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OD3 - Clinical Optometry Practice > BVP - Clinical Management of Oculomotility Dysfunction in Children - Week 9 > Flashcards

BVP - Clinical Management of Oculomotility Dysfunction in Children - Week 9 Flashcards

1
Q

Is the optokinetic nystagmus reflex slow or quick? Is it conjugate? When does it occur?

A

Slow, conjugate

When looking at objects passing across our field

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2
Q

What is the vestibulo-ocular reflex? Is it slow or quick? Is it conjugate?

A

Stabilises image on the retina when the head moves

Slow, conjugate

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3
Q

List four voluntary types of eye movements. Note if they are fast or slow, and if they are conjugate.

A 
Fixation - inhibition of movement
Saccades
-fast, conjugate
Pursuit
-slow, conjugate
Vergence
-slow, disjunctive
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4
Q

What four extraocular muscles are supplied by CN3?

A

Superior rectus
Inferior rectus
Medial rectus
Inferior oblique

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5
Q

What extraocular muscle is supplied by CN6?

A

Lateral rectus

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6
Q

What extraocular muscle is supplied by CN4?

A

Superior oblique

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7
Q

List the primary action for each extraocular muscle.

A 
Superior rectus - adduction
Inferior rectus - abduction
Medial rectus - up
Lateral rectus - down
Superior oblique - intorsion
Inferior oblique - extorsion
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8
Q

List the secondary actions (2) for four of the extraocular muscles.

A

Superior rectus - intorsion, adduction
Inferior rectus - extorsion, adduction
Superior oblique - down, abduction
Inferior oblique - up, abduction

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9
Q

Is the OKN reflex an advanced or primitive eye movement response?

A

Primitive

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10
Q

Concerning the OKN reflex in infants, what can be said of the symmetry between temporal-nasal response vs the nasal-temporal movement? What happens around 6 months of age? How does this relate to strabismus/amblyopia? Explain.

A

Temporal-nasal response greater than nasal-temporal movement
Becomes more symmetrical by 6 months
Strabismus/amblyopia delay this semmetry - possible to use this difference to screen?

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11
Q

Is the VOR advanced or primitive?

A

Primitive

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12
Q

Concerning VOR, what direction do the eyes move relative to the head’s movement?

A

Opposite

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13
Q

Concerning VOR, do infants have higher or lower gain compared to adults? What does this do? What happens to the gain with age? Why?

A

Have a higher gain - stabilises the image to ensure development of optimal acuity
Gain reduces with age as the other reflex systems sevelop to augment gaze

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14
Q

what are saccades like in infants vs adults (2)? What is the latency like in infants vs adults? What evolutionary purpose may this have? When is it thought to be developed by (age)?

A

Infant saccades are variable and inaccurate compared to adults
Latency higher in infants - 800ms infants vs 200ms adults
Made in response to maintain fixation of the mother
Developed by 6 to 12 months

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15
Q

List four subtypes of saccades.

A

Prosaccades
Regressive saccades
Antisaccades
Reflex saccades

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16
Q

What types of saccades do infants rely mor on to track vs smooth pursuit (note: not saccade subtypes)? What happens with age?

A

Depend on small saccades rather than smooth pursuit

With age, small saccades decrease and smooth tracking increases in between saccades

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17
Q

Are saccades attention dependent?

A

Yes

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18
Q

Is the devlopment of smooth pursuit in children symmetrical? Explain, giving age when mature (2).

A

Asymmetrical
Horizontal pursuit is mature by age 7
Vertical pursuit is mature by age 11

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19
Q

What aspect of oculomotor control us fully developed at birth? What happens following birth? What happens by age 1?

A

Virtually no aspect of oculomotor control is fully developed at birth but quickly develops following birth
Is close to adult levels at age 1

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20
Q

List four factors that limit oculomotor performance in neonates.

A

Attention
Motivation level of alertness
Distracton
Fatigue

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21
Q

What three things can the development of eye movements be affected by?

A

Stress/fatigue
Environmental factors
Genetic factors

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22
Q

Does oculomotor control develop slowly or quickly in children during primary school years? Is it fully developed when they start school?

A

Slowly

Not fully developed when they start

23
Q

What cellular pathway controls smooth pursuit? What else does it control? Keeping this in mind, what do smooth pursuit skills reflect?

A

Magnocellular pathway
Also controls focal visual attention
Smooth pursuit skills reflect attention capability

24
Q

In which two lobes of the brain saccades initiated? What are saccades influenced by?

A

Frontal and parietal

Influenced by attention

25
Q

Are oculomotility dysfunctions associated with learning problems?

A

Yes

26
Q

List 8 symptoms of an oculomotility dysfunction.

A

Moving head excessively when reading
Skipping lines when reading
Omitting or transposing words when reading
Losing place when reading
Requiring a finger or marker to keep place
Experiencing confusion during the return sweep phase of reading
Experience illusory text movement
Having deficit ball-playing skills

27
Q

What percentage of children with a learning difficulty also have an oculomotor dysfunction?

