Vision Screening Online Training Program

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

The monocular fix and follow test is used to test each eye individually in its ability to visually follow an object and stay fixed on it. The inability to follow an object may be indicative of strabismus or amblyopia. Since younger children who have a visual dysfunction may become upset at their good eye being covered, the fix and follow test is also useful in bringing about these reactions.

Ages: 4 months to when visual acuity can be measured.
Purpose: To check for vision and the movement of the eye when it is following a continuously moving target with the other eye covered.
Description: Target is moved horizontally then vertically in relation to a center point on a visual axis of each eye.
Equipment: Penlight or interesting target.
Procedure:

Horizontal -
Cover the left eye, attract the child's attention to a target (14-16 inches) centered in front of the child's right eye (center point), slowly move the target horizontally to your right until the child's eye is in its extreme left viewing position. (This should take 2-3 seconds.) Slowly move the target to your left, crossing the center point and continuing until the eye is in the extreme right viewing position. (This should take 4-5 seconds.) Return target to center point.

Vertical -
Starting at the center point, raise the target until the eye reaches the extreme up viewing position. (This should take 2-3 seconds.) Lower the target through the center point until the eye reaches the extreme down view position. Return target to center point.

Cover the right eye and repeat the procedure for the left eye.

Image of screener covering right eye of child and demonstrating the Fix and Follow procedure.

Pass: Each eye follows the target easily and smoothly, with or without head movement.
Re-screen/Refer: The child does not attend to the target; either eye shows jerky movements, or the child objects to one eye being covered but not the other.
Note: Several different toys should be available to use as the target to hold the child's interest. This procedure is checking for vision. The child may follow with eye or head movements.

 

Binocular Fix and Follow/Extra Ocular Movement (EOM)

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 that it is only the child’s eyes that move to follow the object. This will give the screener the best vantage point of observing for any deviation in the child’s eye movements.

Ages: 4 months to when visual acuity can be measured.
Purpose: To check for symmetrical movements of the eyes when following a moving target.
Description: The child's head is stabilized while a target is moved in horizontal, vertical and oblique patterns in relation to a center point on a visual axis. The target is also moved from the center point toward the child.
Equipment: Penlight or interesting target.
Procedure:

Horizontal -
Hold the target (14-16 inches) 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. (This should take 2-3 seconds.) Slowly move the target to your left, crossing the center point and continuing until the eyes are in the extreme right viewing position. (This should take 4-5 seconds.) Return target to center point.

Vertical -
Start at the center point, raise the target until the eyes reach the extreme up viewing position. Lower the target through the center point until the eyes reach the extreme down viewing position.

Oblique -
Start at the center point, raise the target until the eyes reach the extreme upper right viewing position. Lower the target through the center point until the eyes reach the extreme lower left viewing position. Repeat this procedure for the upper left to the lower right viewing position.

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

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.


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