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Special Needs > 2. Adult vs SN clinic > Flashcards

2. Adult vs SN clinic Flashcards

1
Q

How is H&S different in an adult clinic to SN clinic?

A

Adult: Patient is usually directly asked questions
SN: Parents are asked questions, while also interacting with children.

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2
Q

What is recorded in SN clinic when VA is measured?

A

What test is used, presenting VA is the most important and should be given importance. Need to be fast when recording VA. And what specs were used? - distance/ near?

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3
Q

Why is it important to note down the test used to measure VA?

A

The same test can be used in the next visit, and helps compare results- improvement? worsen?

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4
Q

Why are GH & Med questions asked?

A

Need to identify certain health issues as it can affect eye health, certain drugs/ meds can also carry risk to the eye.

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5
Q

Children are not still with volk- hence which test can be used?

A

Headset bio
Ophthalmoscopy

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6
Q

Mohindra advantage and disadvantages in children?

A

Advantage: easy fixation target and helps control accommodation. Not invasive as cycloplegia.
Disadvantage: Oblique cyl can’t be identified.

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7
Q

Why is cyclo preferred over dilation in refraction?

A

Dilation- more aberrations
Cyclo- relax accommodation, and also dilates pupils enough.

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8
Q

How to accurately estimate cyl- and avoid making cyl guess?
whent the child is not comfortable with the frame?

A

Use child friendly frames. Ask them to wear the frame for short intervals.

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9
Q

Is fan & block ideal for refraction?

A

Yes, as children do not understand questions.

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10
Q

How is accommodation measured in children?

A

Dynamic ret

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11
Q

CT different in adults vs children?

A

Toy used as a target for children vs adults- budgie stick.

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12
Q

CT is combined with with other test?

A

CT & VA

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13
Q

What is important before using KAY- Pictures?

A

Make the child familiar with the pictures and identify what the child calls/ terms the pictures

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14
Q

Is refraction used in SN- why?

A

It is only possible to use this when the patient understands questions and can express opinions. Additionally, the child can’t hold attention on a distance target. Hence, this technique is rarely used.

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15
Q

Is cycloplegic refraction used in SN clinic?

A

No- usually last resort. Because:
1. Hurts the child and they develop a fear for eye exams.
2. Rare, but possible side effects
3. Long wait for drops to take effect hence, the child might get bored and not perform well on the test.
4. Once cyclo is effective can’t measure BV, Near acuity, corrected acuity.
5. Child leaves with uncomfortable glare.
6. Near work not possible all day.

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16
Q

What is the most ideal technique to do refraction in SN?

A

MOHINDRA RETINOSCOPY

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17
Q

Advantage of mohindra in SN clinic?- 4

A
  1. Monocular hence, no convergence clues
  2. Accomodation is stable and not variable
  3. Working distance allowance can be taken into account.
  4. All other test are possible after ret- e.g. BV, Near function.
18
Q

How is accommodation different in adult clinic vs special needs?

A

Adult- push up used, SN- push down used

19
Q

How is push down used?

A

Place the stick very close to the child’s eye- very close (knowing that they won’t be able to accommodate that close). And ask the child to tell you what the letter or picture is- move it away child the child can see and tell the optom what the picture is- move slowly- they have a slower reaction time compared to the normal population. Ask soon as they can see the target = amplitude of accommodation.

20
Q

What does DYNAMIC RETINOSCOPY (Notts) measure?

A

Measures accuracy of accommodation not amplitude of accommodation.

21
Q

How is dynamic ret done?

A
  • Correct distance refractive error. Then place the target at the child’s habitual working distance.
  • Place target alongside the ret.
  • If child is accommodating, the reflex will be neutral. Hence, if the child has neutral reflex= child has accurate accommodation.
  • If a child is under-accommodating, there will be a ‘with’ movement – a lag. Move back to find neutral.
  • If child is over-accommodating, there will be an ‘against’ movement – a lead. Move closer to find neutral.
  • ‘Normal’ is zero to 0.75D lag.
22
Q

Why is it important to measure accommodation in SN clinic?

A

To measure near function, children do learning at near. SN children have accommodation deficits, this technique helps determine of hypertropia needs to be corrected. And measure the impact of the squint.

23
Q

What are the 3 preferential looking tests for babies under 12months?

A
  1. Teller cards
  2. Keeler cards
  3. Cardiff test
24
Q

Why are cards with grating used?

A

Effective target & attention grabbing.

25
Q

How to judge where the child is looking in preferential looking tests?

A

Identify where the child holds attention most- not where the child saw first.

26
Q

How to preferentail looking?

A
  1. The examiner should NOT know where the grating is.
  2. Ensure that the child is looking straight ahead at the optom.
  3. Look through the peephole and present the card quickly.
  4. Estimate where the grating is from the child’s response.
  5. If correct at least twice, assume the child can see the grating.
27
Q

What are the calibration units and distances for teller, keeler and cardiff tests ?

A
  • Teller (VA in Snellen Feet, hence 20/x – then converted)
  • Keeler (VA in LogMAR and Snellen) —– 38, 55 and 84cm.
  • City-Cardiff 50cm. – VA in LogMAR and Snellen
28
Q

What preferential looking test is used for children 2.5 years and old? And what is the working distance?

A

Kay pictures. and for children that know letters: Keller LogMAR crowded
3m

29
Q

Why are boxes used in Kay pictures?

A

To equalize crowding.

30
Q

When kay pictures are used- what are the 3 methods of identifying the picture?

A
  1. Name
  2. Sign
  3. Matching
31
Q

What should be recorded when VA is measured?

A
  1. The test used.
  2. The distance (unless obvious from the score – e.g. 3/6, 1.5/12 etc).
  3. How the patient responds (Naming, Signing, Matching).
  4. Which eye tested first if measuring one eye at a time.
  5. Or ‘Alternate Occlusion’
  6. Any relevant observations e.g.
    - Unusual head turn.
    - Screwing eyes up.
    - Identifies end letters more promptly than middle letters in line.
32
Q

Always end measuring VA on a good note in SN- what does this mean?

A

End when the child has started failing and we have reached the end point move closer and let them read the final words where they are likely to succeed.
* The last thing the child should remember is getting the correct answers at the end of the test.

33
Q

Why is which eye used to measure recorded in SN clinic- for VA?

A

Measuring acuity in one eye at a time risks the child becoming bored and giving up sooner for the second eye. If this method is used, record which eye was tested first and then reverse the order and check the other eye first the next time.

34
Q

In normal clinics, VA Is measured in a systematic system- monocular, binocular etc… how is this different to SN clinic?

A

Priorities what acuity needs to be measured and do that first. This is identified through H&S.

35
Q

3 Options for near acuity?

A
  1. Childrens reading book
  2. Maclure
  3. Near Kay Pictures
36
Q

3 contrast sensitivity tests available?

A
  1. Pelli- Robson
  2. Cardiff contrast test
  3. Universal contrast test
37
Q

2 possible/ available tests for stereopsis in SN?

A
  1. Frisby
  2. LANG
38
Q

is it true the word no is avoided in SN clinic?

A

YES, Instead say, brillent, well done, now try doing it with the your head still.

39
Q

How are VF done in SN?

A

Confrontation used.

40
Q

3 amblyogenic risk factors?

A
  1. Hypermetropia
  2. Anisometropia
  3. Strabismus

Special Needs (5 decks)

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