Optometric Examination in Children Flashcards
Why is paediatric optometry important?
Its the best way of monitoring visual development - the majority of strabismus start to be noticed around 18-32 months.
If a child comes in for their first eye test ever what components/features of an eye exam would you pay extra attention to?
History and symptoms
Investigating visual acuity, binocularity, colour vision.
Any management they would need going forward.
Parents will often say a child has a ‘squint’ - why is this language problematic?
You don’t know whether they mean that the child screws up both their eyes to have a look in to the distance or whether one eye turns in - you really need to clarify this!
Why is an intermittent manifest deviation in a 2 month old not uncommon?
Sensory and motor fusion develop between the ages of 3 to 6 months therefore an intermittent manifest deviation is not uncommon before this age
What additional questions would you ask in a paediatric examination?
Birth history
Full Term Normal Delivery (FTDN)?
Whether they have Low birth weight (this is around 2.5kg, 5lb 8oz)
Or were a Premature birth
Or for any Problems in utero or on delivery
Developmental history
Normal developmental milestones achieved
Sitting up, walking, talking
If a parent notices the same eye constantly turning in/out is amblyopia more or less likely to be the cause?
More likely to be the cause
If a parent notices different eyes constantly turning in/out in their child, is amblyopia more or less likely to be the cause?
Amblyopia is less likely to be the cause for an alternating deviation
If a deviation has an early onset is it more or less likely to be an accommodative issue, and so is surgery required or not?
Early onset, most likely non-accommodative, surgery probably required
If a deviation has an late onset is it more or less likely to be an accommodative issue, and so is surgery required or not?
Late onset, most likely accommodative, surgery probably not required
If a px has a constant deviation do they have binocular single vision?
no
If a px has an intermittent deviation do they have binocular single vision?
Yes they have some BSV
What is a premature birth?
before 37 weeks
What ocular conditions are associated with premature births from 28 to 37 weeks?
Increased risk of myopia and significant (>2D) astigmatism
Retinopathy Of Prematurity (ROP)
What is classed as ‘extremely premature’?
before 27 weeks
What ocular conditions are associated with extremely premature births?
One-third of extremely prematurely born children in this study (n=411) had some kind of eye or visual problems e.g. visual impairment, strabismus, or major refractive error.
ROP (retinopathy of prematurity) is a risk factor for strabismus (O’Connor et al., 2002)
How may problems in utero or on delivery affect the eyes?
Issues with delivery could cause retinal haemorrhages or corneal trauma.
True or false- a family history of poor vision can mean a child is more likely to need glasses at an early age
True
True or false- if one monozygotic twin has a manifest deviation there is an increased chance the other twin shall do
True- 73% of monozygotic twins will develop manifest deviation if other twin does
What are the four basic types of acuity measurement?
Four basic types of acuity measurement:
Detection (minimum visible)
Resolution (minimum resolvable)
Recognition (minimum recognisable)
Hyper-acuity (minimum discriminable
How do you carry out a detection test?
Refer to smallest test object that can be detected
What is a resolution test and how do we carry it out in children?
A test which allows us to measure smallest angular separation between adjacent targets.
In clinic we use Preferential looking (PL).
(These are the cards with the gratings on them).
What are different examples of resolution tests?
Keeler Acuity cards
Cardiff acuity cards
Kay picture tests
Keeler LogMAR crowded test
Peekabo App
How do you use keeler acuity cards?
How do you carry out a cardiff optotype test and what are the possible cons?
How do you carry out a kay picture test and what are the possible cons?
How do you carry out a keeler LogMAR test?
What are some near vision tests for children ?
- Kay test ( at 33cm)
- Lea symbols (at 40cm)
- Sonksen-Silver Sheridan Gardiner
What are examples of binocular vision assesments?
•Stereopsis
•
•Hirschberg test
•
•Cover test
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•Motor fusion
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•Motility
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•Near point of convergence
