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3F: Low Vision > Pediatric Low Vision Rehab > Flashcards

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

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2
Q

Diagnosis of kids with low vision

A
  • albinism
  • optic atrophy
  • hereditary retinal condition
  • optic nerve hypoplasia
  • cortical vision impairment
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3
Q

Kids in poorer areas in the world and low vision

A

Higher incidence of child blindness

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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?
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5
Q

Most people with low vision is over the age of

A

60

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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

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7
Q

Parent goals for kids with low vision

A

School related
Expectations for future
Psychosocial

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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?
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9
Q

Onset of vision impairment in kids

A

Often at birth

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10
Q

Scotoma and VI in kids

A

Uncommon

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11
Q

Contrast sensitivity in kids with VI

A

Often normal/near normal

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12
Q

Accommodation and kids with VI

A

Present

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13
Q

Refracfive error and kids with VI

A

Often significant

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14
Q

Nystagmus and kids with VI

A

Common

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15
Q

Symmetry and kids with VI

A

Usually symmetrical

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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
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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
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18
Q

Refraction for kids with VI

A

Retinoscopy
Refraction
Cycloplegic ret/refraction

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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

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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?
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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
Q

Albinism and reading

A

They read at a differnet reading speed due to their nystagmus

26
Q

MNRead and bifocal

A

-giving bifocal to kids can help improve reading speed

27
Q

Reading reserve

A
  • 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
Q

Reading rates in nystagmus

A
  • 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
Q

Color vision in kids with VI

A

Large D-15

Can also just prestn multiple colors to them and ask them to point to specific colors

30
Q

Contrast sensitivity and kids with VI

A

MARS if they know letters

If not, use hiding heidi

31
Q

Binocularity and kids with VI

A
  • hirschberg/Krimsky
  • CT
  • W4D
  • stereopsis
  • nystagmus does not rule out binocularity, nott does it pervent testing
32
Q

Nystagmus

A
  • 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
Q

Dome magnifiers for kids

A

Less expensive and they are more likely to break them

34
Q

Reading stands

A

Get closer to the material so it helps back pain

35
Q

HHM

A

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
Q

Telescopes for kids in VI

A
  • 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
Q

Extra short focus telescope for kids VI

A

More at a distance

More like a telemicroscope

38
Q

Spectacle mounted telescopes

A
  • considerations
  • size of face
  • cost
  • cosmesis
  • goals (marching band, driving)
39
Q

Device selection for kids

A
  • task
  • target acuity
  • cost
  • cosmesis

Children are not miniature adults

40
Q

Reasons for CCTVs may be indicated for kids

A
  • to enable a parent to read to a young child

- to facilitate a love for reading and learning

41
Q

Electronic magnification and kids

A

Need to habe a distance capability too. Tend to have problems with distance vision more in kids

42
Q

Tablets and smart phones and kids

A

Zoome and large text used more in kids. Voice over is not a favorite in kids

43
Q

Bookshare.org

A

Free to US students

-has a differnet formats for low vision kids

44
Q

Calculator for kids in VI

A

Talking scientific calculator

45
Q

Blind square

A

Uses phones GPS in conjunction with free 3rd part navigation apps

46
Q

High tech/high cost assistant technology

A

Augmented reality type things

47
Q

ADHD and vision impairment in kids

A

2x ADHD rate diagnosis in kids with vision impairment

-referring kid to someone who specializes in ADHD and not a regular practitioner

48
Q

Educational recommendations for kids in low vision

A
  • 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
Q

Individuals with disabilities education act

A

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
Q

IEP

A

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
Q

Teach of the visual impaired

A
  • 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
Q

Reading medium

A
  • decision cannot be made by OD alone
  • requires input of parent,s child, and educational team

Options

  • Braille
  • large print
  • audio
  • regular print

3F: Low Vision (16 decks)

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