14. PD V - Visual Efficiency Flashcards
What are the 3 key facets of vision?
- Visual Integrity - eye health & VA
- Visual Efficiency - clear & comfortable vision
- Visual Information Processing - understanding & analysing what we see
According to OAA, it is widely accepted that approximately ...%/... of school aged children suffer from ....
According to OAA, it is widely accepted that approximately 25%/ 1 in 4 of school aged children suffer from an undetected visual problem.
What are the 4 visual integrity problems and 3 visual efficiency problems that children may experience?
Visual integrity problems: anterior eye conditions, posterior eye conditions, refractive error, visual acuity
Visual efficiency problems: accommodative vergence dysfunction, oculomotor dysfunction, uncorrected refractive error
Visual information processing problems affects ... including the non-motor aspects of visual perception and cognition and integration with ..., ..., ..., and .... This may affect:
* Visual ...
* Visual ...
* Visual ...
* Visual ...
Visual information processing problems affects higher brain functions including the non-motor aspects of visual perception and cognition and integration with motor, auditory, language, and attention systems. This may affect:
* Visual spatial orientation
* Visual analysis
* Visual motor integration
* Visual auditory integration
Referral rate for children with visual defects is ...% in Australia. Early detection of visual deficits helps .... Children with uncorrected refractive error is associated with .... Improvements in ... was observed once vision problems are identified and treated.
Referral rate for children with visual defects is 20% in Australia. Early detection of visual deficits helps remediate effects of learning difficulties. Children with uncorrected refractive error is associated with lower achievement test scores. Improvements in reading was observed once vision problems are identified and treated.
Hyperopes of school age were more likely to manifest ... in the development of ... than that of emmetropes or myopes or equivalent age. Hyperopes treated by ... yo were found to have ... than those treated after. In pre-schoolers with >...D of uncorrected hyperopia is likely to have compromised ..., ... and .... Children with compromised ... also performed more poorly on tests measuring ....
Hyperopes of school age were more likely to manifest lags in the development of visual perceptual skills than that of emmetropes or myopes or equivalent age. Hyperopes treated by 4 yo were found to have better visual perceptual skills than those treated after. In pre-schoolers with >3D of uncorrected hyperopia is likely to have compromised VA, stereopsis and accommodation. Children with compromised binocular vision also performed more poorly on tests measuring early literacy.
Studies have found that children have shorter ... in classrooms (...cm) compared to that of clinical (...cm). This causes ... demand to be very high. In primary school screenings in the US, the ... (COVD-QOL) questionaire was provided. Around ...% children had visual symptoms scores >20. Combining comprehensive eye and vision examination, 71% of criteria-eligible symptomatic primary school children had ... and/ or .... A significant relationship was found between ... and ... in every academic area.
Studies have found that children have shorter working distance in classrooms (20-25cm) compared to that of clinical (33-40cm). This causes vergence demand to be very high. In primary school screenings in the US, the College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionaire was provided. Around 25% children had visual symptoms scores >20. Combining comprehensive eye and vision examination, 71% of criteria-eligible symptomatic primary school children had non-strabismic accommodative and/ or vergence dysfunction. A significant relationship was found between accommodation vergence dysfunctions and academic scores in every academic area.
Why is early vision screening is important?
Important in identifying children achieving below their learning potential and nature optimal vision for learning. Visual efficiency deficits will influence learning potential. Children referred at the screening were found to have significantly lower scores in national standardised tests.
Associate the following risk factors in children with accommodation-vergence dysfunctions:
* Fatigue/ near stress/ prolonged near work - ..., ..., ..., ...
* Genetic predisposition - ..., ..., ..., ...
* Uncorrected refractive error - ..., ..., ...
* Down Syndrome, Cerebral Palsy, Fragile X syndrome - ..., ...
* Diabetes, Myasthenia Gravis, Medications (..., ..., ...) - ..., ...
* Trauma (ABI), Graves’ disease, Parkinson disease can affect ... - ..., ...
