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Pediatric Optometry > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What ratio of pediatric patients will develop amblyopia?

A

1/30

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2
Q

What ratio of pediatric patients will develop strabismus

A

1/25

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3
Q

What ratio of pediatric patients will show a significant refractive error?

A

1/33

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4
Q

What ratio of pediatric patients will show eye disease?

A

1/100

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5
Q

How commonly does a vision disorder cause disability in the United States?

A

4th most common!

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6
Q

What is the most common handicapping condition of childhood?

A

Visual problems

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7
Q

What percent of children aged 9-15 need glasses? Of this percentage, how many of those children have glasses?

A

20% need glasses

10% of the 20% have them

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8
Q

How likely are pediatric patients to have had a comprehensive eye exam by age 6? 6-16?

A

By age 6: 14%

Ages 6-16: 31%

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9
Q

Explain how common vision screenings are by pediatricians. What is a pediatrician’s vision screening?

A

66% of pediatricians do vision screenings
A vision screening is: “When 10 seconds are taken to evaluate a patient’s vision by trying to get the patient to cooperate”

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10
Q

How common is it for a patient to fail a vision screening and have the parents unaware?

A

50% of children who have failed a vision screening have parents who are unaware 2 months later!

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11
Q

What are some of the primary benefits of pediatric eye exams? What are some secondary benefits?

A

Primary Benefits:

  1. Early detection and treatment of amblyopia
  2. Early detection and treatment of strabismus
  3. Early detection of significant disease

Secondary:

  1. Looks good for our profession, more recognition of contribution to public health
  2. Importance of vision in normal development can be stressed
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12
Q

What are the different stages of pediatric patients?

A 
Premie: Less than 37 weeks. 
Neonate: 0-28 days
Infant: 29 days - 11 months
Toddler: 1 - 3 years 
Child: 3- 13 years
Adolescent: 10-19 years
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13
Q

Explain adjusted age with premies.

A

Premies are born at less than 37 weeks and this can affect developmental milestones. Adjusted age is calculated by determining the time between birth and the due date to appropriately scale developmental milestones

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14
Q

What are the AOA frequencies of examination for different age groups?

A 
A = Asymptomatic
R = At risk

Birth-24 months:
A: 6 months
R: 6 months/as recommended

2-5:
A: 3 years
R: 3 years/as recommended

6-18:
A Before 1st grade, then every 2 years
R: Annually/as recommended

18-60:
A: Every 2 years
R: Every 1-2 years/as recommended

61+:
A: Annually
R: Annually/as rec

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15
Q

What are some purposes of an infant eye exam?

A
  1. Optimize visual function that is important for the development of the infant

Determine if the eyes are straight, healthy, and can the baby see? Do you need to intervene to:

a) improve vision
b) prevent/treat an eye turn
c) prevent amblyopia
d) prevent/treat an ocular health issue

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16
Q

When is the best time for a pediatric eye exam?

A

The best time is in the morning or after a nap. Patients will not be as well behaved if the appointment is during the scheduled nap time!

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17
Q

How do you navigate an infant eye exam?

A

Base your judgment and prescribing on observation, reflexes and gauge your expectations. Don’t expect perfect vision, just make sure basic functions are present

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18
Q

What is the assessment protocol for pediatric eye exams?

A
  1. VA:
    Fix and follow
    Richman Face Paddles
    Vertical Prism
  2. RE:
    Mohindra
    Cyclo
3. BV: 
CT
Vertical Prism
Bruckner
Hirschberg
  1. Motility:
    EOM
5. Health: 
Visual field 
Pupils
Gross external 
Dilated internal
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19
Q

What are some important questions to ask regarding case history for infant eye exams? (6)

A

Normal developmental milestones met?
Full-term pregnancy? (less than 37 weeks is preterm)
Normal birth weight?
Problems during pregnancy/delivery?
Medical issues?
Any current therapies or medical interventions?

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20
Q

When are three important ages that the average pediatric patient should have an eye exam?

A

Before age 1
At age 3
Before 1st grade

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21
Q

What percent of pediatric patients have never had an eye exam?

A

70%!

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22
Q

What is a good range of RE for an infant?

A

Plane - +4.00D

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23
Q

What are the two main objectives for VA’s in pediatric patients?

A

Quantitative: What is the acuity threshold? OD? OS? OU?
Qualitative: Are they adapting, using both eyes?

