Visual impairment and development — viva

Opening (must-hit)

“I will assess threat first with red-reflex and visual behaviour, separate ocular from cerebral patterns, protect the critical period with urgent specialty referral when indicated, and plan developmental habilitation in parallel.” [1] [2] [3]

Branch A — Red reflex

Examiner: How do you examine the red reflex and what is abnormal?
Candidate: Darkened room, direct ophthalmoscope, compare both eyes. White, dark or asymmetric reflexes are abnormal and require urgent ophthalmology. [2]

Branch B — Classification

Examiner: How do you organise causes?
Candidate: Media opacity, retina/optic nerve, amblyopia pathway, and cerebral visual impairment. Severity and functional impact are layered separately from mechanism. [1] [3]

Branch C — Critical period

Examiner: Why is congenital cataract urgent?
Candidate: Dense early deprivation damages cortical development through unequal competition. Timing of surgery and subsequent amblyopia care protect recoverable acuity. [4] [5]

Branch D — CVI

Examiner: Eye exam is normal but the child navigates poorly.
Candidate: I consider CVI, especially with prematurity, PVL or CP. I assess crowding, visual guidance of movement and performance in quiet versus busy settings, and I do not equate normal structure with normal function. [3]

Branch E — Dual diagnosis

Examiner: Could this just be autism?
Candidate: Poor eye contact is a differential, not a diagnosis. Autism, intellectual disability and CVI can co-occur. Vision and hearing still need assessment. [6]

Branch F — Habilitation

Examiner: What is the paediatrician’s role after ophthalmology owns refraction?
Candidate: Coordinate early intervention, orientation and mobility, school access, sleep support, family education and follow-up of development. Treat function, not only acuity numbers. [1] [7]

Branch G — Safety-net

Examiner: What return advice do you give?
Candidate: New white pupil, new nystagmus, sudden drop in visual behaviour, or caregiver concern that vision is worse — return urgently. [1] [2]