Children With Special Needs and Co-Management of Pediatric Patients

Question 1

What is the life expectancy for a child with Down syndrome?

Answer 1

47 years old

Question 2

There are ________ copies of chromosome 21 in 95% of Down syndrome cases

Answer 2

three

Question 3

57-80% of people with Down syndrome have what type of refractive error?

Answer 3

Hyperopia

Question 4

Accumulating oblique eyelid pressure and the mechanical force of the eyelid are thought to be responsible for what type of refractive error?

Answer 4

Astigmatism

Question 5

One hypothesis for refractive error in children with Down syndrome is the failure to ________________

Answer 5

emmetropization

Question 6

What has been linked to myopia progression in more than half of children with Down syndrome?

Answer 6

large lag of accommodation

Question 7

Cognitive ability, mental deficiency and post-retinal reduction in acuity are thought to be linked to the lack of growth in what structure in the visual cortex?

Answer 7

Dendritic Tree Structure

Question 8

55% of children with DS have a (lead/lag) of accommodation >1.00D

Answer 8

lag

Question 9

What type of glasses helped improve reading grade levels in children with Down syndrome?

Answer 9

bifocals

Question 10

What is the overall prevalence of strabismus in children with DS?

Answer 10

19-34%

Question 11

What laterality is most common in esotropia?

Answer 11

alternating (70%)

Question 12

Why must we use caution when prescribing atropine amblyopia therapy for children with DS?

Answer 12

Atropine may increase heart rate

Question 13

What type of cataracts make up 71% of cataracts diagnosed after age 12 in children with DS?

Answer 13

Cerulean Cataracts

Question 14

What are focal areas of iris stromal connective tissue hyperplasia surrounded by relative hypoplasia?

Answer 14

Brushfield Spots (found in 52% of children with DS)

Question 15

What is thought to play a role in the development of keratoconus in children with Down syndrome?

Answer 15

itchiness of blepharitis leads to eye rubbing

Question 16

What percent of patients with autism have an ocular manifestation?

Answer 16

40%

Question 17

Do children with autism tend to have normal or reduced stereo?

Answer 17

reduced

Question 18

41% of children with autism had some form of ____________

Answer 18

strabismus

Question 19

What percent of children with autism required strabismus surgery?

Answer 19

11%

Question 20

Strabismus, amblyopia and anisometropia are (more/ less) commonly found in children with autism than children without autism

Answer 20

more

Question 21

What structural and functional abnormalities contribute to poor oculomotor control in children with autism?

Answer 21

abnormalities in cerebellar vermis lobules VI-VII, fastigial nucleus, and brainstem; atypical activation of prefrontal cortex during oculomotor tasks

Question 22

What may be an early marker for ASD?

Answer 22

oculomotor function

Question 23

fear of escalators, impaired eye-hand coordination (catching a ball), difficulty learning to drive occur as a result of reduced top-down control of which type of ocular motility pattern?

Answer 23

Pursuits

shown in fMRI as diminished activation in V5, and higher order projections of V5

Question 24

Which gender experiences milder symptoms related to fragile X syndrome?

Answer 24

females

Question 25

What condition consists of autistic-like behaviors, sensory integration and mild to severe intellectual disabilities

Answer 25

Fragile X Syndrome

Question 26

What are ocular manifestations of Fragile X?

Answer 26

strabismus, amblyopia, refractive errors, nystagmus, ptosis, convergence insufficiency

Question 27

What is the cause of cerebral palsy?

Answer 27

non progressive disturbances that occur in the developing fetal or immature brain

Question 28

What are the 4 types of Cerebral Palsy?

Answer 28

Spastic diplegia, spastic hemiplegia, spastic quadriplegia, extrapyramidal

Question 29

Vision problems are prevalent in which type of cerebral palsy?

Answer 29

spastic cp

Question 30

Which types of vision problems are prevalent in more than 50% of children with cerebral palsy?

Answer 30

Strabismus (70.5%), significant refractive error (53.3%)

Question 31

What is the typical range of reduced VA's in children with cerebral palsy?

Answer 31

20/25-20/63

Question 32

Which type of optic nerve abnormalities are found in children with cerebral palsy?

Answer 32

optic nerve cupping, optic atrophy and optic nerve hypoplasia

Question 33

Pallor is commonly seen in children with q___________ or n___-__________ cerebral palsy

Answer 33

quadriplegic, non-ambulatory

Question 34

What disorder comprises visual malfunction due to retro-chiasma visual and visual association pathway pathology?

Answer 34

Cerebral Visual Impairment

Question 35

CVI is common in children with __________ ________ and ________________

Answer 35

cerebral palsy, hydrocephalus

Question 36

CVI is secondary to to pathologies affecting what pathways?

Answer 36

visual pathways, pathways serving higher visual functions

Question 37

what can CVI interfere with?