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24
Q

What are 3 ways to perform VA on pediatric patients?

A

Fix and follow
Resistance to occlusion (Will get fussy if having to use “bad” eye)
Vertical prism (Eyes will jump between if using both eyes)

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25
Q

What are three ways you can quantify VA on pediatric patients?

A
  1. Detection acuity with Cardiff cards
  2. Resolution with lea paddles or teller paddles
  3. Recognition by naming/matching
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26
Q

What age/situations would preferential looking be optimal for?

A

0-12 months or developmentally delayed.
The child will look at black/white lines instead of grey. You continue to decrease contrast until the child alternates fixation (cannot see grating anymore)

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27
Q

What is the VEP?

A

Visually Evoked Potential

Measures electrophysiological response to light. This is more reliable than preferential looking but is more expensive

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28
Q

What is the difference between static and dynamic ret?

A

Static occurs when fixation is at optical infinity and is relaxed
Dynamic involves near accommodative abilities

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29
Q

Explain the Mohindra Technique.

A

Near ret performed in a dark room at 50cm. If performed monocularly, subtract 1.25D from neutralizing lens. If performed binocularly, subtract 0.75 - 1.0 D from neutralizing lens

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30
Q

Autorefraction has minimal value without ___________.

A

cycloplegia

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31
Q

What are the expected results for Hirschberg?

A

Equal reflexes that are ~+1.00mm nasal

1mm = 20^

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32
Q

What are some rules of thumb for birth weight in children?

A

Should double by 5 months
Should triple in 1 year
Should quadruple in 1.5 years

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33
Q

What is the rule of thumb for the length of a newborn?

A

Should increase 1.5x in 1 year

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34
Q

What are the body structure proportions as a person develops from birth to adolescence?

A 
Head should increase 2x 
(Head contributes 1/4 of birthweight, 1/12 of weight at maturity) 
Trunk should increase 3x
Upper extremities should increase 4x
Lower extremities should increase 5x
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35
Q

What are tissue proportions as a person develops from a newborn to an adult?

A

Muscle:
Neonate -> 20%
Adult ->45%

Internal Organs:
Neonate -> 15%
Adult -> 10%

Nervous System:
Neonate -> 15%
Adult -> 3%

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36
Q

What point in embryological development is the eye discernable? When are structures identifiable?

A

The eye is discernable in 3 weeks

Structures are identifiable by 5 weeks

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37
Q

What are the two goals of eye development?

A

Create a transparent optical system

Develop neural transmission of information

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38
Q

What is the master control gene for eye formation?

A

Pax-6

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39
Q

What occurs in the embryonic period? When is the embryonic period?

A
  1. Mesoderm surrounds the optic vesicle (day 26)
  2. Mesenchyme fills the optic cup with vitreous and supplies early posterior chamber with blood supply
  3. The early hyaloid system is formed by the end of the second month
    Embryonic period is Up to 9 weeks
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40
Q

When is the fetal period?

A

Fetal period is 9 weeks of gestation (63 days) to birth

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41
Q

Abnormalities in the fetal period result in _______ abnormalities whereas abnormalities in the embryonic period result in _______ abnormalities.

A

Fetal: functional problems
Embryonic: Structural

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42
Q

What occurs before the eyes open in the gestational period?

A

Retinal structures have differentiated and formed. Axons connecting retinal to LGN to cortex have connected

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43
Q

When do axons enter the LGN from the optic tract?

A

7-8 weeks

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44
Q

What is Hebb’s Law?

A

Neurons that fire together wire together

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45
Q

Explain LGN formation and the probability of vision problems.

A

If LGN is formed and then there is a problem, likely there will be a significantly lower risk of vision problems occurring. If a problem is before LGN forms, there is a higher chance of vision problems.

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46
Q

When are the visual cortex cells developing?

A

6 weeks to 5 months

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47
Q

Which layer of the cortex is formed first in development?

A

Innermost layer

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48
Q

When do axons from the LGN reach the cortex?

A

11-13 weeks

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49
Q

When are synapses made into the cortical plate?

A

23-25 weeks

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50
Q

When do ocular dominance columns arise?

A

AFTER the eye is open

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51
Q

Structural abnormalities are due to insult in the _______ period and functional abnormalities are due to insult in the ________ period. (REPEAT CARD)

A

Structural: Embryonic
Functional: Fetal

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52
Q

What are the three phases of axial length?

