Ophthalmological examination of children is one of the most important areas of diagnostic medicine. The accuracy and timeliness of diagnosis determine not only the quality of vision, but also the development of the child. Vision is a key channel for understanding the world, forming spatial orientation, coordination of movements and speech.
Unlike adults, children can be restless and have a limited ability to consciously engage in the examination process. Many congenital and early acquired pathologies occur without pronounced symptoms and remain unnoticed without a detailed instrumental examination.
In pediatric ophthalmology, carefully selected diagnostic tools are of crucial importance, ensuring an effective, fast and maximally comfortable examination. It must meet the anatomical features of the child's eye, age restrictions and behavioral reactions of young patients. High optical quality, functionality, ergonomics, reliability and the ability to flexibly adjust to each clinical situation are mandatory characteristics of modern equipment for pediatric ophthalmology.
Psychoemotional sensitivity
Children have increased sensitivity to external stimuli and often react emotionally to medical instruments, bright light or physical contact during examination. An essential condition for effective diagnostics is the creation of a calm, friendly atmosphere and the examination as delicately and quickly as possible. This approach helps minimize stress and maintain the readiness of the little patient for further examinations or treatment.
High light sensitivity
Children's eyes are especially sensitive to bright light, which can cause discomfort during examination of the fundus. Therefore, modern, for example, indirect ophthalmoscopes, are equipped with a yellow filter, softening the intensity of the light flux without reducing the quality of diagnostics.
Anatomical differences
Children's eyes are smaller in size, have a narrow pupil, and also more delicate and delicate structures - thin corneas and sclera, which requires special care during examination. In addition, the limited range of eye movements and less transparent optical media can make visualization difficult.
Therefore, ophthalmic instruments for children should provide precise adjustment of the viewing angle, a narrow beam of light, and be lightweight for the doctor's comfort.
The need for visual fixation
Children, especially those under 5 years of age, have difficulty keeping their gaze on one object for a long time. This can make it difficult to accurately examine individual areas of the retina or optic nerve. To facilitate the examination, ophthalmic instruments, such as direct hand-held ophthalmoscopes, for children are equipped with fixation targets or stars projected into the field of view, as well as other visual stimuli that hold the little patient's attention.
Dynamic retinoscopy cards
During dynamic retinoscopy and accommodation studies in children, it is especially important to maintain their visual attention, because the accuracy of the diagnosis depends on it. For this purpose, special fixation cards with simple words, bright images or geometric figures that are easy for children to perceive are used. Such cards serve as effective visual stimuli that help the child concentrate his gaze on the desired area, making the examination process more comfortable and effective.
Using parallax and convergence
Professional ophthalmological equipment, in particular binocular indirect ophthalmoscopes from the German company HEINE Optotechnik, allow you to synchronously adjust parallax and convergence. This significantly facilitates navigation during examination even with a narrow pupil, allows you to more accurately assess the three-dimensional depth of the eye structures and identify volumetric lesions, subretinal changes, neoplasms and other pathologies.
VisionBoost - additional visualization of darkened areas
The OMEGA 600 indirect ophthalmoscope is equipped with the VisionBoost function, which increases the brightness of the illumination up to 20%. This is especially important for a clear visual examination of dark areas of the fundus, such as peripheral areas or pathologically altered areas. Increased brightness thanks to VisionBoost allows the doctor to better recognize changes in the fundus, increasing the efficiency of diagnostics.
Indirect ophthalmoscopes
Monocular indirect ophthalmoscopes are convenient for quick examinations in difficult conditions, such as on-site or in emergency situations. They provide high-quality illumination and sufficient visibility, but without volumetric perception.
An indirect ophthalmoscope is an instrument that, with the help of an additional ophthalmic lens, allows the doctor to obtain a three-dimensional, stereoscopic image of the fundus. This allows to assess the depth and spatial relationships of the structures of the retina, blood vessels, optic nerve and other anatomical elements in detail. Of particular importance are binocular indirect ophthalmoscopes, which provide a detailed overview with a wide field of view even for a narrow pupil. Due to the ability to adjust convergence, parallax, as well as the presence of various apertures and filters, such devices are indispensable for accurate and comfortable examination of children.
Filters:
Green (redless) - increases the contrast of vascular structures and hemorrhages, since it absorbs red light, helping to see blood vessel pathologies more clearly.
Yellow - softens bright light, reduces patient discomfort, is especially useful for high photosensitivity of the child's eye.
Cobalt (blue) is used for fluorescence when using special dyes (for example, fluorescein), which helps to identify corneal damage.
Aperture:
A large aperture provides a wider field of view, but at the same time the light intensity is higher.
A small aperture narrows the light beam, increasing the contrast of details, which is important when examining a narrow pupil.
A diffuser diffuses the light for softer illumination, which reduces glare and discomfort.
Direct ophthalmoscopes
A direct ophthalmoscope is a compact instrument for a quick and high-quality review of the fundus. It provides an enlarged image, but without a stereoscopic effect. Its convenience in mobility and ease of use makes it indispensable for initial reviews and screening.
Modern ophthalmoscopes provide automatic integration of apertures with filters, especially green (red-free), which increases the contrast of vascular structures and improves the visibility of pathologies. Thanks to this combination, the doctor receives a clearer and more informative image even in difficult examination conditions.
Interchangeable apertures of different shapes and sizes (from large round to small pinpoint, as well as special shapes - semicircle, slit, fixation star) allow precise adaptation of the light flux and field of view to specific clinical tasks, optimizing visualization of different areas of the fundus.
One of the important functions is diopter compensation, allowing the doctor to adjust the focus depending on the refraction of the patient's eye. For example, some models have a wide correction range from -36 to +38 D with 74 adjustment steps, which ensures precise adaptation to the individual characteristics of the child's vision.
Retinoscopes
Retinoscopes are a reliable tool for objective assessment of refraction in children of all ages, including infants and children who require a special approach during examination. Due to the ability to quickly and accurately determine the refractive indices of light, retinoscopy is a key procedure for timely diagnosis and correction of visual impairment in pediatric ophthalmology. An important function of modern retinoscopes is the ability to adjust the width of the light slit - it can be increased or decreased in accordance with individual viewing needs. This allows you to adapt the illumination of the patient's eye, increasing the accuracy of measurements and convenience of the procedure.
Particularly noteworthy is the innovative ParaStop technology, which ensures fixation of a parallel beam of light during the examination. It minimizes the influence of the child's eye and head movements, which significantly increases the stability of the light beam and the accuracy of the results.
Portable slit lamps
Compact and mobile, portable slit lamps allow you to examine the anterior segment of the eye in detail without the need for stationary equipment. They are especially convenient for examining infants, young children or in conditions where space is limited - for example, in mobile or small offices. Equipped with optical filters - yellow and blue interference. Additionally, many models are equipped with a replaceable 10x magnification lens, which allows the ophthalmologist to examine the smallest structures of the eye in detail for more accurate diagnostics.
Ophthalmic hand-held examination lamps
Hand-held ophthalmic examination lamps are used for general external examination of the eye. Thanks to the soft but bright enough light, the child does not feel discomfort, which allows the doctor to carefully examine the eyelids, conjunctiva, cornea, sclera. Often used during screenings in maternity hospitals. Often used during daily visual screenings in newborns, as well as to monitor the condition of the eyelids, conjunctiva, cornea and other external structures of the eye.
Modern ophthalmic instruments, specially adapted for working with children, significantly increase the accuracy and comfort of diagnostics. They help doctors quickly identify visual impairments and promptly carry out the necessary treatment, which is important for the normal development of the child and maintaining his health.
