Optometric examination of children part 1 Flashcards
what age does majority of accommodative strabismus start to be noticed and what does this mean for us as a primary care advisor
- accommodative strabismus starts to be noticed around age of 18-30 months
- as a primary care advisor, we should be equipped to test children
list 4 things you should do before you begin a sight test on a child
- Smile!
- Say hello to the child and parent/carer/guardian
- Introduce yourself
- Observe appearance and visual behaviour:
Note obvious manifest deviation
Broad epicanthal folds
at what age can a child: Understand several short words Imitate sounds Speak 20 words or more Use short sentences Know name and gender Understand abstract words Sit alone Crawl Walk Touch object with forefinger Begin to knows colours
Understand several short words - 1 year Imitate sounds - 1 year Speak 20 words or more - 18 months Use short sentences - 2 years Know name and gender - 3 years Understand abstract words - 5 years Sit alone - 6 months Crawl - 8 months Walk - 12 months Touch object with forefinger - 10 months Begin to knows colours - 3 years
describe 3 things about how communication with a child 0-6 months usually is
- Non-verbal
Facial expressions - Tone of voice
Baby talk
Singing! - Child is held by parent/ guardian
describe 4 things about how communication with a child 6-18 months usually is
- Mainly non-verbal
- Talk to child
- Beware of stranger anxiety
- Child is held by parent/guardian
describe 6 things about how communication with a child 18-36 months is
- More verbally independent
- Some reliance on non-verbal
- Understand more words than they can speak
- Stranger anxiety
- Still prefers parents lap
- Do not like to sit still!
describe 3 things about how communication with a child 3-6 years is
- Learning to explore and be
- Can be very talkative
Understand most simple and some complex words - May prefer to sit alone
describe 5 things about how communication with a child 6-12 years is
- Address child
use more complex sentences but simple terms - Try to engage child
talk about favourite character, toys etc - Avoid babyish terms
- Involve child in discussions
Which eye shall I put the drops in first? - Fear failure, inferiority
describe 2 things about how communications with a child 12+ years is
- Talk to the child directly
Treat them like a mini-adult
Involve them in decisions - May be aware of body image
Wearing spectacles
Cosmesis of deviations
what 3 main things does the optometric examination of children consist of
- History and symptoms
- Investigation
- Management
what 5 things are investigated in an optometric examination of children
- Visions/visual acuity
- Binocular vision assessment
- Refractive error
- Ocular health
- Colour vision
list 5 main things you will ask during history and symptoms and 4 things you will ask to identify risk factors
- Reason for visit
Routine
Specific problem - Observations of parents, family members, teachers
- Does visual behaviour seem normal?
- Allergies
- General health
To identify risk factors:
- Birth history
- Developmental history
- Family ocular history of refractive error
- Family ocular history of strabismus
if a parent reports that they can see a turn in their child’s eye, list all the follow up questions you will ask and what each answer can entail
Does one or both of the eyes appear to turn in/out/up/down?
Which eye affected?
Same eye, amblyopia likely
Alternating, amblyopia unlikely
Duration of deviation
Early onset, most likely non-accommodative, surgery probably required
Late onset, most likely accommodative, surgery probably not required
Frequency of deviation
Intermittent, some BSV present
Constant, no BSV present
when does sensory and motor fusion develop and what can this mean in your investigation
Sensory and motor fusion develop between the ages of 3 to 6 months therefore an intermittent manifest deviation is not uncommon before this age
Reassure the patient
what 4 questions will you ask about birth history
- FTDN (full term delivery normal)
- Low birth weight (2.5kg, 5lb 8oz)
- premature birth
- problems in utero or on delivery
what 2 questions will you ask about developmental history
- Normal developmental milestones achieved
- Sitting up, walking, talking
what will you ask about family ocular history of refractive error and why
- Spectacles at an early age
Genetic link for refractive error
Link between refractive error and development of strabismus
why is it important to ask about family ocular history of strabismus
- 30% children with strabismic parent will develop manifest deviation
- 73% of monozygotic twins will develop manifest deviation if other twin does
- Amblyopia (lazy eye)
why is it important to ask about allergies
- important for when putting in eye drops
- allergies to Elastoplast, as need to know if can do patting to treat amblyopia
list 2 ocular problems a child with cerebral palsy and downs’s syndrome may have and 2 ways to treat/manage this
Less likely to emmetroparise
Reduced accommodation
Don’t undercorrect hyperopic prescriptions
Consider bifocal correction
