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Binocular Vision > Optometric examination of children - Ahalya > Flashcards

Optometric examination of children - Ahalya Flashcards

1
Q

what are the key stages in paediatric eye exam?

A
  • H&S
  • Visual function (VA and visions, maybe CS)
  • refraction (objective + usually cyclo)
  • BV status
  • Colour vision
  • Anterior segment and Fundus examination
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2
Q

what are the key things to ask in a child’s H&S?

A
  • rfv
  • if parents are worried about anything
  • when did worries begin, freq, duration, anything making it worse?
  • POH
  • FOH
  • birth history (premature? birth weight? type of delivery? maternal illnesses such as rubella?
  • normal milestones?
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3
Q

what is an important milestone for a 10 month old baby?

A

touch object with finger

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4
Q

what is an important milestone for a 3 year old?

A

begins to know colours
know names and gender

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5
Q

important milestone for 2 year old?

A

use short sentences

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6
Q

normal va at birth?

A

6/120

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7
Q

normal va at 3years

A

6/12

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8
Q

normal va at 4 years

A

6/9

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9
Q

normal va at 5 years?

A

6/6

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10
Q

what is an electrophysiological way of testing va?

A

using VEPs (visually evoked potentials)
- flash VEP stimulus at birth
- pattern VEP stimulus when older

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11
Q

examples of preferential looking tests?

A
  • keeler acuity cards (CITY)
  • cardiff cards (CITY)
  • peekaboo app
  • teller acuity cards
  • lea grating paddles
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12
Q

are the preferential looking tests using an iso-illuminant stimuli?

A

yes

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13
Q

what is spatial frequency measured in?

A

cycles/degree

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14
Q

on a preferential looking test, as the stripes become more narrow…?

A

the spatial frequency is higher

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15
Q

what age do you use preferential looking tests for?

A

0-24 months (0-2 years)

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16
Q

what distance do you use keeler acuity cards?

A

38cm

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17
Q

what do keeler acuity cards look like?

A

15 cards with black & white stripes on right or left side
1 blank card
4 mm hole in centre to look through

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18
Q

what is the range of the keeler acuity cards?

A

0.32 - 38 cycles/deg

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19
Q

with keeler acuity cards, how do you know a child can resolve it?

A

identify the same stimulus 2x

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20
Q

what is a clinically significant interocular difference with keeler acuity cards?

A

2 or more cards

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21
Q

how do teller cards and lea paddles work?

A

same as keeler acuity cards but diff working distance

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22
Q

what principle does cardiff cards work on?

A

vanishing optotypes

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23
Q

who are cardiff cards used for?

A

0-24 months or special needs

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24
Q

what do cardiff cards look like?

A

pictures at the top or bottom of the card (duck, house, fish, car, train, boat, dog)

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25
Q

do cardiff cards exhibit crowding
?

A

no

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26
Q

what are the disadvantagesof using cardiff cards?

A

may overestimate VA due to no crowding - amblyopic px’s will see 6/6 but may acc be 6/36

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27
Q

working distance for cardiff cards?

A

50cm or 1m depending on age

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28
Q

what is the VA range of cardiff cards at 1m?

A

1.0 - 0.1 logMAR

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29
Q

what is the VA range of cardiff cards at 0.5m?

A

1.3 - 0.5 logMAR

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30
Q

what is a clinically significant interocular difference using cardiff cards?

A

more than 2 cards

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31
Q

how does the peekaboo app work?

A

2 forced choice or 4 forced choice
px has to touch the pattern which makes a “YIPEE” sound and cartoon appearing- this Yipee sound is an example of positive feedback

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32
Q

which other preferential looking test is comparable to keeler acuity cards?

A

peekaboo app

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33
Q

working distance of peekaboo app?

A

25-50 cm

34
Q

what are the tests available for 2-4 year olds?

A

picture naming/matching
lea symbols
kay pictures

35
Q

Va tests for 0-2 years?

A
  • preferential looking cards
  • keeler acuity cards
  • teller acuity cards
  • lea paddles
  • peekaboo app
  • cardiff cards
36
Q

Va tests for 3-5 years?

A
  • letter naming/matching (keeler logMAR cards and landolt C/tumbling E)
  • picture naming/matching (kay pics and lea symbols)
37
Q

va tests for above 5 years old?

A

regular charts

38
Q

what tests are available for measuring near vision?

A
  • kay picture near test
  • lea symbols near vision
  • reduced snellen (landolt’s C/ tumbling E)
39
Q

what age do you measure near vision?

A

above 2 years old

40
Q

what are the 2 contrast sensitivity tests?

A
  1. cardiff CS test
  2. hiding heidi
41
Q

how does the cardiff CS test work?

A

wd = 50 cm
use preferential looking or naming/matching depending on age

42
Q

how does hiding heidi work?

