BVP - Development of Visual Function and Review of Paediatric Examination - PAP Week 1 Flashcards
Describe the growth of the infant eye in the first three years of life (2).
Grows rapidly in the first two years of life, then slows dramatically after three years of life
Does the average retinal thickness at the fovea in infants increase or decrease with age?
Increases
Does the development of the eye depend on the eye itself? Explain.
Has very little to do with the eye, and more to do with multiple regions of the brain
When is visual acuity expected to be fully developed (not necessarily 6/6+ vision)?
Around three years of age
How can the visual acuity of infants be measured? Give the equivalent of 6/6 visiond.
Using forced preferential looking in infants, typically involving a large card with flaps to reveal gratings.
30 cycles per degree is 6/6
When is 6/6+ vision typically achieved?
5-6 years of age
Describe an electrophysiological method to measure visual acuity and compared to psychophysical tests, what is the acuity development like?
Visually evoked potentials
Compared to psychophysical tests, it shows acuity develops more rapidly
Using preferential viewing tests, at what age does visual acuity level out to adult levels, and how quickly/consistently?
Improves from birth, increasing at a steady pace to adult levels at around age 3
At what age can 6/6+ vision be expected with Lea matching symbols?
Around age 6
Describe at what ages the dispersion of refraction is largest, and narrowest.
Largest shortly after birth
Narrows at 6 months
Narrowest at 6 years
The spherical equivalent Rx at what age of a child is the most predictive of later spherical equivalent?
At age 1
Children with what kind of spherical equivalent and astigmatism rule (2) are more likely to be myopic vs the other astigmatism rule?
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)
Compare the incidence of myopia in children of two myopic parents vs children of just one or none.
Increased incidence of myopia in children with two myopic parents vs one or none
Does the refractive state of most children change very much after around 12 months?
No, minimal changes
List three red flags when examining children.
No eye-eye contact >6 months
Large, slow, roving nystagmus
Slow roving eye movements
How does the dosage of cyclopentolate differ between pale and dark irises?
Pale irises - 0.5% recommended
Otherwise 0.5% for 0-6 months, and 1% for 6+ months
Describe Mohindra retinoscopy, including the room illumination, working distance, mono/binocularly, and neutralisation.
Done at 50cm in a darkened room monocularly
Neutralise, then add -0.75D for infants and -1.25D for >2 years
What does Mohindra retinoscopy correlate well with?
Reasonably well with cycloplegic refraction but not the same result
When should Mohindra retinoscopy be done? Can it be relied upon in isolation?
When cycloplegia is contraindicated and as a supplementary refraction method
Shouldnt be relied on in isolation
Describe a blur function and its purpose (2).
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
Write a general checklist for a paediatric eye exam (12).
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
