BVP - The Paediatric Examination: Communication and Management Approach - Week 9

Question 1

In what two paediatric cases is measuring VA not typically possible?

Answer 1

If the child is very young or unable to respond due to cognitive difficulties

Question 2

What is a possible way to begin VA testing if you are unsure of a child’s cognitive ability?

Answer 2

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

Question 3

Consider how VA is normally tested in a regular adult. How should VA be tested in children and why?

Answer 3

Normally tested monocularly, then binocularly
Best to test binocularly with children first to gain confidence and minimal disruption to the child

Question 4

When should a logMAR chart be used in a paediatric case?

Answer 4

Only when you are sure the child is able to understand

Question 5

Why shouldnt hard tests be done first on a child?

Answer 5

You risk losing the childs ability to respond reliably

Question 6

What would children typically do if they think a test is going to be too hard?

Answer 6

They will freeze or ithdraw

Question 7

At what age child would you typically expect 6/6 vision?

Answer 7

Age 7 - 6/6-

Question 8

What two tests are vital for a first examination and what additional purpose can they serve and why?

Answer 8

Stereo tests and colour vision
Both are easy to carry out and can be an ice breaker for the children

Question 9

What is an important consideration when testing children with cover test, NPC, and ocular motility?

Answer 9

They must always be interested and engaged with the fixation target

Question 10

List 7 things to look out for when testing eye movements.

Answer 10

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

Question 11

In what 4 cases should you always cycloplege when doing retinoscopy?

Answer 11

Children with:
-reduced visiond
-strabismus
-amblyopia
-whenever in any doubt

Question 12

What should always be done before cyclopleging?

Answer 12

Near tests

Question 13

Describe mohindra retinoscopy, the age group it is used for, the light settings, working distance, and the retinoscopy lens power needed.

Answer 13

Done at 50cm in the dark monocularly
-0.75D for infants
-1.25D after 2 years old

Question 14

Is it worth doing keratometry/corneal topography routinely on all newly-presenting school-aged children or only on indication?

Answer 14

Should be done routinely

Question 15

Is autorefraction accurate? What is it best with and how does it estimate?

Answer 15

Can be considered, but is best with cycloplegia and often overestimates cyl

Question 16

What is important considering that children have a very active accommodation?

Answer 16

Over-minusing needs to be especially avoided and maximum plus tolerated should be known

Question 17

What cues are children more dependent on and what does this affect?

Answer 17

They are more dependent on spatial/proximal cues, and if behind a phoropter, accuracy may be compromised due to accommodaion

Question 18

Is it worth doing a subjective refraction in children <8?

Answer 18

No

Question 19

Describe how to do a blur function.

Answer 19

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

Question 20

If a patient has asymmetric visiond, how would you do a blur function?

Answer 20

Do it monocularly

Question 21

Describe the bruckner test, light conditions, and working distance. What can an unequal reflex indicate? How would it appear with strabismus?

Answer 21

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