A

0-2 years: 4mm in year 1 and 2mm in year 2
2-5years: 1mm
5-13 years: 1mm

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53
Q

What is the power of the cornea at birth and what is the power at 6 months? What is the corneal power at 12 months?

A

Birth: 52D
6 Months: 46D
12 Months: 42-44D

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54
Q

What is the diameter of the cornea at birth? As an adult?

A

Birth: 10mm, +/- 0.5mm
Adult: 12mm

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55
Q

When does OKN become apparent? (Pursuits/Saccades)

A

34 weeks

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56
Q

Which gaze, horizontal or vertical is established at birth? Which takes 6 months?

A

Birth: Horizontal

6 Months: Vertical

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57
Q

When do Accommodation and NPC develop?

A

3 months

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58
Q

When are melanin deposits evident on the iris?

A

6-12 months

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59
Q

When is the pupil reactive?

A

31 weeks (2 months before birth)

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60
Q

What is a normal pupil size in an infant -> 2-year-old?

A

5mm

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61
Q

What is the typical IOP measurement in infants? What about in school-age children?

A

Infant: 10-12mmHg

School-age: 14mmHg

62
Q

When are cones differentiated?

A

4 years after birth

63
Q

When does myelination of the optic tract finish?

A

2 years after birth

64
Q

When does a patient first have normal acuity (~20/20)

A

6-7 months old

65
Q

Is optokinetic nystagmus normal in infants?

66
Q

In what situations will an infant have OKN regardless of the direction that the drum spins?

A

Binocular situations and monocular situations when the infant is 3 months or older

67
Q

In what situations will an infant have OKN in temporal to nasal direction but NOT nasal to temporal direction?

A

Monocular situations when aged 1-2 months

68
Q

What does an asymmetric OKN response in children indicate?

A

Abnormal binocularity. This may be strabismus or amblyopia!

69
Q

When do infants develop stereopsis?

70
Q

What is the typical timetable for color vision development? When does color vision reach near-adult levels?

A

1 month: Improved blue/green vs gray
3 month: red/yellow/green/blue vs gray

Confirmed with preferential looking

Adult like levels of color vision occur around 3-4 months but the threshold is much higher (lower sensitivity)
VEP says the color threshold is adult-like in early teenage years

71
Q

What are some causes of disrupted development? Name 3-4.

A 
Nutrition 
Teratogens
Trauma
Prematurity
Genetics
Hypoxia
Fever
Infection
Sensory Deprivation
Sleep Deprivation
72
Q

How might the malnutrition of the mother impact development?

A

The mother must be severely malnourished for there to be an impact. One example is once the fetus is pulling calcium from the bones. If this occurs there will likely be a low birth weight

73
Q

What are 3important nutrients that are essential for normal development?

A

Folic Acid: Prevents Spina Bifida
Iodine: Deficits cause slow growth/impaired neural dev
Omega 3’s: Promote vision and brain development

74
Q

How does type II diabetes impact pregnancy?

A

Parents are are type II must take insulin to control diabetes while pregnant to prevent drug issues.

75
Q

What are some teratogen examples that can impact fetal development?

A

Lead
PFC
Phthalates (food packaging/makes plastic soft) CAUSE SPEECH DELAYS

76
Q

What are three examples of trauma that may cause fetal/child developmental problems?

A

Birth trauma
Immature vasculature (cerebral palsy)
Acute accidents (TBI) -> Learning disabilities
Chronic subclinical concussion (soccer/football hits)

77
Q

What are some examples of the impact of prematurity on growth and development?

A

Prematurity can cause a low birth weight. If vasculature is not fully developed, vessels can break during the birthing process and cause injury.

78
Q

What are 3 genetic conditions that can impact development?

A

Down Syndrome
Fragile X
Turner Syndrome

79
Q

How does excess TV/Video games impact development?

A

It can cause sensory deprivation. Patients who are less than 2 years of age should have minimal media exposure. Ages 2-5 should be limited to 1 hour of media per day. GET OUTSIDE AND PLAY

80
Q

What supplement can you give an 8-10-year-old to improve academic performance?

81
Q

What level of fever can cause brain trauma?

82
Q

What is a low birth weight by definition?
What is a very low birth weight by definition?
What is an extremely low birth weight by definition?

