BVP - Development of Visual Function and Review of Paediatric Examination - PAP Week 1

Question 1

Describe the growth of the infant eye in the first three years of life (2).

Answer 1

Grows rapidly in the first two years of life, then slows dramatically after three years of life

Question 2

Does the average retinal thickness at the fovea in infants increase or decrease with age?

Answer 2

Increases

Question 3

Does the development of the eye depend on the eye itself? Explain.

Answer 3

Has very little to do with the eye, and more to do with multiple regions of the brain

Question 4

When is visual acuity expected to be fully developed (not necessarily 6/6+ vision)?

Answer 4

Around three years of age

Question 5

How can the visual acuity of infants be measured? Give the equivalent of 6/6 visiond.

Answer 5

Using forced preferential looking in infants, typically involving a large card with flaps to reveal gratings.
30 cycles per degree is 6/6

Question 6

When is 6/6+ vision typically achieved?

Answer 6

5-6 years of age

Question 7

Describe an electrophysiological method to measure visual acuity and compared to psychophysical tests, what is the acuity development like?

Answer 7

Visually evoked potentials

Compared to psychophysical tests, it shows acuity develops more rapidly

Question 8

Using preferential viewing tests, at what age does visual acuity level out to adult levels, and how quickly/consistently?

Answer 8

Improves from birth, increasing at a steady pace to adult levels at around age 3

Question 9

At what age can 6/6+ vision be expected with Lea matching symbols?

Answer 9

Around age 6

Question 10

Describe at what ages the dispersion of refraction is largest, and narrowest.

Answer 10

Largest shortly after birth
Narrows at 6 months
Narrowest at 6 years

Question 11

The spherical equivalent Rx at what age of a child is the most predictive of later spherical equivalent?

Answer 11

At age 1

Question 12

Children with what kind of spherical equivalent and astigmatism rule (2) are more likely to be myopic vs the other astigmatism rule?

Answer 12

Children with a negative spherical equivalent in infancy and against-the-rule astigmatism (x180) or no astigmatism are more likely to be myopic at school age than children with infanile with-the-rule astigmatism (x90)

Question 13

Compare the incidence of myopia in children of two myopic parents vs children of just one or none.

Answer 13

Increased incidence of myopia in children with two myopic parents vs one or none

Question 14

Does the refractive state of most children change very much after around 12 months?

Answer 14

No, minimal changes

Question 15

List three red flags when examining children.

Answer 15

No eye-eye contact >6 months
Large, slow, roving nystagmus
Slow roving eye movements

Question 16

How does the dosage of cyclopentolate differ between pale and dark irises?

Answer 16

Pale irises - 0.5% recommended

Otherwise 0.5% for 0-6 months, and 1% for 6+ months

Question 17

Describe Mohindra retinoscopy, including the room illumination, working distance, mono/binocularly, and neutralisation.

Answer 17

Done at 50cm in a darkened room monocularly

Neutralise, then add -0.75D for infants and -1.25D for >2 years

Question 18

What does Mohindra retinoscopy correlate well with?

Answer 18

Reasonably well with cycloplegic refraction but not the same result

Question 19

When should Mohindra retinoscopy be done? Can it be relied upon in isolation?

Answer 19

When cycloplegia is contraindicated and as a supplementary refraction method
Shouldnt be relied on in isolation

Question 20

Describe a blur function and its purpose (2).

Answer 20

It evaluates maximum plus and controls accommodation
Using a trial frame, add +1.00D to +1.50D over ret findings binocularly
Using a randomised chart, make the letters smaller while making it easier to see
Continue until their vision plateaus or maximum plus at 6/6

Question 21

Write a general checklist for a paediatric eye exam (12).

Answer 21

Vision (binocular first, then monocular)
Cover test
NPC (check for suppression)
Excursions (check for head movement)
Retinoscopy
Stereopsis
Colour vision
Topography/autorefraction
Refraction (blur function or subjective if old enough)
Ocular health
Binocularity
Visual efficiency