Final Flashcards
what type of global delays can loss of vision cause?
- cognition (object permanence- fairy phenomenon)
- speech (learn by watching others)
- motor (impedes exploring)
- psychological (bonding)
- self-care (social cues)
what is an important part of case history for pediatric low vision?
establish visual goals (school tasks, IEP or IPSP goals, community/vocational tasks, independent travel, avocational activities, reading, things they do for fun)
should you measure formal VA in a pediatric exam first?
not necessarily, more challenging than you think, maybe observe and do things like EOMs first for comfortability
what are some informal ways to measure visual acuity in peds?
- observations made during assessment, use familiar objects to estimate VA
- open hand thrust in front of face
- objection to occlusion
formal acuity tests for birth-2 years
- Teller Acuity cards
- Keeler cards
at what age do you use Cardiff cards?
3-5 years
at what age range do you usually use Lea symbols?
5-7 years
when do you use Feinbloom charts?
7 and above
does Teller Acuity over or underestimate VA?
over-estimates VA
what are some things you should take into consideration with presentation location of Teller Acuity cards
- alternate between horizontal and vertical
- consider visual field findings (hemianopias? can they see in these gazes?)
what is the testing distance of Keeler and what is one con of it?
38cm
blank side of card has open circle that can distract patient
what VA test uses targets that are vanishing optotypes at 1m or 50cm where the child makes vertical eye movements and looks/points towards the picture
cardiff acuity tests
what test distance are lea symbols calibrated for?
10 feet
what does the “visual acuity package” mean?
- no VA test in isolation can accurately and completely assess visual functioning, doctor must combine data from history, outside reports, observations, and formal and informal acuity
- remember that resolution tests overestimate VA
what test do you want to obtain if possible when evaluating ocular alignment and binocularity?
sensory fusion status, RDS if possible
what are the “3 things you need to be able to walk” according to Heyman
- vision
- vestibular (ear)
- proprioception (feet)
increased head turning with horizontal tracking on ocular motilities may indicate:
- homonymous VF loss
- neurological midline abnormalities
whats the best method for measuring accommodation?
MEM (objective) and patients with low vision have weird accommodation
do we evaluate contrast sensitivity on every low vision peds patient?
- no, low data point because most have poor contrast
- may test (Ex: Hiding Heidi) if child’s VA is better than low vision range but they aren’t performing well
- always want to have high contrast accommodations for low vison kids
what cognitive level does a child have to be for color naming?
3-4 years
what is the most common type of adaptation used to manage low vision peds patients?
relative distance magnification
hold the material closer to the eye
what type of mag is using enlarged print ?
relative size magnification
what are some considerations to make when selective prescriptive low vision devices?
- choose aids with a need/goal in mind
- consider cognitive ability, motor ability, visual ergonomics (like slant boards, classroom seating)
list management options for a Preschool/Early Elementary age kid with mild to moderate impairment
- Srx, reading add
- Paperweight- stand mag (go-to)
- filters (ex: transitions)
- classroom modifications (ex: slantboard)
list management options for a Preschool/Early Elementary age kid with moderate to severe impairment
- Srx
- CCTV/ video mag
- filters
- classroom modifications
list management options for a Older Elementary Age kid with mild to moderate impairment
- hand held telescope (prerequisite to bioptic)
* in addition to early age stuff
list management options for a Older Elementary Age kid with moderate to severe impairment
- portable video magnification
* in addition to early age stuff
list additional management options for a middle school to high school age kid with mild to moderate impairment
- bioptic
- laptop
list additional management options for a middle school to high school age kid with moderate to severe impairment
- portable video magnification
- laptop w/video magnification
what information do you include on a vision report
- visual acuity
- refractive status
- sensory status
- ocular health
- recommendations/ classroom accommodations (slant board, large print, seating (null point considerations))
which “team member” assesses student, writes individual education plan, and usually has daily contact with parents and patient?
classroom teacher
what is part of an occupational therapy evaluation?
- standardized testing and clinical assessment
- identifies factors attributing to delays
- sets up goals and treatment plan
what is a key goal for occupational therapy?
sensory integration (tactile, touch, proprioception, vestibular, etc.)
definition of physical therapist
therapeutic treatment designed to prevent or alleviate movement dysfunction through the use of exercise and physical agents
what types of language concerns does a speech and language therapist work on?