A

Low Birth Weight: <2,500g (5lb 8oz)
Very Low Birth Weight: <1,500g (3lb 5oz)
Extremely low birth weight: <1,000g (2lb 3oz)

83
Q

When should a child sit unsupported?

84
Q

When should a child walk with support?

85
Q

When should a child climb stairs?

86
Q

When should a child walk unsupported?

87
Q

When should a child walk up stairs?

88
Q

When should a child alternate feet while walking up stairs?

89
Q

When should a child say double syllables?

90
Q

When should a child say two words?

91
Q

When should a child say a 3-word sentence?

92
Q

When should a child know rhymes?

93
Q

When should a child be able to count to 10?

94
Q

When should a child know colors and ABC’s?

95
Q

What are the two main factors of emmetropization?

A

Genetics: Growth: Nature
Environment: Maturation: Nurture

96
Q

What is considered the passive process of emmetropization?

A

The natural growth of the body and development of the eye.
Axial length increases
Cornea flattens
Etc

97
Q

What are 3 general trends of newborns?

A
  1. Hyperopia is more common, 88% between plano and +4.00D (average is +2.00D)
  2. Astigmatism is common and goes away in a couple of years
  3. Anisometropia is not common
98
Q

What is active emmetropization influenced by?

99
Q

At what age(s) does active emmetropization have the greatest effect?

A

First two years of life

100
Q

What is the mean refractive error by age 5-6 (school age)?

A

+1.00D +/-1.00D

101
Q

Children at age 6 with RE of _____ were at high risk for significant myopia by 6th grade.

102
Q

Which groups have less hyperopia? Which groups have more astigmatism?

A

Less hyperopia: Asians

More astigmatism: Hispanic/African American

103
Q

Which patients (RE + Posture) have more risk of myopia progression?

A

Low myopes with eso posture

104
Q

Which age group has the lowest prevalence of myopia?

A

5-7-year-olds (1-2%)

105
Q

What is a protective factor for myopia progression? What is a negative factor for myopia progression?

A

Protective: Outdoor time
Negative: Device time

106
Q

What RE has the highest prevalence?

107
Q

What are 3 conditions associated with high hyperopia?

A

Microphthalmia
Optic atrophy
Fragile X

108
Q

How does hyperopia vary with age?

A

Increased from 3-6 years by 1D
Decreased from 7-puberty by less than 1D
Congenital high hyperopia does NOT tend to progress

109
Q

At what amount of hyperopia should parents be informed the child will remain hyperopic?

A

1.50D+ in 5-6-year-old

110
Q

During what age does astigmatism have the highest incidence?

A

first year

111
Q

How much astigmatism might a child have at 6 months? 18 months? 24 months? How does this affect treatment?

A

6 months: 2-2.5D
18 months: 1D
24 months <0.50D

Wait for astigmatism to stabilize before you treat

112
Q

When do you need to start treating astigmatism if it significant?

A

2 years of age

113
Q

How should you treat hyperopia in kids?

A

Prescribe for optimal BV function, you don’t want a hyperope to develop strabismus or amblyopia, but you don’t want to impair emmetropization. Better to have a patient be hyperopic than eso or amblyopic!

114
Q

What is 3x3 rule?

A

3 visits over at least a 3-month span

115
Q

What are some complications of uncorrected hyperopia?

A

> 2.00D risk increases for strabismus, amblyopia, and learning difficulties

116
Q

What is a likely cause of anisometropia?

A

BV issues, fix the BV issue, fix the anisometropia

117
Q

What is the single highest risk factor for developing amblyopia?

A

Anisometropia

118
Q

Is anisometropia more problematic for myopes or hyperopes?

119
Q

What is the main goal when treating anisometropia?

A

Equal BV like lag/amps in each eye

120
Q

Which type of astigmatism (WTR/ATR/OBL) is most important to correct? Least?

A

Most: OBL
Least: WTR

121
Q

In a preschooler, myopia that is greater than _____D should be corrected.

122
Q

When should you first start fully correcting myopia in children?

A

Kindergarten age

123
Q

What are 3 ways to combat and slow myopia progression?

A

Atropine
VT
CL

124
Q

How does VT slow myopic progression? (3)

A

Improves binocularity
Improves accommodation
Improves peripheral awareness

125
Q

Where should you position a bifocal on a child?

