Embryology

Fertilization : morula (12-16 cells)

6 Days : Blastocyst
Embryology
Embryoblast : Epiblast
Hypoblast
Embryology
3rd Weeks : 2 Layers 3 Layers
Invagination of central epiblast cells
Longitudinal groove : Primitive Streak

Gastrula
Embryology
21 Days :
Neural ectoderm

Neural Plate

Neural Folds

Neural Groove

Epiblast : Ectoderm
Mesoderm
Endoderm
Embryology
23 Days
Embryology
23 – 26 Days
Embryology
28 Days
Embryology
6 -7 Weeks
Embryology
7 Weeks
Embryology
8 – 9 Weeks
Embryology
10 Weeks
Child Eye Development
Neonatal eye : one of most fully developed sensory
organ
Similar to adult eye, tremendous changes
Refractive power
Axial length
Corneal shape
Iris color
Pupillary respons
Retinal & neurologic
Child Eye Development
Anterior segment : 75 – 80% of adult
Posterior segment one-half of adult
Enlargement continues to 13 – 15 years
Child Eye Development
Dimensions
Weight : 2.3 – 3.4 g vs 7.5 g
Volume : 2.20 – 3.25 cm3
AxL : 16.8 – 17.5 mm
Growth
1st year : 2.5 – 3.8 mm AxL increase … avg 20.7 mm
≥ 2nd years : 0.4 mm
5th year approximately adult size
5 – 15th < 1.0 mm
Child Eye Development
Child Eye Development
 Cornea
 At birth : 9 – 10.5 (9.8) mm vs 11 – 12 mm
 Macro > 11 mm, micro < 9 mm
 Flattening in first 2 – 4 weeks of life, slows after 8 weeks
 48.06 – 47.00 D vs 42.0 D at 20 years
 Thickness : 581 vs 510 μm
 Iris
 Pigmentation for at least 6 months
 Retina
 Cones elongated & narrower, increased foveal cone density
 Reaches adult configuration by 45 months
Vision Development
At birth
 Poor
 Hand motion – finger counting
 Immaturity of visual centers
Rapidly improves during the first few months
 Clear retinal images stimulates neurodevelopment of visual
centers
 Requires appropriate & equal visual stimulation in both eyes
Most active & vulnerable during the first 3 months
“Critical period of visual development”
Vision Development
Developed rapidly during 12-24 month of life
 At Birth
• Very sensitive to light small pupil
• Peripheral vision, developing central vision
• Few weeks : retina developing, more dilated pupil,
bright/dark & shape differentiation
• Attracted to big, bright objects
 1 Month
 Brief focusing to an object
 Bright objects up to 1 meter
 Attracted to surroundings objects
Vision Development
 2-4 Months
• Undeveloped eye coordination : temporary eso/exo
• 2 months : moving objects
• 3 months : eye-hand coordination, reaching out
 5-8 Months
• Developed depth perception : reaching near & far objects
• Color perception
• Recognizing faces (parents) & smile
• See objects behind window
• Remembering objects
 8 Months
• Crawling : eye-hand coordination development
Vision Development
 9-12 Months
• Predicts distance & size of objects : begin to stand
• Permanent iris color
• 10 months : distance & size prediction developing,
reaching objects with thumb & fingers
 1-2 Years
• Developed eye-hand coordination & depth perception
• Exploring the surroundings, listen to conversations
• Recognizing familiar objects, simple drawings on paper
Vision Development
Disturbance in visual development
 Nystagmus
 Strabismus
 Refractive error
 Amblyopia
Evaluation : visual acuity measurements
Refractive change during childhood mandates frequent
rechecks
Vision Development
Visual acuity
Measure the finest feature detectable by an observer
Visual angle subtended by a stripe element (minutes
per stripe)
‘cycles per degree’
Adult : 1 min/stripe, or 30 cycles/degree Snellen
20/20
Vision Development
Measurement :
Preverbal child
 Optokinetic nystagmus (OKN)
 Visual evoked potential (VEP)

 (Forced) preferential looking (FPL/PL)

Older child, 2.5 years

 Optotype

 3 vs 6 m

 Pictures & letters

Vision Development
Preverbal Child
 Optokinetic Nystagmus
 Evaluation of the presence or absence of opticokinetic nystagmus :
first “technologic” approach to acuity measurement in preverbal
Children
 Square-wave gratings (alternating black and white stripes with
sharp, distinct interfaces) placed on arcs were moved across an
infant’s visual field
 20/400 (6/120) acuity at birth
 20/20 (6/6) by 26–30 months
Vision Development
Visual Evoked Potential
 Visual stimuli yield a measurable electroencephalographic
pattern received by occipital scalp electrodes
 evaluate acuity in aphakic, amblyopic, and strabismic
children and in those who have large refractive errors
 expensive, delicate equipment (and the subsequent need for
technical assistance) and lack of standardization of
equipment
 20/200 (6/60) in Newborns
 20/20 (6/6) by 6–12 months
Vision Development
Preferential Looking
 Infants prefer to view a pattern stimulus rather than a
homogeneous field
 Using flat, calibrated, square-wave gratings : Teller Cards
 20/400 (6/120) in newborn
 20/20 (6/6) occurs at 18–24 months
Vision Development
Vision Development
Older Child
Graded Optotype, 2.5 – 4.5 years
Allen Charts
 Illiterate children
 Pictures are not constructed according to the Snellen formula (each
element in the target subtends 1 min of arc)
 Some (the telephone) may not be familiar to modern children
 Targets are variably larger than the
corresponding Snellen letter target
 Smallest target size is labeled 20/30 (6/9)
Vision Development
HOTV
 Pattern recognition and matching of progressively smaller
optotypes with those on a hand-held card
 Average recognition difficulty, vertical axis of symmetry,
obviates the issue of right-left confusion
 Exact correspondence of the target to
the graded Snellen optotypes
Vision Development
Lea Symbols
 Pattern recognition and matching of progressively smaller
optotypes with those on a hand-held card
 Average recognition difficulty, vertical axis of symmetry,

obviates the issue of right-left confusion

 Exact correspondence of the target to

the graded Snellen optotypes

Vision Development
Tumbling E & Landolt C
 Child points to a similar object on a hand-held card
 right-left disorientation is common, limits the usefulness of
the test
 Often confuses younger child , useful for illiterate adults

 Advantage : corresponding directly to the Snellen chart

Emmetropization
Newborns are hyperopic & have short AxL relative to
the refractive power of cornea & lens
Influenced by vision dependent retinal mechanism
Blurred retinal image : AxL elongation & induced
myopia
1st year : rapid AxL growth decrease hypermetropia
Clearer retinal images
Disturbance : delayed emmetropization