Answer 37

* Visual guidance of eye, head, and body movement; * visual search and attention; * visual acuity, fields, contrast perception; * face, object, route recognition

Question 38

Where does image data under go basic processing

Answer 38

occipital visual cortex

Question 39

What area of the brain creates a visual representation of the surroundings?

Answer 39

posterior parietal lobes that are connected to visual cortex by the dorsal stream

Question 40

What does the ventral stream do?

Answer 40

matches incoming information with prior visual memories | Ventral stream: What

Question 41

Damage or malfunction of the visual association territories of the brain and their pathways causes what?

Answer 41

Visual perception dysfunction

Question 42

What kind of changes happen in the brain in response to ocular blindness?

Answer 42

structural and functional changes

Question 43

What are the 3 groups of patients with CVI?

Answer 43

1. Profound visual impairment 2. impaired but functionally useful vision with cognitive and often motor challenges 3. impaired but functionally useful vision and work at or near expected academic level for their age

Question 44

What are the causes of CVI?

Answer 44

1. Hypoxic-ischemic encephalopathy 2. TBI 3. Infections of CNS 4. Neonatal hypoglycemia 5. Metabolic Disorders 6. Seizure disorder 7. Maternal intake of drugs 8. Acquired causes of CVI (respiratory arrest, head injury, cardiac arrest, focal infection, cerebrovascular accident, encephalitis) 9. Cerebral Palsy 10. Hydrocephalus 11. Williams Syndrome 12. Autism

Question 45

Children with CVI often have preference for a specific color; in general, ____________ is better

Answer 45

brighter

Question 46

What does visual latency look like in a child with CVI?

Answer 46

may take time for a child with CVI to look at an object

Question 47

What are some ways to help a child with CVI that has difficulty with visual complexity?

Answer 47

provide simpler colored objects (single colored stuffed animals); use solid color backgrounds

Question 48

What does light gazing and non-purposeful gazing look like in a child with CVI?

Answer 48

staring at lights, gazing out windows, looking at things not there

Question 49

What does visual field preferences look like in a child with CVI?

Answer 49

child will prefer to look at objects in particular direction

Question 50

what does it look like when a child with CVI has impaired visually guided reach?

Answer 50

often look away from object, then reach for it

Question 51

What are ocular manifestations of spina bifida?

Answer 51

strabismus, amblyopia, nystagmus, coloboma, optic nerve abnormalities

Question 52

# When considering global developmental delays What are the developmental domains?

Answer 52

gross or fine motor; speech/language; cognitive; social/ personal; ADL | GDD: significant delay in 2 or more domains ## Footnote GDD is the term used for children under 5; ID is used for older children (IQ testing reliable)

Question 53

GDD can predict future ID, but milder delays may be ___________

Answer 53

transient | kids may catch up

Question 54

What 3 questions are we most concerned with when examining a patient with special needs?

Answer 54

Can the child see? Are the eyes aligned? Are the eyes healthy?

Question 55

Congenital exotropia is a large angle divergent strabismus that presents at what age?

Answer 55

within 1st year of life

Question 56

What other abnormalities is congenital exotropia associated with?

Answer 56

neurological abnormalities or craniofacial syndromes

Question 57

What type of surgery is typically used for congenital exotropia? | congenital XT > 35 PD

Answer 57

bilateral LR recessions or monocular MR resection with LR recession

Question 58

What are 3 types of exotropia?

Answer 58

sensory, consecutive, convergence insufficiency

Question 59

When do we refer for congenital esotropia?

Answer 59

constant alternating esotropia before 6 months

Question 60

What are characteristics of congenital esotropia?

Answer 60

associated latent nystagmus, IOOA, DVD; typically > 30 pd

Question 61

What is the goal of surgery for congenital esotropia?

Answer 61

align to within 8pd of ortho

Question 62

what type of surgeries are used for congenital esotropia?

Answer 62

bilateral MR recessions, bilateral LR resections, uniocular MR recession or LR resection

Question 63

Are cranial nerve palsies comitant or noncomitant deviations?

Answer 63

noncomitant

Question 64

What condition is a congenital hypoplasia or absence of CN6 nerve or nuclear that results in abnormal innervation of LR by CN III?

Answer 64

Duane Syndrome

Question 65

Globe ____________ and palpebral fissure __________ are seen in Duane syndrome

Answer 65

retraction, narrowing

Question 66

What causes deprivation amblyopia?

Answer 66

structural abnormalities (ptosis or other asymmetric lid abnormalities, corneal opacities, hyphema, cataract, vitreous hemorrhage)

Question 67

What visual findings are associated with learning problems?

Answer 67

hyperopia, anisometropia, exophora, low vergence ranges, reduced or asymmetric near VA; accommodative infacility and poor oculomotor control

Question 68

What are categories of an IEP that optometrists might be involved in?

Answer 68

specific learning disability, visual impairment; deaf-blindness; traumatic brain injury