A

5 contrast levels (25%, 10%, 5%, 2.5% and 1.5%)
2 cards- 1 white, 1 with heidi
use preferential looking or naming/matching depending on age
wd = variable

43
Q

what are the tests to measure binocular status? (8)

A
  1. cover test
  2. hirschberg test
  3. extra ocular motility
  4. motor fusion
  5. sensory fusion
  6. NPC
  7. stereopsis
  8. accommodation
44
Q

which binocular function test is gold standard?

A

cover test

45
Q

when doing cover test what must you make sure is stimulated? and how do you do so ?

A

accommodation - use an interesting target e.g. a toy

46
Q

what is normal on a cover test at near?

A

XOP with rapid recovery - if SLOW RECOVERY IT IS A PROBLEMO

47
Q

if cover test is difficult which test do you do?

A

hirschberg

48
Q

how do you encourage fixation when doing the hirschberg test?

A

flash light on and off

49
Q

if you see a temporal reflex on hirschberg what does this mean?

A

esotropia

50
Q

if you see the light is nasal on hirschberg test, what does this mean?

A

exotropia

51
Q

if you see the light is higher up on a hirschberg test, what does this mean?

A

hyoptropia - but record as a HYPER deviation eg L hypo noted as R hyper (Aliya edit)

52
Q

if you see the light is lower down on a hirschberg test, what does this mean?

A

hypertropia

53
Q

what is a motor fusion test?

A

20D base out

54
Q

on the 20 base out test what does no movement mean?

A

no fusion or lack of attention

55
Q

on 20 base out test what does slow movement/slow recovery mean?

A

possible poor fusion

56
Q

when do you reduce the power on a 20 BO test?

A

if slow to over come use 15 then 10

57
Q

what is an exmaple of a sensory fusion test?

A

worths lights
bagolini lenses

58
Q

what does NPC test for?

A

gross convergence ability

59
Q

at what age should you be able to do NPC from?

A

6 months

60
Q

what are some stereopsis tests you can do in a visually impaired person? and why are they good?

A

lang stereo, frisby

NO GLASSES NEEDED

61
Q

stereopsis tests in older children

A

TNO
Titmus
Randot

62
Q

is accommodative lag/lead objective or subjective?

A

objective

63
Q

what do minus lenses do? (in terms of accommodation)

A

INDUCE ACCOM

64
Q

what do positive lenses do? (in terms of accommodation?

A

relaxes accom

65
Q

which accommodative test is a ‘clinical pearl’ in children with special needs reduced accom?

A

dynamic ret

66
Q

if you see an accommodative lag more than +0.75DS what does this suggest?

A

accommodative insufficiency

usually seen in children with learning difficulties (e.g Downs)- may need bifocals

67
Q

if you want to cyclo a kid, what % do you use in 3-6 months?

A

cyclopentolate 0.5%

68
Q

if you want to cyclo a kid, what % do you use in 6-12 months with light irises?

A

cyclopentolate 0.5%

69
Q

if you want to cyclo a kid, what % do you use in 6-12 months with dark irises?

A

cyclopentolate 1%

70
Q

if you want to cyclo a kid, what % do you use in >12 months?

A

cyclopentolate 1%

71
Q

do you cyclo a kid with epilepsy?

A

NO

72
Q

advantages of cycloplegic refraction

A
  • relaxation of accommodation
  • accurate fixation not needed
  • large pupil: view of fundus
73
Q

disadvantages of cyclo refraction

A

temporary blurred vision and photophobia

74
Q

when do you cyclo a kid?

A
  • pre school children especially 1st ST
  • when prescribing glasses
  • unexplained poor VA
  • reduced stereopsis
  • presence of squint
  • underactive accommodation or fluctuating accom
  • FOH of squint or high hyperope
75
Q

what is near mohindra retinoscopy?

A
  • non cyclo
  • occlude 1 eye
  • dark room
  • 50 cm
  • ret as normal
  • correction factor +1.25Ds
76
Q

why is mohindratachnique used?

A
  1. Do not need to dilate = dark room = large pupil
  2. quick + easy
  3. not complex = easy = can track fixtion losses
77
Q

what is the gold standard for identifying RG colour vision defects?

A

colour vision testing made easy (CVTME)

78
Q

what principle does colour vision testing work on?

A

psuedoisochromatic principles

79
Q

what does colour vision testing made easy look like?

A

1 demonstration plate
9 test plates
circle, star and/or square

80
Q

which colour vision test has a good validity when compared to ishihara?

A

colour vision testing made easy

81
Q

how to take IOPs in children?

A

tonopen
digital palpatation

82
Q

For infants younger than 1, what mydriatic do you use?

A

0.5% tropicamide and 1 drop of 2.5% phenylephrine

Binocular Vision (30 decks)

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