Pediatric Low Vision Rehab Flashcards
1
Q
Problems with determine prevalence in pediatric low vision
A
Lack of standardization of definitions
Most population based studies do not include younger chidlren
Co site Fe of multiple disabilities
2
Q
Diagnosis of kids with low vision
A
- albinism
- optic atrophy
- hereditary retinal condition
- optic nerve hypoplasia
- cortical vision impairment
3
Q
Kids in poorer areas in the world and low vision
A
Higher incidence of child blindness
4
Q
Case Hx/patient interview for pediatric Low vision
A
- why are they here, how did they find out about vision rehab
- description of how child functions (age appropriate questions)
- do they have special concerns about they child’s vision
- what is their child’s diagnosis and what do they understand about it
- has the kid had any eye surgeries
- has either eye been patched
- do they wear glasses? Are they compliant?
5
Q
Most people with low vision is over the age of
A
60
6
Q
Kids goals and low vision
A
Psychosocial: they want to look normal and interact with other kids normally
Don’t want to wear funny glasses
School related: doing well in school
7
Q
Parent goals for kids with low vision
A
School related
Expectations for future
Psychosocial
8
Q
Case history: school
A
- do thy have an IEP
- where do they sit in the classroom?
- do they have large print books
- do they have electronic access to books? Is that different than their classmates?
- what type of bard does the teacher use?
9
Q
Onset of vision impairment in kids
A
Often at birth
10
Q
Scotoma and VI in kids
A
Uncommon
11
Q
Contrast sensitivity in kids with VI
A
Often normal/near normal
12
Q
Accommodation and kids with VI
A
Present
13
Q
Refracfive error and kids with VI
A
Often significant
14
Q
Nystagmus and kids with VI
A
Common
15
Q
Symmetry and kids with VI
A
Usually symmetrical
16
Q
Visual function and kids with VI
A
- not all kids with the same visual acuity or disease demonstrate the same visual function.
- ability to perform ADLs, IADLs
- visual disabilities: night blindness, glare sensitivity, poor contrast, peripheral vision, central vision, colro vision, light/dark adaptation, illumination
17
Q
Electronic VA testers for kids with VI
A
- advantage is flexibility: letters numbers, HOTV, allen figures; rows, columns, isolated, with crowding bars
- impossible to memorize
- best on a moveable cart
18
Q
Refraction for kids with VI
A
Retinoscopy
Refraction
Cycloplegic ret/refraction
19
Q
Refractive error and kids wtih VI
A
70% of eyes had SE refractive error greater than +/- 1D
53% OD and 50% OS had astigmatism >1D
20
Q
Refractive error and nystagmus
A
Higher amounts of WTR astigmatism in patients with albinism and congential nystagmus
- due to meridonial emmetropization?
- due to mechanical pressure of the lids?
- interference with emmetropization due to image smear from nystagmus?
21
Q
Spectacle efficacy and kids with VI
A
- 35 pateitns with albinism
- mean binocualr VA uncorrected was 20/108
- mean binocular VA corrected: 20/81
- they got a line of improvement with correction
- put them in CL. It stays on the eye even i fits moving and it can help dampen the nystagmus due to the feel of the CL. They still have fovea hypoplasia though
- 7.2PD without glasses and 10PD without glasses at distance
- most had good compliance with glasses. Can make a deal with the kid
22
Q
Accommodative testing in kids with VI
A
- push up amps-nearly worthless-most kids with VI will trade blur for RDM
- negative lens to blur=kids with VI have greater tolerance to defocus, so again worthless
Best technique is the accommodative response
23
Q
Accommodative response for kids with VI
A
- reduced AR has been shown in: albinism, juvenile macular degeneration, congential nystagmus, achromatopsia, and amblyopia
- 85% were outside the 95% range of normal and that the errors were often more than predicted bu the increased depth of focus due to their low vision
24
Q
MNRead in kids with low vision
A
- measures the reading rate at different print sizes
- critical print size
- minimum print size
- reading accessibility index
25
Albinism and reading
They read at a differnet reading speed due to their nystagmus
26
MNRead and bifocal
-giving bifocal to kids can help improve reading speed
27
Reading reserve
- acuity reserve-ratio of print size to patient’s VA threshold
