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Special Needs > 4. Children with DS > Flashcards

4. Children with DS Flashcards

1
Q

Children with DS are at high risk for?

A

Heart defect, hypothyroidism, leukaemia, hearing impairment, susceptibility to infection digestive problems, epilepsy, autism etc.

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2
Q

Alzheimers and DS

A

Adults with DS have an earlier onset of Alzheimer’s.

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3
Q

Accomplishment development in normal child vs children with DS?

A

Children with DS are much delayed to reach accomplishments compared to a typical child.

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4
Q

DS children have a different learning profile, what does this mean?

A

They have speech delay, reduced fine muscle control (difficulties in saying/ forming words) – hence rely on sign language. Biggest weakness in auditory processing. Visual learning is a strength – they do well at visual task. Hence, they learn by showing them what to do rather than telling them what to do.

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5
Q

Emmetropisation meaning

A

Growing out of refractive errors in children

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6
Q

Relationship between refractive error and Emmetropisation?

A

Higher the refractive error (+)- faster the process of Emmetropisation. It is hence an active process.

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7
Q

Relationship between emetroprisation and axial length?

A

Hypermetropic eyes have a short axial length as the child grows the axial length grows, hence they grow out of the hypermetropia.

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8
Q

True or false: * Emmetropisation drives the eyes towards low hypermetropia

A

True

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9
Q

Do children with DS emmetropise?

A

NO

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10
Q

Emmetropisation- does it apply to myopic eyes ?

A

No, because myopic eyes have a long axial length

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11
Q

Does Emmetropisation occur in CP?
Why?

A

No
CP is an adverse event that causes brain damage. At birth children with CP will have the same refractive error as normal children because this defect happens after birth.

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12
Q

Most common form of cerebral visual impairment is?

A

CP

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13
Q

What are the guidelines for prescribing a child with hypermetropia- normal vs child with DS?

A

Guidelines for prescribing ‘ordinary’ children:
1. Monitor refractive error over time.
2. Allow time for Emmetropisation before 2 years.
3. Prescribe only if Emmetropisation is not event.

For children with Down’s syndrome:
1. Emmetropisation is much less likely.
2. Prescribe more readily at a young age.

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14
Q

Do children at risk with amblyopia and strabismus emmetropes?

A
  • Children at risk of strabismus and amblyopia are those that DO NOT emmetropise.
    Hence, this risk can be minimized by prescribing early.
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15
Q

 If you find an ordinary child who is hypermetropic and not emmetropising- seen 2+ more times by optom and RX not changing. What is this child at risk for?

A

The child is at high risk of developing strabismus and amblyopia. This risk is minimised by prescribing early before they get strabismus or amblyopia.

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16
Q

What is the relationship between DS and strabismus?

A

No relation, strabismus in children with DS cab occur with any or no RX, with no risk factors.

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17
Q

Children with DS- more likely to have a convergent or divergent strabismus?

A

Convergent

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18
Q

Why is it important to check accommodation in children with DS?

A

Accommodation is an important factor when testing children. Because, for children near tasks are very important compared to distance. All the learning takes place at near.

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19
Q

Where does light focus in the retina for a myopic eye vs hyperopic eye?

A

Myopia- light from optical infinity distance comes to focus in front of the retina.
Hypertropia it is in focus behind the retina.

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20
Q

For Notts dynamic ret- does the px have to wear RX?

A

Yes

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21
Q

Target in Notts is at what distance?

A

20- 25cm

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22
Q

What is seen on Notts - if a child is accommodating to the target?

A

Neutral movement on ret reflex

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23
Q

Under or over accommodation on Notts- what is seen on ret reflex?

A

Under accommodating- with movement- corrected by moving back to get neutral. LAG ACCOMODATION
Over accommodating- against movement- corrected my moving forward - LEAD ACCOMODATION.

24
Q

How is the amount of lag or lead calculated?

A

Amount of lag or lead is given by the difference between the position of the target and position of neutral reflex

25
Q

How is dynamic ret used to find lag/lead of accommodation?

A

To find neutral as the optom has had to move back. Because px is not accommodating enough. Neutral point = position of the ret. Hence, large lag of accommodation.

26
Q

If distance of target is 25cm, what is the accommodative demand?

A

100/25 = 4D

27
Q

How is the accommodative response different for a normal child compared to a child with DS?

A

Children with DS have an under accommodation- hence target is usually out of focus for them.

28
Q

Children with DS have a visual or learning issue?

A

They have a visual issue that needs to be address to help them learn better because they are visual learners.

29
Q

Children with DS, even if they have a small RX- 1/2D need to be corrected, why?

A

Because they are unable to overcome the accommodation and need to be prescribed even small amounts of Rx.

30
Q

Depth of focus is related to?

A

pupil size and visual acuity, the smaller the pupil size greater the depth of focus.

