Office Procedures

Sensory means how the eyes perceive the vision and how the brain utilizes this visually acquired information. Motor refers to how each of the eye’s 6 extraocular muscles controls the eye movements and how they are coordinated with the other eye.

The sensory motor evaluation is a special ophthalmologic procedure that may be performed in addition to the complete eye examination. Pediatric ophthalmologists perform this procedure often because we are specialists in strabismus. Strabismus refers to those states of the eyes when they are not properly aligned. A sensory motor examination consists of multiple measurements of the ocular alignment positions and may include tests of fusion and binocular (3D) vision.

A sensory motor evaluation detects, assesses, monitors, and/or manages strabismic conditions including esotropia, exotropia, and hypertropia. These conditions can have important visual, developmental, and/or systemic implications. The sensory motor evaluation is necessary to diagnose strabismus, in follow-up to detect improvement or progression in the strabismic condition, and also to determine whether optical correction is affecting the strabismic condition. Information from the sensory motor examination is used to plan medical, optical, and surgical treatments.

As with all special ophthalmologic procedures, this procedure is billed separately from the overall examination.

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What should you know about the refraction?

A refraction is a special procedure that measures the optical properties and focusing power of each eye. Eye drops may be necessary to accomplish these measurements. Together, with a complete ophthalmologic exam, the refraction permits a better understanding of the health of the eye and its vision.

When a refraction is performed, does that always mean glasses are necessary?

Only when indicated for medical or optical treatment, a prescription for corrective lenses is written and given to the parent.

Why is the refraction billed separately?

As with all special ophthalmologic procedures, this procedure is billed separately from the overall examination. Unfortunately, some insurers fail to accept or understand that refractions are a medical necessity in children. Because of this, refractions may be a non-covered service and not paid by your insurance. In this case, you will be personally responsible to pay for this necessary and special part of the total eye evaluation.

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The shape of the eye, or globe, is formed by the cornea (the clear, watch glass cover like front of the eye which we see through), the white sclera (firm shell of the eye), and by the internal fluid pressure maintaining the proper inflation.

Measurement of the intraocular pressure is particularly important when we are concerned that the pressure of the eye is too high. When the pressure of the eye is too high this disease state is called glaucoma. Fortunately, this problem occurs very rarely in children.

There is a very serious disorder we call infantile glaucoma. Infant’s eyes are special since the outermost layers of the eye, the cornea and sclera, are distensible and stretchable until the age of around 3 years.

When an infant has glaucoma the eye is stretched and enlarges faster than occurs during the natural growth and development of the eye. This causes the eye or eyes to appear larger than normal. However, the cornea does not stretch as easily as the sclera. As the cornea stretches too much, the internal membranes leak fluid into the cornea. This initially causes the infant to have teary, watery eyes and significant light sensitivity (photophobia). As the fluid leak increases, the clear cornea becomes hazy or partially opaque. If these symptoms were to occur, immediate Pediatric Ophthalmology evaluation is indicated. Urgent surgical treatment is often required.

When the intraocular pressure measurements are needed in infants and children, examination under anesthesia is almost always required. In older children and teenagers, intraocular pressure measurements are easily accomplished in the office. An anesthetic eyedrops are necessary prior to the measurement because the instrument briefly touches the eye.

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First Visit To A Pediatric Ophthalmologist

What you need to know about their first visit to a Pediatric Ophthalmologist

Before the examination, you will be asked to complete a 2 page questionnaire where you will share what concerns you have about your child’s eyes as well as detailing all of your child’s medical problems, past surgical procedures, medications, and allergies. Dr. Burke will thoroughly review this information with you specifically addressing facts that may impact the child’s eye problem.

Parents are requested to stay with their child throughout the entire examination. Infants and small children are examined while sitting on the parent’s lap while older children are encouraged to sit in the exam chair by themselves.

The examination consists of a vision evaluation (visual fixation ability, age-appropriate and easily recognizable pictures, or alphabet letters), check eye movements and eye muscle alignment, perform an external and microscopic examination of the eye and eyelids, determination of the focusing powers of the eye (refraction), and the evaluation of the inside the eye (retina and optic nerve). When necessary, eyedrops are used to help verify the refraction as well as dilating the pupil allowing an easier view of the structures inside the eye. There is no discomfort from the many instruments and lights that are used during an eye doctor’s evaluation. The only part of the eye examination that may be uncomfortable is the brief stinging the eyedrops cause.

When the examination has been completed, Dr. Burke will discuss his findings and recommendations. All your questions will be thoroughly answered.

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