- language stimulation
- auditory processing
- augmentative and alternative communication
- auditory training and total communication
what does an audiologist do?
- determines if hearing is normal (various testing strategies)
- treats any loss (hearing aids, cochlear implants)
list some goals of orientation training
- develop confidence moving within classroom
- sound sourcing and echolocation
- develop body awareness including parts, laterality, and directionality
- develop simple routes at school
- eventually move into community
list some goals of mobility training
- develop curiosity to move in environment
- teach protective skills
- develop pre-cane skills such as trailing
- introduction of aids such as white cane if appropriate
- basic skill development
- travel of routes at school and into community
what does a “teacher of the visually impaired” do?
- adapts education materials as needed snd works closely with optometrist
- trains student on the use of low vision aids Rxed by OD
- provides Braille and pre-Braille activities (visual stimulation)
- technology help, with the school district
what are some pre-braille and braille teaching techniques?
- tactile information books
- cupcake tin
- swing cell (horizontal for typing and vertical for reading)
what are the 3 types of Braille?
I- no contractions
II- over 200 contractions
III- no punctuation
what type of Braille is used for math>
Nemeth code
what adult low vision patients can benefit from occupational therapy?
-patients with poor ADL skills
-patients who need EV training
(need 20/70 or worse for Medicare billing)
what is the department of rehab and how do you get services from them?
- state agency that supports individuals with disabilities
- must have goal of becoming a productive member of society (patient needs to have a plan), adults only
- DOR will provide education and low vision services and each patient is assigned a counselor
what does the Braille Institute do?
-nonprofit organization in So-cal offering free classes to eliminate barriers to a fulfilling life (cooking, assistive technology, Q&M, art, daily living skills, support services)
what does the Dayle MacIntosh Resource center do>
- nonprofit organization offering free services to persons with disabilities to help them live fully and independently (for senior citizens, don’t have to be blind)
- services are advocacy, aging with vision loss, assistive tech, transition programs, deaf services, and disability awareness/ ADA training
common causes of low vision from reduced acuity (blurred vision)
- albinism
- cataract
- cortical visual impairment
- congenital nystagmus
management of patients with reduced acuity
- determine mag for near, intermediate, and distance
- determine most appropriate devices depending on ability to use devices to meet visual goal
- use of CLs to dampen nystagmus
common causes of low vision from central field loss
- ARMD
- diabetic retinopathy (CSME)
- cone dystrophy
- Stargardt
- macular dystrophy
management of patients with central field loss
- determine best eccentric viewing location
- train and make EV efficient and visual skills in relation to EV
- determine mag needs and appropriate devices
- respond well to magnification
common causes of low vision from peripheral field loss
- glaucoma
- traumatic brain injury
- retinitis pigmentosa
- stroke
management of patients with peripheral field loss
- assess visual field loss and impact on safe independent travel
- train visual skills (scanning, locating, searching)
- manage night blindness (prolonged light/dark adaptation, normal light levels may appear dim) so use reverse TS, mirror, minus lens but limited response to magnification
common causes of low vision with reduced contrast sensitivity and glare sensitivity
- optic atrophy
- corneal dystrophies/degenerations
- cataract
- pretty much any disease can cause it
management of patients with reduced contrast sensitivity and glare sensitivity
- evaluate filters (NOIR, tints, coatings, acetate sheets, lighting)
- typscope, bold-lined paper, felt tip pens
- provide magnification as needed
- consider contrast enhancing magnifiers (like CCTV)
define Albinism and its inheritance patterns and prevalence
- congenital condition characterized by the lack of pigment (body’s inability to produce pigment) or reduced pigment
- can be oculocutaneous (AR or AD 1:20,000), tyrosinase-negative (severe) and tyrosinase-positive (better acuity)
- can be ocular albinism (X-linked 1:40,000)
what is the expected acuity for the different types of Albinism
- tyrosinase-neg: 20/200-20/400
- tyrosinase-pos: 20/200 or better
- ocular albinism: 20/40-20/100
In Albinism, what is normal or abnormal for color vision, VF, and stereo?