Associate the following risk factors in children with accommodation-vergence dysfunctions:
* Fatigue/ near stress/ prolonged near work - Accommodative Insufficiency, Accommodative Excess, Convergence Insufficiency, Convergence Excess
* Genetic predisposition - Convergence Insufficiency, Convergence Excess, Divergence Excess, Divergence Insufficiency
* Uncorrected refractive error - Convergence Excess, Basic Esophoria, Acccommodative Insufficiency
* Down Syndrome, Cerebral Palsy, Fragile X syndrome - Accommodative Insufficiency, Convergence Excess
* Diabetes, Myasthenia Gravis, Medications (ADHD, Antidepressants, Epilepsy) - Accommodative Insufficiency, Accommodative Excess
* Trauma (ABI), Graves’ disease, Parkinson disease can affect vergence - Accommodative Spasm, Convergence Insufficiency
Symptoms that indicate a child may have accommodative-vergence dysfunctions:
* ... associated with near work
* ... vision
* ..., closing or covering ...
* ... of near visual tasks
* Inability to ... near visual tasks
* Difficulty ... on near task
* ... concerns in class
* Symptoms developing with ... near work
* ... or ... during reading or desk work
* ... when reading
* ... when changing fixation
* Words ...
* Blinking, tearing, redness, squinting, ... with near work
* Poor ... with reading and homework
* Loss of place, slow ..., uses ... to read
* Poor reading ..., avoiding reading
* Suspect ...
* Errors when ...
Symptoms that indicate a child may have accommodative-vergence dysfunctions:
* Headaches associated with near work
* Blurred vision
* Diplopia, closing or covering one eye
* Avoidance of near visual tasks
* Inability to sustain near visual tasks
* Difficulty concentrating on near task
* Behavioural concerns in class
* Symptoms developing with prolonged near work
* Eyestrain or fatigue during reading or desk work
* Losing place when reading
* Near/ distance blur when changing fixation
* Words moving or running together
* Blinking, tearing, redness, squinting, rubbing with near work
* Poor attention and concentration with reading and homework
* Loss of place, slow reading speed, uses finger to read
* Poor reading comprehension, avoiding reading
* Suspect learning concerns
* Errors when reading/ writing/ spelling
What are the 4 main assessments needed for assessing children’s visual efficiency? Detail the types of test for each
- Binocularity - stereopsis, suppression, VA differences, fixation, diplopia awareness
- Accommodation - posture, amplitude, facility
- Vergence - posture, amplitude, facility
- Accommodation-vergence - combined skill evaluation of visual efficiency
What are the 8 minimum battery of tests for screening accommodation vergence problems in children?
- Cover test/ Hirschberg test
- NPC (any age)
- Stereopsis (Randot or Lang)
- MEM retinoscopy (any age)
+ if school age: - Phorias (distance, near, ±1, ±2, AC/A)
- NPA (monocular)
- Accommodation facility (±2@near)
- Vergence facility (12ΔBO/ 4ΔBI @near)
Management considerations with accommodative vergence problems in children:
* Think about why ..., what are the ...?
* Think about management in terms of ...
* ... options thoroughly with the child and parent, their ... is essential to what you decide to do
*When discussing diagnosis with child/parent, you need to ... them individually and whether ...
* Discuss the ... in their individual cases
Management considerations with accommodative vergence problems in children:
* Think about why your patient might have this condition, what are the risk factors?
* Think about management in terms of what the goal of treatment is
* Communicate the management plan options thoroughly with the child and parent, their involvement is essential to what you decide to do
*When discussing diagnosis with child/parent, you need to relate back to how it is affecting them individually and whether treatment can help their symptoms
* Discuss the consequences of no treatment in their individual cases
Manage Convergence Excess in children (prevalence = ...%)
* Correct ... - ... left uncorrected is a risk factor for the development of accommodation vergence problems, particularly ...
* Give ... - ... will support a system that is ... or ... by reducing ... and reducing ... at near. when emmetropia or myopia is present, the best treatment options for CE are ....
* Consider ... - ...% success in one study
Manage Convergence Excess in children (prevalence = 1-7%)
* Correct refractive error - hyperopia left uncorrected is a risk factor for the development of accommodation vergence problems, particularly convergence excess
* Give plus at near - plus will support a system that is fatigued or overloaded by reducing accommodative demand and reducing esophora at near. when emmetropia or myopia is present, the best treatment options for CE are plus lenses at near, vision therapy, or both.
* Consider VT - 84% success in one study
Most commonly presenting BV disorder in children = c.... This can be managed using .... ... is the most successful mode of delivery (CITT). May consider a combination of ... (weekly-monthly). ... is also available using a computer.
Most commonly presenting BV disorder in children = convergence insufficiency. This can be managed using vision therapy. In-Office is the most successful mode of delivery (CITT). May consider a combination of in-office and home VT (weekly-monthly). Home based VT is also available using a computer.