31
Q

Relation between visual acuity and depth of focus?

A

Poor visual acuity = larger depth of focus.

32
Q

Are children with DS less sensitive to blur?

A
  • No, its not that they can’t accommodate accurately or that they do not have enough accommodation available. THEY DO NOT MAKE USE OF THE AVAILABLE ACCOMODATION.
  • Children with DS do not appreciate several dioptres of blur different from clear.
33
Q

If you can pass the venier acuity test depends on?

A

depends on your sensitivity to blur

34
Q

Relationship between accurate accommodation in relation to strabismus and hypermetropia?

A
  • Children with accurate accommodation are much less likely to have strabismus.
  • Studies have identified that children with accurate accommodation are less likely to be hypermetropic.
35
Q

How to deal with accommodative defect in children with DS?

A

Bifocals
- Better accommodation with bifocals and small lag.

36
Q

Bifocals fitting guide in DS?

A

Straight- topped D-28 bifocals, fitted with the segment top, or just below the pupil centre.
- The fit is critical.
- Fitted very high
bifocals is a temporary measure, used for 2-3 years to allow children to accommodate they then return to SV later on.

37
Q

Should accommodation be measured at every SN clinic?

A

Yes, children with DS likely to have defective accommodation, that needs to be checked at every visit.

38
Q

TRUE OR FALSE- Strabismus is common in children with an accommodative deficit whatever the refractive error

A

True

39
Q

TRUE OR FALSE- Bifocals are also warranted to control convergent strabismus at near.

A

True

40
Q

How do bifocals in myopia help?

A

Help with good posture, most children with myopia look over the top of their spectacles for near work.

41
Q

Frame choice for DS vs normal child?

A

DS Child has a narrower PD and wider head width. Hence, he needs spec with a narrow PD but a wide frame so that the sides fit well. DS- frame sides need to be shorter, and ears are lower, hence- lower pantoscopic tilt for DS.

42
Q

2 frame choices for DS?

A
  1. Erin World
  2. Tomato glasses
43
Q
  • Children with DS don’t push themselves enough compared to a normal child to do well on tests done- How to work on this?
A

optom testing a child with DS choose a test that they can easily carry out- the child should not be struggling to do the test. Useful to mix difficult targets with small targets to keep the children engaged.

44
Q

How to end a test in a child with DS?

A
  • Always end with success. – once child reaches limit- end with them winning- by moving closer or making the target bigger so they feel accomplished at the end of the test.
45
Q

Is it true that VA and contrast sensitivity is poor in children with DS compared to normal children?

A

Yes, confirmed with VEP’s EEG visual stimulus

46
Q

Children with DS are supported by?

A

Local VI (Visually Impaired) service.

47
Q

How does the fundus look of a normal child compared to a child with DS?

A

– Child with DS Disc has peripherally atrophy. The disc looks myopic and atrophied around disc. It is not a myopic eye however, but a hyperopic eye.
– Both eyes have the same RX (+)
– DS have weird discs : small, unusual, distorted, look like optic nerve hypoplasia (ONH).
– DS children have more blood vessels in the fundus compared to a normal child. That spread out more and wheel spoke shaped. Blood vessels on the surface on fundus in DS look different as well.

48
Q

How is the cornea different in children with DS compared to normal children?

A
  • Cornea is significantly thinner in DS.
  • Cornea is steeper in DS.
  • Since cornea is steeper it is more powerful – its refractive power is greater.
  • If the cornea is more powerful, and axial length is the same, the lens must be weaker.
49
Q

Why is the diagnosis of keratoconus more important in DS compared to a normal child?

A

Cornea is steeper and thinner in children with DS- hence diagnosis is very critical.

50
Q

Why is keratoconus diagnosis trick in px’s with DS?

A

less likely to report symptoms, have a reduced acuity.

51
Q

Most children with DS are diagnosed with keratoconus even if they do not have the condition, why?

A

They naturally have thin corneas, this can be eliminated by confirming diagnosis through retinoscopy.

52
Q

What is SENCO?

A

Special education needs coordinator

53
Q

Why will audiologist want to know results of a visual exam?

A

lip reading is difficult in patients that can’t see. Hearing aid interferes with glasses. Remind parents to take specs when going to audiologist.

54
Q

Why is it important for dispensing optoms to know if a child has special needs?

A

Important for dispensing options to identify if a child is wearing a hearing aid.- this changes how the frame will be dispensed and the type of frame selected.

55
Q

What is QTVI?

A

Qualified Teachers of the Visually Impaired
Complete a 2 year course in visual impairment.

56
Q

QTHI?

A

Qualified teacher of the Hearing Impaired

  • Is also trained in audiology so they can measure the child’s hearing loss.
57
Q
A

Special Needs (5 decks)

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