- color vision normal
- visual fields full
- lack of stereo (b/c optic nerve fibers do not cross at optic chiasm)
what are other ocular signs in albinism?
- white eyebrows and eyelashes
- irides light blue with transillumination causing photophobia
- lack of foveal pigment with macular hypoplasia
- nystagmus
- high hyperope, myope, or with-the-rule astigmatism
- strabismus
what are 2 other associated sydromes with Albinism and what questions should you add to your case history for them?
- Hermansky-Pudlak: Puerto Rican that easily bruises, epistaxis, profuse bleeding with injury due to serum platlet defect (Bleed a lot?)
- Chediak-Higaski: rare, increased susceptibility to infection (get sick a lot?)
low vision management for Albinism patient
- correct refractive error with glasses or contacts, which may improve acuity and reduce the nystagmus
- control illumination with tints, aperture control contacts, UV, visors, hats, etc.
- magnification at distance and near, will usually respond as predicted
- ideal low vision patient without central or peripheral defect
- telescopes (monocular or bioptic for driving)
- prism, if null point causes head turn/tilt
- genetic counseling
- support groups (NOAH)
Stargardt macular dystrophy: what is it and what is the inheritance pattern?
“fundus flavimacultus” characterized by a “beaten bronze appearance to the fovea with parafoveal flecks (fish shaped)
- Juvenile Macular Degeneration
- autosomal recessive
low vision management of Stargardt macular dystrophy patients:
- vocational rehab and counseling (b/c young patients)
- refractive error correction
- eccentric viewing techniques
- mag and distance and near
- direct illumination
- filters, sun lenses, non-optical
- support groups
what are some special considerations for low vision devices with a diabetic patient
- opt for flexible easy modified or adaptable systems
- avoid expensive custom made systems that are fixed-focused or unadaptable
- realize several different powers may be needed by diabetic patient due to changing visual status
special low vision considerations for myopic degeneration patients
- best Rx, note vertex (soft or rigid contacts best option is not contraindicated)
- spectacle design (poly, 1.66 or 1.74, myodisc or blended myodisc, rolls and polish, A/R coating (front and back)
- magnification devices (distance and near)
- simply removing Rx provides built in microscope
- clip on telescope system may not work due to edge thickness of Srx
- can use handheld telecscope w/Srx
- O&M referral if extensive PRP, cyro or scleral buckle
define retinitis pigmentosa
a group of retinal hereditary dystrophies characterized by progressive visual field loss, night blindness, and abnormal ERG
what are the different inheritance patterns for RP and % affected in each
- AR (60-80%)
- AD (10-25%) milder and later onset
- X-linked (5-18%) severe and earlier onset
odds 1 in 2,000 to 1 in 7,000 (males>females)
ocular signs and symptoms of RP
- bone spicule pigment formation, loss of pigment, motheaten, prominent choroidal vasculature, attenuated retinal arterioles, waxy pallor, smaller c/d ratio, ONH drusen
- CME, PSC
- night blindness
- delayed dark and light adaptation speed
- decreased color sensitivity, photophobia
constricted visual field symptoms
- prolonged light/dark adaptation
- normal light levels may appear dim
- use reverse TS, mirror, minus lens
- limited response to magnification
strategy for constructed visual field
- assess visual field loss and impact on safe independent travel
- train visual skills (scanning, locating, searching)
- night blindness
- consider other technologies in rehab plan
what magnification on a telescope is ideal in an end stage glaucoma patient
2.5x or 2.8x hand held galilean for both magnification and minification (easy to use)
what is rod monochromatism and what inheritance pattern
true color blindness
AD
what is blue cone monochromatism and what inheritance pattern
loss of red/green cones
X-linked
ocular signs and symptoms of achromatopsia
- VA 20/60-20/200, better in dim
- reduced central acuity in bright light
- decreased color perception
- photophobia (extreme)
- nystagmus
- blonde fundi and RPE disturbances in macula
low vision management in achromatopsia
- reduce illumination with filters, tints, and sideshields
- red tinted or dark tinted lenses and sunglasses
- magnification devices for distance and near
- genetic counseling
- support groups
