Page 128 - July-August 2020

and appropriate referral has to be years of age without a primary Additional testing can be
made. As eye care professionals are complaint of strabismus decided by the clinician based
used to touching the kids during c. Undilated refraction can on the visual complaints of the
examination, it is important to be deferred if a cycloplegic patients. It is important to optimise
consciously ensure not to touch the refraction is planned, and and reduce the time spent for
kids during assessment and to use refraction or prism adaptation
the help of the parent or caregiver subjective acceptance can which is done as part of the
to assist during visual acuity be deferred wherever the decision‑making process in
assessment, testing eye alignment, decision is to be taken based on binocular vision.
performing refraction and slit‑lamp cycloplegic refraction
examination. d. Applanation tonometry to VISION THERAPY (VT)
be done only in aphakia, In regular optometry clinics
PAEDIATRIC WORK‑UP AND pseudophakia, and glaucoma
REFRACTION where infrastructure support is
BINOCULAR VISION AND not available to maintain physical
Visual acuity assessment: The VISION THERAPY CLINIC distancing during in‑office vision
optometrist should use noncontact GUIDELINES therapy, software‑based home
occlusion such as tissue papers therapy should be prescribed. In
and extra precautions need to be HISTORY TAKING general, software‑based home
taken to avoid peeking. In younger vision therapy (VT) options can
children, parents can hold the tissue Although history taking is be explored toward providing
paper to occlude, after appropriate an important component of a tele‑vision therapy consultation
hand hygiene is ensured for them. binocular vision/orthoptic clinic and management. Indigenous
Use handheld autorefractors work‑up, it is important to reduce software available commercially
to assess refraction as it has the time taken for the same. The can be utilised toward the same.
been validated in the paediatric history can be administered over The VT instructions can be
population. [19‑21] Over refraction phone or the symptom survey can e‑mailed or sent as photos to the
with retinoscopy can be done if be e‑mailed if patients have prior patient to reduce the use of paper
visual acuity is 6/6 and wherever appointments and email access. copies. Also, it is advised that the
applicable to reduce the time taken CLINICAL PROTOCOL patient procures their own home
for work‑up. VT kit for additional teaching and
Use over‑refraction to quickly training rather than using the
What can be omitted from re‑check the refraction. Borish
the regular work‑up during the delayed testing and modified equipment in the clinic.
COVID‑19 times to reduce the Borish delayed testing can be Due to the increased use of
work‑up time? digital devices and related visual
utilised to manage refraction in
a. Children less than 3 years the presence of accommodative complaints, webinars can be
seeking emergency consultation dysfunctions to reduce the need organised for patients and parents
can be directly referred to the for cycloplegic refraction. In place to raise awareness about visual
ophthalmologist of a comprehensive binocular hygiene and binocular vision
dysfunctions during the long hours
b. Conventional routine sensory vision assessment, the minimum of work from home.
and motor evaluation test battery that includes phoria
procedures such as stereopsis measurements at distance and near, LOW VISION PRACTICE
and worth four dot testing can binocular accommodative facility, GUIDELINES
be deferred in children who near point of convergence and near To reduce the chair time and
come for routine testing and in point of accommodation can be number of visits to the clinic,
refractive error testing. Avoid performed. This is to ensure that the the following strategies can be
touching, maintain physical binocular vision assessment timing considered:
distancing. Hirschberg’s test can is reduced and yet to ensure that
be performed to document eye common non‑strabismic binocular a. Relevant history and information
alignment in children above 12 vision anomalies are not missed. on functional needs can be

| JULY-AUG 2020 | 124 OCI GUIDELINES