What the Fundus

An Office-Based Fix-And-Follow Grading System Assessing Visual Function in Preverbal Children published in the November 2021 issue of BMC Ophthalmology outlines a reproducible method in assessing visual function of infants and toddlers. I must admit that I do not have much experience working with this patient population. I feel more comfortable working with kids five and up. However, whenever I have the chance to learn something I don’t know much about, I’m all over it.

The authors outline the Fix-and-Follow method which involves holding a small (1 cm) target in front of the patient, moving it, and observing how the child responds.

Fixation was categorised as grade 1 if there was no response to the target and grade 2 if there was a response but only for < 3 s. Grades of 3 and 4 were assigned based capacities to (1) fix on a moving target for ≥3 s, and (2) shift fixation from one target to another. If only one of these two criteria was met, grade 3 was assigned. If both were met, grade 4 was assigned

Following was evaluated using smooth pursuit movement, where grade 1 indicated no movement, grade 2 partial movement, and grade 3 complete movement.

Add the two scores together, and you come up with a score of 0-7. They found it to be very reproducible for an individual practitioner and fairly reproducible between practitioners. They only studied two ophthalmologists doing this, but it is a pretty simple technique and a good way to follow patients within your own practice.