- optimum acuity reserve allows for most efficient reading. CPS tells you what size is needed. CPS: RA=reading reserve
- acuity reserve 4x for normally sighted and 3x for VI
- acuity reserve 2.5:1 and 7:1 is best
- patients with poorer VA required less reserve
28
Reading rates in nystagmus
- 18.8% slower in albinism and 14.7% in INS
- adutls with nystagmus read more slowly than controls using either continuous text or RSVP, but continuous text was faster
- reading rates exceeded nystagmus frequency-reading is occurring during non-foveating periods
29
Color vision in kids with VI
Large D-15
| Can also just prestn multiple colors to them and ask them to point to specific colors
30
Contrast sensitivity and kids with VI
MARS if they know letters
| If not, use hiding heidi
31
Binocularity and kids with VI
- hirschberg/Krimsky
- CT
- W4D
- stereopsis
- nystagmus does not rule out binocularity, nott does it pervent testing
32
Nystagmus
- common in pediatric low vision
- often pendular, jerk, or periodic alternating
- may be accompanied by an anomalous head posture to achieve a null point
- surgical correct by kestenbaums procedure can be highly successful. Do not expect visual improvement
33
Dome magnifiers for kids
Less expensive and they are more likely to break them
34
Reading stands
Get closer to the material so it helps back pain
35
HHM
Good for kids that have to move from classroom to classroom
- usefor for spot checking
- portable, inexpensive
- can be worn around the neck for convenience
36
Telescopes for kids in VI
- nearly all school age chidlren need one
- most prefer telescope that enables them to read 20/20 if possible
- M=reference acuity/goal acuity
- ex: VA=20/100
- M=100/20=5X
37
Extra short focus telescope for kids VI
More at a distance
| More like a telemicroscope
38
Spectacle mounted telescopes
- considerations
- size of face
- cost
- cosmesis
- goals (marching band, driving)
39
Device selection for kids
- task
- target acuity
- cost
- cosmesis
Children are not miniature adults
40
Reasons for CCTVs may be indicated for kids
- to enable a parent to read to a young child
| - to facilitate a love for reading and learning
41
Electronic magnification and kids
Need to habe a distance capability too. Tend to have problems with distance vision more in kids
42
Tablets and smart phones and kids
Zoome and large text used more in kids. Voice over is not a favorite in kids
43
Bookshare.org
Free to US students
| -has a differnet formats for low vision kids
44
Calculator for kids in VI
Talking scientific calculator
45
Blind square
Uses phones GPS in conjunction with free 3rd part navigation apps
46
High tech/high cost assistant technology
Augmented reality type things
47
ADHD and vision impairment in kids
2x ADHD rate diagnosis in kids with vision impairment
| -referring kid to someone who specializes in ADHD and not a regular practitioner
48
Educational recommendations for kids in low vision
- seating placement (in front (RDM), may need to consider null point)
- print size or reading medium
- adaptive PE
- exemtopon from using scantron answer sheets
- extended testing time\
- lighting recommendations
49
Individuals with disabilities education act
Also students are entitietld to
- free, appropriate, public education (FAPE)
- in at least restrictive environment (LRE)
Provides for individual education plans
Provides for expanded core curriculum
50
IEP
Mandated by the IDEA
Includes
-statement of present level of performance
-educational goals and details of how and when they will be measured
-modifications and accommodations the school will provide
-accommodations for standardized test taking
-transition planning for life after high school
51
Teach of the visual impaired
- typically itinerant (travel)
- interacts with school personnel, parents, and a classmates to help them understand the students unique educational needs and learning characteristics
- provides functional vision assessments and learning media assessment
- provides direct services to the child in conjunction with the classroom teacher
- ensures that special materials (LP, Braille, etc) are provided in a timely manner
52
Reading medium
- decision cannot be made by OD alone
- requires input of parent,s child, and educational team
Options
- Braille
- large print
- audio
- regular print