A

Up to 96%

28
Q

What do studies suggest of the incidence of accommodation deficits in children with developmental dyslexia? What about oculomotor tracking and vergence deficits?

A

Higher incidence of all three in dyslelxic children vs those without

29
Q

Slow reading in school-age children with anisometropic amblyopia is related to what (2)?

A

Increased frequency of saccades

Fixation instability of the fellow eye

30
Q

Consider the relationship between dyslexia and increased incidence of ocular disturbances (and its impact on reading), do studies suggest there is improvement after therapy/treatment/refractive correction, or is it negligible?

A

78% showed an improvement

31
Q

What is binocular coordination like in dyslexic children during and after saccadic eye movement? What does this imply?

A

poor binocular coordination

-implies they have an oculomotor deficiency

32
Q

In comparison with age-matched control readers, what three features do dyslexic readers’ eye movements have when reading words, pseudowords, and sentences?

A

Longer fixations
Shorter saccades
More regressions

33
Q

What is thought to cause reading difficulties in dexlexia? Emerging evidence suggests that this arises from what? What stream specifically?

A

Phonological deficits
-how words are sounded out
Emerging evidence suggests phonological problems and reading impairment both arise from poor visual coding
-attention mechanisms controlled by the dorsal visual stream

34
Q

Describe how observation can be used to evaluate eye movements (2)?

A

Use HH test

-check smooth pursuit, saccades

35
Q

What is meant by NSUCO/SCCO testing?

A

HH test for smooth pursuit/saccades, but is quantitative and rated

36
Q

What is the king devick test?

A

Reading eye movement test

37
Q

What is the DEM test?

A

Looks at reading eye movements only

38
Q

How should the HH test for qualitative observation ideally be done (2)?

A

Do not give specific instructions, just ask them to watch the moving target and follow it as it moves
-observe and document
If they move their head, document and repeat the test, asking to use just their eyes, then document

39
Q

What test uses wolff wands and what are they?

A

NSUCO two rods held in a V shape, to test saccades and pursuits

40
Q

What is the king devick saccadic fixation test designed to stimulate? Is it timed or untimed? Are errors recorded? Does it take into account the child’s rapid automatic naming skills?

A

Designed to stimulate normal reading process
Timed test and errors recorded
Doesnt take into account childs rapid automatic naming skills

41
Q

Describe the king devick test.

A

3 test cards of increasing difficulty
Patient must read them out loud quickly without using fingers to guide them
Time is taken and number of errors

42
Q

What is the DEM test designed to stimulate and does it take into account the child’s rapid automatic naming skills?

A

Designed to stimulate reading eye movements

Does take into account the child’s rapid automatic naming skills

43
Q

Describe the DEM test. Is it reliable and repeatable?

A

Test cards check vertical naming speed with horizontal reading eye movement speed
Repeatable and reliable

44
Q

Does the DEM test correlate with saccadic eye movement skills or symptomatology?

A

No

45
Q

What is the DEM test related to (2)?

A

Reading performance and visual processing speed

46
Q

What do studies conclude of poor readers’ horizontal scanning and what is this related to? What is the recommendation

A

poor readers showed poor horizontal scanning when assessed with DEM and this was related to slow reading speed
-DEM should be used by optometrists as a screening tool to idenfity poor reading in school children

47
Q

Do studies suggest that low DEM is a cause of poor reading or an effect? Why?

A

Low DEM is an effect of poor reading, not a cause

-DEM measures reading eye movements that are dependent on proficiency of reading

48
Q

Is DEM a reliable measure of saccadic eye movement function? Can it be used in isolation?

A

Not reliable for saccades

Not to be used in isolation

49
Q

What are three treatment options for oculomotor dysfunction? Explain why each is an option.

A

Refractive correction - will have a spinoff effect on improving eye movement
Near add - impacts on visual efficiency and therefore performance, including eye movement skills
Vision therapy
-address any accommodation/vergence problems
-address any oculomotor deficiencies
-consider other factors first before starting VT

50
Q

What 5 other factors should you consider before starting vision therapy for treatment?

A 
Neurological involvement
Poor muscle tone
Dyspraxia
Gross motor problems
Fine motor problems
51
Q

Who can you refer to for an assessment before you beign vision therapy?

A

Occupational therapist

52
Q

Can accommodative and vergence therapy alone have the potential to improve reading speed and reading eye movements? Explain.

A

Yes

Additional VT can be given for accommodative and saccadic function

53
Q

Can vision therapy be applied to oculomotor dysfunctions in acquired brain injury?

A

Yesd

54
Q

List 8 vision therapy activites for developing oculomotor skills.

A 
Saccadic pyramid fixations
Rapid fixations - find the word
Smooth pursuit activities - mazes
Computer tracking activities
Pie tin rotations - smooth pursuit
Letter/number tracking sheets
Marsden ball games
torch chases

OD3 - Clinical Optometry Practice (114 decks)

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