Part 2 Exam Techniques Flashcards
common CC: Infants
- eye turn
- excessive tearing
- monocular lid closure
- red eye
- not common but important: shaking eyes, white pupil, not responding to light
common CC: Preschool
- squinting
- avoiding reading/near activities
- closing eyes in sunlight (photophobic)
- rubbing eyes
- head tilts
- eye turns
- clumsy
common CC: School Aged
(same as preschool) +
- can’t see board at school/kindergarten
- failed school screening
VAs from easiest to hardest
- informal tests (fix and follow, resistance to occlusion, fixation preference)
- OKN drum
- Teller acuity (preferential looking)- Gold standard for infants
- Cardiff (preferential looking)
- LEA: 2 alt.forced choice, matching, naming (recognition acuity
- Directionality charts (recognition acuity and directionality)
- HOVT: matching naming (recognition)
- Snellen (recognition acuity)
who is fixation preference most sensitive to
-strabs and anisometropic ambyopes
what age is fixation preference best for and what prism do you use?
< 3 years
10pd vertical prism
when are the preferential looking acuities good to use (Teller and Cardiff)?
6months- 3 years
for Teller acuity, what working distance changes do you have with what ages?
for < or = 6 months= 33cm testing distance
for > 6 months = 55cm testing distance
Cardiff:
- how many cards are there per acuity level
- how many cards do you show at threshold
- test distance
- 3 cards per acuity level
- 2/3 or 3/4 for threshold
- 50cm testing distance
Isometropic potentially amblyopia numbers
astigmatism > 2.50
hyperopia > 5
myopia > 8
anisometropia potentially ambylogenic numbers
astigmatism > 1.50
hyperopia > 1
myopia > 3
what are some options for contortion fields on kids
from easiest to hardest
- non-seeing to seeing, object presentation (binocular)
- non-seeing to seeing, object presentation (monocular)
- FTFC (sticker on nose, for older kids)
ocular deviation tests from lowest to highest level
- gross observation
- Bruckner
- Hirshberg/Kappa/Krimsky
- Cover Test
on the Bruckner test, what can be causes of the brighter eye reflex
- Strabismus (strab eye)
- Anisometropia (higher RE)
- pathology (larger pupil, leukocornia, other)
- false positive (from media opacities)
Bruckner sensitivity/sensitivity shows you:
-pretty good at telling you there is something if there is, but not good at telling you if there is for sure something or not
(specificity better than sensitivity)
what is the mm to pd in Hirschberg and when do you use a + vs. -
1mm= 22pd
+ is nasal displacement (exotropia)
- is temporal displacement (esotropia)
how do you use Krimsky test
- place prism over non-deviated eye (BI for exo, BO for eso) until reflexes are equal
- approximation of magnitude
what is different between Hirschberg and Kappa
Hirschberg is one eye to another (both eyes open)
Kappa is one eye closed at a time (alternating)
how do you calculate the approximate strab with Hirschberg/Kappa
displacement binocularly (Hirschberg) - displacement monocularly (Kappa) (keep signs of + and -)
accommodation tests from lowest to highest level
- pull away
- push up
- MEM
stereo tests from lowest to highest level
- worth 4 dot (peds flashlight)
- LANG
- random dot (global stereopsis) -> PASS usually the easiest to administer
- lateral disparity (has monocular cues)
which stereo test does not require polarized glasses
LANG
finding refractive error tests from lowest to highest level
- Mohindra Ret
- retinoscopy (with lens bar)
- retinoscopy (in the phoropter)
- manifest refraction
anterior seg testing from lowest to highest level?
- gross observation
- 20D lens and transilluminator
- 8D transilluminator magnifier
- bluminator
- handheld slit lamp
- slit lamp
IOPs from lowest to highest level
- digital pressure
- tonopen
- i-care
- GAT
- NCT
what do you dilate a <1 year old with
- 5% cyclo
0. 5% phenyl
