10 reasons why you should be an InfantSEE® provider

Excerpted from page 46 of the July/August 2021 edition of AOA Focus.

The AOA recommends a baby receive their first comprehensive eye assessment between 6-12 months of age. InfantSEE^®, a program of Optometry Cares^®—The AOA Foundation, encourages caregivers and our communities to seek these exams with no barriers or limitations. Why is 6-12 months such a critical period for our littlest patients? Early detection and intervention are the keys in preventing many avoidable vision and learning complications.

Here are 10 reasons why you should be an InfantSEE provider:

1. Fifty percent of what we need to know in life is learned in the first year of life. In the second year, 25% is learned, and surprisingly, only 25% of life’s survival skills are added in the third year and beyond! These babies need to be able to see to develop and learn.
2. One in 30 babies will develop amblyopia.
3. One in 25 babies will develop strabismus.
4. One in 33 babies will show significant refractive error.
5. Eye diseases will be evident in 1 in 100 babies.
6. Retinoblastoma is rare, but possible (1 in 20,000.)
7. Emmetropization occurs very rapidly from birth to 9 months old, and then the amount of change slows considerably. Therefore, doing the InfantSEE exam between 9 and 12 months will reveal a refractive error that is less likely to change drastically.
8. Based on 95% confidence intervals of refractive errors, if you examine a 3-year-old who is more than 3D hyperopic, then emmetropization without intervention is unlikely.
9. You have a captive audience to educate the parents of the importance of yearly, comprehensive eye exams for the entire family.
10. It is the most enjoyable exam you will do all day!

These babies will need lifelong optometrists; therefore, with proper education to the parents, they will become your lifelong patients. These babies have siblings and parents who also are potential patients. Set these babies up on your recall system to ensure they return at or before 3 years of age and before starting school (as recommended by the AOA.)

This program is a reasonable investment in your community’s wellness. It is not a charitable program, but a public health initiative that is intended to change the way parents think about eye care for their infants and families. It also places optometry in the role of the primary eye care provider.

There are many ways that you can implement InfantSEE into your practice. Press releases in local media, community lectures, internal marketing with posters/brochures/social media posts, getting local pediatricians on board, or sending a congratulations letter to new parents/grandparents with InfantSEE materials are some examples. Many of these free resources and other ideas can be found on the InfantSEE website. As a provider benefit, there is a “doctor locator” for the public to assess your name and practice information on the website.

Clinical pearls

As that sweet baby transitions into your lifelong patient and you start examining them yearly, here are some helpful tips for a children’s examination:

Consider not wearing your lab coat. A child may associate a white coat with pain (vaccines, dentist, etc.).

Be flexible. Do the exam wherever you can. This may mean sitting on the floor to do retinoscopy. The skills you learn on your littlest patients are very useful and transferrable. They can be used on an adult who is nonverbal or with special needs. When relying on your objective testing, you can do an eye examination on just about anyone.

Talk directly to the child. Address them by their first name and keep eye contact. I often chat with the child first to get them comfortable and then speak to their parent for a moment before we begin. Remember to treat the child with respect and encourage them to express their thoughts. Praise their efforts and accomplishments, not their personality. For example, “Chris, you make it easy for me to check your eyes. Thank you for sitting so still.”

Have all your equipment ready and within reach. Use fun fixation targets (lights, spinning toys, videos of their favorite cartoons on the computer screen). Work quickly and efficiently. Be flexible in selecting tests and in changing the order of the examination sequence to meet the needs of the patient.

Here are some recommendations on how to adjust for different personality types of children:

Shy: Begin testing with “fun” activities such as stereopsis, color, KVS. I even keep bubbles on hand to use for infants and young children to “pop” (eye/hand coordination) or use to check eye tracking. Bubbles make everyone smile.

Perfectionist: Keep in mind this child does not want to give a wrong answer. Praise the effort and encourage the child to try.

Hyperactive: Decrease the room lights, be organized and switch quickly from one test to the next. Reduce distractions: close the exam door and limit the number of people in the room.

Written by Jennifer Smith Zolman, O.D., chair of the AOA InfantSEE and Children’s Vision Committee.