Paediatric Optometry Flashcards
know the average Rxs for each age group from baby - 6 years old
ok - check ss
Give some tips for good communication in child eye tests
-direct your communication towards the child by adapting to age, maturity and ability to understand
-include accompanying adult in the conversation
-explain what youre going to do before you do it
-keep encouraging the patient throughout even if they’re getting it wrong
-pay close attention to non verbal communication
what tests should you do on children?
-monocular va
-cover test
-ret
-stereopsis
-ophthalmoscopy/ volk
-assess objective accommodation
-assess near vision
-assess ocular muscle balance
what tests can you do to check VA in children and babies?
-teller cards
-keeler cards (same as teller but gratings are presented inside circles)
-cardiff cards
-kay singles
-crowded kay pictures
-lea kay singles (used in canada and america alot)
-sonksen LogMAR test = Keeler LogMAR test
for teller cards:
what age are they for?
what do they measure?
what type of test are they?
how do they work?
-birth to ~12 months
-measures resolution acuity
-preferential looking
-made up of gratings that become increasingly fine and get presented to the px 4 times and the VA is recorded as the last grating the patient saw
-does not work after 12 months old as the child will become more drawn to the practitioner behind them
for cardiff cards
what age are they for?
what do they measure?
what type of test are they?
how do they work?
-around 12 months to around 2.5 years
-resolution acuity
-preferential looking
-made of vanishing optotypes and you have to watch the px eye movements to judge where they are looking. the practitioner does not know where the picture is and the VA is the last card the px saw 2 out of 3 times
-may get boring as the child gets older as they are grey so not as visually stimulating
for kay singles
what age are they for?
what do they measure?
what type of test are they?
how do they work?
~2years to ~4years
-recognition acuity
-picture matching/ naming
-px either uses matching card to match the pictures or names them
for crowded kay pictures
what age are they for?
what do they measure?
what type of test are they?
how do they work?
-~2 years to ~4 years
-recognition acuity
-picture matching/ naming
-patient uses either matching cards to match the pictures or names them
(better than kay singles because children with amblyopia may seem to have better visual acuity if you use single pictures so it’s better to use multiple pictures to diagnose potential amblyopia and multiple pictures are also more like real life images they would see day-day)
for lea crowded singles
what age are they for?
what do they measure?
what type of test are they?
how do they work?
-~2 years to ~4 years
-recognition acuity
-picture matching/ naming
-patient uses either matching cards to match the pictures or names them
popular in Canada and USA - also come in single format but multiple images to match is better than singles to help diagnose amblyopia
for Sonksen LogMAR test
what age are they for?
what do they measure?
what type of test are they?
how do they work?
-~+3 years
-recognition acuity
-letter matching/ naming
-patient either uses matching card to match the letters or they name them
how is Keeler LogMAR crowded test different to Sonksen LogMAR tes?
in keeler the test comes with two booklets where one has letters that are crowded and the other has letters that are uncrowded. otherwise they’re the same
when doing cover test on a child, what could be a positive sign that the two eyes are clear?
a patient not rejecting an eye being covered
why are autorefractors not good on childeren?
-children can be very wriggly and autorefractors need a few seconds to work
-the child can accommodate at the target especially if they have not had cycloplegic drops so can give an unusual reading
what is the average Rx for children who are:
-three months old
-six months
-nine months
-one year
-18 months
-2 years
-3 years
-4 years
-5 years
-6 years
+3.00
+2.50
+2.25
+2.00
+1.50
+1.25
+1.00
+0.50
+0.50
+0.50
when should you recall a child?
-6 moths if they seem to have no problems
-if they have a turn then best to do 3 moths
-minimum recall in scotland and wales is 12 months, in england is 6 months
as long as your recall is sensible and you can back it up with necessary evidence and reasoning then that’s fine
how would you tell a parent you want the child to wear glasses full time?
- explain their vision is a little worse than what we would like
- start off slow with glasses wear and encourage wearing glasses while their hands are busy like eating or playing on ipad
- if parents/ anyone else in the house wears glasses encourage them to wear them around the child
- if they are at school ask the school to help
how should you end an eye test with a child/
end on a positive - Reassure parents after an eye test if the child turns out to need glasses talking about the plastic period and that there’s plenty of time to fix the child’s vision - helps them not to feel guilty
how can you measure a child’s near va?
-if they can read then use letter chart
-if not then you can use near picture charts
how can you measure a child’s accommodation?
with dynamic ret - most likely will not understand AoA
how can you test stereopsis in childeren?
using frensel prisms with lang I and lang II charts
-dont always work as they need to look at it for a few secs before the picture appears and some children will not look long enough
how can you test moto fusion in children up to age 5?
use 20 dioptre base out prism in front of one eye and in a normal response:
Eye behind the prism rapidly adducts to restore fusion
On prism removal, the eye quickly abducts again
what is a manifest deviation?
a deviation that’s detectable when both eyes are open
what is the incidence of heterotropia?
present in 2-4% of the population
what are the characteristics of tropias?
-Constant or intermittent
-Present only at either distance or near
-Changes with refractive error or does not change - so you need to make sure to state whether what you’re seeing is with or without glasses
-Can develop in childhood or later in life and consequences are different as in childhood, patient is at risk of developing suppression or arc or amblyopia or eccentric fixation whereas in adults they will develop diplopia and in only in some rarer cases where they develop suppression