A

Top of the segment to bisect pupil to encourage the use of bifocal

126
Q

Define the following terms.
Growth:
Differentiation:
Maturation:

A

Growth: Proliferation
Differentiation: Increased complexity
Maturation: Repeated experience and purposeful use

127
Q

What is the timing of fundamental skill development and then refinement?

A

Fundamental: 0-6 years
Refinement: 6-12 years

128
Q

What is the most important hormone in childhood?

A

Pituitary hormone. It reduces the deposition of fat and causes protein to be laid down for growth

129
Q

What directions does a person grow?

A

Head to foot (cephalocaudal)

Center to periphery (Proximodistal)

130
Q

What are the steps in motor development?

A 
1. Posture control: 
Balance 
2. Locomotion: Moving through the spatial environment
Walk/Run
3. Contact: Manipulating objects 
Grasp/Hand to hand
4. Receipt and Propulsion: Purposeful intersection with a moving object and imparting movement to an object
Catch and throw
131
Q 
What is the timeline for the following gross motor milestones?
Head control: 
Roll Over: 
Sitting: 
Walking: 
Kicking ball:
A 
Head Control: 3 months
Roll Over: 4-5 months 
Sitting: 5-8 months 
Walking: 12 months 
Kicking ball: 15 months
132
Q

What is the timeline for the following fine motor milestones?
Grasp: Voluntary let go
Grasp: Pincer and purposeful release
Hand dominance:

A

Grasp: Voluntary let go: 8 months
Grasp: Pincer and purposeful release: 12 months
Hand dominance: 12 months

133
Q

When do girls have their growth spurt? Boys?

A

Girls: 9.5-14.5 years
Boys: 11-18 years

134
Q

Are girls superior in gross or fine motor? What about boys?

A

Girls are superior in fine motor

Boys are superior in gross motor

135
Q

What are some factors that affect motor development? (5)

A 
Gender
Socio-economic status 
Health/Disease
Accidents and Injuries 
Physical impairment
136
Q

Is TV associated with activity levels in children?

A

No, but access to facilities and/or opportunities to play (like parks) is related to less activity

137
Q

What ratio of people in the US is hungry?

138
Q

How does poverty impact nutrition?

A

Poverty-stricken families buy less nutritious food, so kids aren’t eating less, they are eating normal amounts of POOR foods, which contributes to obesity

139
Q

What are the key nutrients for kids? (4)

A

Vitamin D
Vitamin A
Iodine
Iron

140
Q

What is the ocular sign of torticollis?

A

Non-commitant strabismus

141
Q

What are some non-ocular signs of torticollis?

A

Dystonia
Skeletal abnormalities
Deafness in one ear

142
Q

What are some complications of muscular dystrophy?

A

Severe myopia/glaucoma
Cant open eyes after a sneeze
CPEO (chronic progressive external ophthalmoplegia)

143
Q

How much more likely are cerebral palsy kids to have behavioral problems?

A

5x more likely

144
Q

What are some ocular characteristics of cerebral palsy?

A

Hyperopia is more common but if myopia, it is HUGE
Nystagmus
Strabismus
Blepharitis (Treat this aggressively)

145
Q

At what part of the CP scale (cerebral palsy scale) does a patient have a visual perceptual impairment?

A

3+ = 70% impairment

146
Q

What are 4 clinical tests are for gross motor?

A
  1. Denver
  2. NSUCO
  3. Standing angels in the snow
    Primitive reflexes
147
Q

What 4 clinical tests are for fine motor?

A
  1. Denver
  2. VMSP
  3. Grooved Pegboard
  4. VMI
148
Q

What are engrams?

A

grouping of neurons in which neurons develop

149
Q

What are important nutrients prenatally? (8)

A 
Vitamin B12
Vitamin C
Vitamin D
Zinc
Iron
Folic Acid
Choline
Omega-3 (DHA)
150
Q

What information resides in the left hemisphere of the brain?

A

Grammar/Vocab
Exact calculation
Fact retrevial
Routine processes

151
Q

What information resides in the right hemisphere of the brain?

A

Visual and auditory
Facial recognition
Spatial concepts
Affect (happy vs depressed)

152
Q

What proportion of the population is right-handed? left-handed?

A

Right: 70-90%
Left: 8-15%

Pediatric Optometry (2 decks)

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