Strabismus occurs most frequently in the newborn and infants and must also be treated at this age to minimize the risk of visual impairment. As the examiner cannot rely on patient cooperation at this age, examination techniques requiring minimal patient cooperation are necessary. The preferential looking test can be used for early evaluation of vision beginning at the age of four to six months. This test cannot reliably detect strabismic amblyopia. However, Teller acuity cards (Fig. 17.7) are sufficiently sensitive for early detection of deficits in the presence of defects of the entire visual system.
Procedure: The infant is shown a card (Teller acuity card) with the same background brightness. The examiner is hidden behind a viewing case that covers him or her from the front and side. An observation pinhole in the middle of the card permits the examiner to observe only the infant's eyes and determine upon which side of the card the infant is fixating. Infants who prefer the striped side have good fixation.
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