

[Jonathan Warner]

Do you feel anxious when a patient asks you to examine their 2-year-old’s eyes? Would you like to feel confident handling pediatric eye exams at any age?

I am considering giving a course to provide that level of confidence. Seeing if there is any interest.

Go for it!

 

[Derek Coombs]

Did the patient express any particular concerns?
For a two year old I would suggest (or refer to) seeing an eye doctor who has the training, experience and office setup to best serve such young people.

 

[AdminWolf]

Do you feel anxious when a patient asks you to examine their 2-year-old’s eyes? Would you like to feel confident handling pediatric eye exams at any age?

I am considering giving a course to provide that level of confidence. Seeing if there is any interest.

We've had a couple of courses at CEwire over the years about pediatric exams, they've all been well attended, so I think there's definitely interest in the topic.

-- adam

 

[Mike Alvarez]

Last week I had a 4 year old who stabbed himself in the eye with a screw driver. 6 mm partial thickness corneal laceration. He was very challenging to examine.

 

[Jenifer Ambler]

I've always examined all ages. Maybe being a mom has helped.

 

[Lloyd Pate]

I have always seen young kids comfortably.

 

[Michael W Ohlson]

This is an easy example of gap analysis. Are ECPs comfortable seeing infants and young children? How much supervised clinical experience is mandatory in school?

There are practices that do not see kids and practices that aim at pediatrics.

Great topic.

 

[Tom Byers OD]

Do you feel anxious when a patient asks you to examine their 2-year-old’s eyes? Would you like to feel confident handling pediatric eye exams at any age?

I am considering giving a course to provide that level of confidence. Seeing if there is any interest.

good idea...Looking forward to it.

 

[Ken Elder]

I just examined two (twins) barely two year olds who wailed, screamed, clenched their eyes shut and thrashed about throughout the entire attempt at an eye exam.

Mom reported that they had not eaten or slept.

 

[Mike Alvarez]

I just examined two (twins) barely two year olds who wailed, screamed, clenched their eyes shut and thrashed about throughout the entire attempt at an eye exam.

Mom reported that they had not eaten or slept.

You can sort of get some idea of what’s going on via distal ophthalmoscopy looking for a red reflex and just trying to see if the eyes look straight. Maybe move a penlight past his face to see if he tracks it. But I really can’t get anywhere near the level of certainty that I’m not missing something on kids like that that I’m comfortable with.

That’s why I generally refer kids under 5 to the pediatric ophthalmologist.

 

[Donnie Akers]

You can sort of get some idea of what’s going on via distal ophthalmoscopy looking for a red reflex and just trying to see if the eyes look straight. Maybe move a penlight past his face to see if he tracks it. But I really can’t get anywhere near the level of certainty that I’m not missing something on kids like that that I’m comfortable with.

That’s why I generally refer kids under 5 to the pediatric ophthalmologist.

In Kentucky where all children require complete examinations prior to kindergarten and pre-school you would have to refer out an awful lot of patients.

There are many ODs uncomfortable with pediatric evaluations. This is not uncommon. The training in optometry programs need to do a better job of both training the skills and instilling confidence in our new graduates. Pediatric optometry is some of the greatest practice building opportunities. You capture the child, you usually capture the immediate and sometimes the extended families.

This is a point of emphasis amongst some colleagues/educators I have been talking to recently.

 

[Jason Bolenbaker]

Nope. But I also stopped seeing the under 5 crowd in general. Analyzed 3 years of data and discovered they no show higher than any other group, even the online appointment makers in their 20’s, at around 50%. Of the ones that showed, only a quarter of them led to additional exams within the family. And the revenue per patient with most being covered under VCPs was a major deficit as they rarely required glasses so no way to make it up in materials. So after 20 years of saying yes I’ve moved on to the things I enjoy far more than pediatric exams.

 

[Jason Kaminski]

Do you feel anxious when a patient asks you to examine their 2-year-old’s eyes? Would you like to feel confident handling pediatric eye exams at any age?

I am considering giving a course to provide that level of confidence. Seeing if there is any interest.

Not any more- after 29 years in practice, I’ve limited my schedule to 5 yo and up.

 

[Steve Jacobs]

Developmentally, 2 years old is typically the toughest age to examine.
At one, they’ll sit in a parent’s lap, you can usually grab their attention for a few seconds to assess alignment, fixation, basic spatial perception, tracking, external ocular health, etc…
By 3, you can usually get verbal responses on basic acuity tests at far and near, may be successful at pirate eye patching for monocular retinoscopy, assess gross binocularity and stereopsis, and may have a shot at semi confident ophthalmoscopy.
But at two…???
Unless there were a concern or specific indication for it, when talking with parents, I wouldn’t recommend routine exams at that age.
All in all though, on average I’d rather examine a 2 year old than a 92 year old

 

[Mike Alvarez]

All in all though, on average I’d rather examine a 2 year old than a 92 year old

I’d prefer the 92 year old.

 

[Anthony Zieja]

I think most ODs shy away from pediatric examinations under 5 years old because they don’t feel confident in their retinoscopy skills. In an age where autorefractors are the norm, I would guess some ODs don’t pick up their retinoscope on a regular basis. Personally, I think retinoscopy is the most valuable entrance tests: it’s what you need to do for pediatrics, it helps to confirm pseudomyopia in pre-teen/teens, helps to show odd corneas/cataracts/anything that would otherwise make an OD spin their wheels (waste time) on refraction longer than it needed to be on older patients. Retinoscopy is also a must for any non-verbal patient: stroke, non-verbal autism, etc.

As for 2 year olds, I find them to be easier than 3-4 year olds. The 3-4 year olds can sometimes “fight back” or think that any doctor is bad since they recall getting shots from their PCPs. 2 year olds are more of a clean slate. Having an acuity chart that can play cartoons is a huge game changer. And for BIO/internal views, have the parent put something on their phone that the child likes to watch, and hold that in various positions as you get the views you need.

 

[Dr. Stanley Hallock]

I am of the opinion that if someone else feels anxious with a 2 year old......that same person scares mighty easily in many other ways too

 

[Jonathan Warner]

I’d prefer the 92 year old.

Same here.

 

[Lloyd Pate]

My old patients with dementia are like a 2yo.

 

[Michael Molamphy]

I think most ODs shy away from pediatric examinations under 5 years old because they don’t feel confident in their retinoscopy skills. In an age where autorefractors are the norm, I would guess some ODs don’t pick up their retinoscope on a regular basis. Personally, I think retinoscopy is the most valuable entrance tests: it’s what you need to do for pediatrics, it helps to confirm pseudomyopia in pre-teen/teens, helps to show odd corneas/cataracts/anything that would otherwise make an OD spin their wheels (waste time) on refraction longer than it needed to be on older patients. Retinoscopy is also a must for any non-verbal patient: stroke, non-verbal autism, etc.

As for 2 year olds, I find them to be easier than 3-4 year olds. The 3-4 year olds can sometimes “fight back” or think that any doctor is bad since they recall getting shots from their PCPs. 2 year olds are more of a clean slate. Having an acuity chart that can play cartoons is a huge game changer. And for BIO/internal views, have the parent put something on their phone that the child likes to watch, and hold that in various positions as you get the views you need.

Just had a 2 yr. old. Challenge to get any cooperation, but was able to collect enough information. A really fast retinoscopy, aided by assistant holding a colorful bunny and talking to the girl.. We give all kids a toy or book if they cooperate.