Vision Screening Online Training Program - Fix and Follow (EOM)

Vision Screening Online Training Program

Module 4 (continued): Binocular Fix and Follow/Extra Ocular Movement (EOM)
(C&TC: Often performed by the health care provider)

The binocular fix and follow test is a great test to see if a child's eyes work together and are symmetric in their ability to follow an object. It is important to keep the child's head staring straight ahead for this test so only the child's eyes move to follow the object. This will give the screener the best vantage point to observe any deviation in the child's eye movements.

Ages: 4 months through 3 years or when visual acuity can be measured.
Purpose:
To check the movements of both eyes when following a continuously moving target.
Description: Target is moved horizontally, then vertically, then obliquely in relation to a center point on a visual axis of each eye. Make sure the child's head does not move; the parent can help steady the child.
Equipment: Penlight or interesting target.
Procedure: Horizontal -
  1. Hold the target 14-16 inches away, centered in front of the child's eyes (center point), and slowly move the target horizontally to your right until the child's eyes are in their extreme left viewing position.
  2. Slowly move the target to your left, crossing the center point and continuing until the eyes are in the extreme right viewing position.
  3. Return target to center point.
Vertical -
  1. Start at the center point, raise the target until the eyes reach the extreme up viewing position.
  2. Lower the target through the center point until the eyes reach the extreme down viewing position.
  3. Return target to center point.

Oblique -

  1. Start at the center point, raise the target until the eyes reach the extreme upper right viewing position.
  2. Lower the target through the center point until the eyes reach the extreme lower left viewing position.
  3. Repeat this procedure for the upper left to lower right viewing position.
  4. Return target to center point.

Convergence -

  1. Starting at the center point, move the target slowly toward the child to a distance of 4 inches.

Image of all fields of Extra Ocular Movements
Image depciting lines in acoordance with all fields of vision previously described and remining to do convergence

Pass: Both eyes follow the target easily and smoothly.

Occasional Crossing: Normal at 2 months of age. Recheck at 4 month visit.

Fixed Crossing: Refer
Re-screen/Refer: Eyes do not follow in unison or movements are jerky, uneven, or "break" further than 4 inches from the bridge of the nose, or child uses head movements. Eye crossing is fixed and/or intermittent.



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