At the 2025 Optometric Management Symposium, Susan Cotter, OD, MS, FAAO, guided attendees through a wide-ranging session on pediatric eye care challenges, emphasizing careful diagnosis and clinical vigilance during her lecture, "Pediatric Potpourri: What Every Optometrist Should Know." 

Careful Diagnosis

Dr. Cotter stressed that the contemporary definition of amblyopia requires both reduced best-corrected visual acuity in a healthy eye and the presence of an amblyogenic factor during the sensitive period—constant unilateral strabismus, amblyogenic refractive error, or visual deprivation. She also illustrated the diagnostic pitfalls with a case of unexplained unilateral vision loss, underscoring the importance of cycloplegic refraction and tests such as visuoscopy, to detect microtropia.^1,2

Further, she addressed abnormal blinking in children, noting that although often benign or related to ocular surface disease, nearly half of cases may be tic disorders. Specifically, she cited new evidence from a large prospective study that shows a high overlap with conditions, such as Tourette syndrome and attention deficit hyperactivity disorder, emphasizing the need for multidisciplinary management and careful follow-up to avoid misdiagnosis.³

Clinical Vigilance

The lecture also covered accommodative esotropia, with Dr. Cotter outlining best practices in prescribing hyperopic correction, the role of bifocals for high AC/A ratios, and the importance of parental education. Additional cases highlighted Duane retraction syndrome, sixth nerve palsy, acute-onset comitant esotropia, and pediatric migraine, reinforcing the need for optometrists to differentiate ocular from neurologic causes of visual complaints.

“As primary eye care providers, optometrists play a critical role in pediatric care,” Dr. Cotter stressed. “Diagnostic vigilance—and always considering other etiologies—is essential to avoid misdiagnosis and ensure the best outcomes for children.” OM

References

1. Helveston EM, von Noorden GK. Microtropia. A newly defined entity. Arch Ophthalmol. 1967;78(3):272-281. doi:10.1001/archopht.1967.00980030274002

2. Wilson S, Doherty DA, Carroll J, et al. Accuracy of non-cycloplegic refraction in children: a systematic review and meta-analysis. Ophthalmic Physiol Opt. 2022;42(6):1276-1288. doi:10.1111/opo.13061

3. Tang N, Wu H, Xu X, et al. Clinical characteristics of tic disorders in children presenting with abnormal blinking: a cross-sectional study. Front Psychiatry. 2025;16:1553358. doi:10.3389/fpsyt.2025.1553358