BVP - The Paediatric Examination: Communication and Management Approach - Week 9 Flashcards
In what two paediatric cases is measuring VA not typically possible?
If the child is very young or unable to respond due to cognitive difficulties
What is a possible way to begin VA testing if you are unsure of a child’s cognitive ability?
Start with a single big symbol that is easy, so the child feels that what you are asking is easy and will have a go
Consider how VA is normally tested in a regular adult. How should VA be tested in children and why?
Normally tested monocularly, then binocularly
Best to test binocularly with children first to gain confidence and minimal disruption to the child
When should a logMAR chart be used in a paediatric case?
Only when you are sure the child is able to understand
Why shouldnt hard tests be done first on a child?
You risk losing the childs ability to respond reliably
What would children typically do if they think a test is going to be too hard?
They will freeze or ithdraw
At what age child would you typically expect 6/6 vision?
Age 7 - 6/6-
What two tests are vital for a first examination and what additional purpose can they serve and why?
Stereo tests and colour vision
Both are easy to carry out and can be an ice breaker for the children
What is an important consideration when testing children with cover test, NPC, and ocular motility?
They must always be interested and engaged with the fixation target
List 7 things to look out for when testing eye movements.
Smoothness of pursuits
Attention to task
Accuracy of saccades
Accuracy when crossing the midline
Difficulty when using only one eye
Reliance on head to guide movement
Excessive head/body movements
In what 4 cases should you always cycloplege when doing retinoscopy?
Children with:
-reduced visiond
-strabismus
-amblyopia
-whenever in any doubt
What should always be done before cyclopleging?
Near tests
Describe mohindra retinoscopy, the age group it is used for, the light settings, working distance, and the retinoscopy lens power needed.
Done at 50cm in the dark monocularly
-0.75D for infants
-1.25D after 2 years old
Is it worth doing keratometry/corneal topography routinely on all newly-presenting school-aged children or only on indication?
Should be done routinely
Is autorefraction accurate? What is it best with and how does it estimate?
Can be considered, but is best with cycloplegia and often overestimates cyl
What is important considering that children have a very active accommodation?
Over-minusing needs to be especially avoided and maximum plus tolerated should be known
What cues are children more dependent on and what does this affect?
They are more dependent on spatial/proximal cues, and if behind a phoropter, accuracy may be compromised due to accommodaion
Is it worth doing a subjective refraction in children <8?
No
Describe how to do a blur function.
Add about +1.00 to +1.50 over ret findings binocularly
Warn that things will be blurry
Ask them to read the best they can, slowly add minus
Keep going until they either plateau or 6/6
If a patient has asymmetric visiond, how would you do a blur function?
Do it monocularly
Describe the bruckner test, light conditions, and working distance. What can an unequal reflex indicate? How would it appear with strabismus?
In a dim room, at 1m away, shine a direct ophthalmoscope directly at the nose bridge, illuminating both pupils
Unequal reflex could indicate refraction differences between the eyes
If strabismus, deviated eye looks whiter/brighter