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Pediatric Optometry > Pediatric Optometry: L5: Pediatric Eye Exam Continued.. > Flashcards

Pediatric Optometry: L5: Pediatric Eye Exam Continued.. Flashcards

1
Q

Allen Pictures

  1. Age?
  2. Threshold Acuity?
  3. Can we use for VA assessment? Why?
A
  1. 3-5 yrs
  2. 20/30
  3. No. Cuz pictures are OUTDATED!
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2
Q

Tumbling E

  1. Widely used in what country?
  2. Equivalent to what?
  3. Problem with it?
  4. Testing?
A
  1. USA
  2. Snellen
  3. L-R problems
  4. at 20ft/10ft
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3
Q

HOTV

  1. Age?
  2. Problem with it?
  3. Testing at what?
A
  1. 3-6 yrs
  2. Letters DO NOT BLUR OUT EQUALLY!
  3. at 10 ft
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4
Q

Snellen/ETDRS

  1. Problem with it?
  2. ETDRS uses what kind of acuity?
A
  1. Letter spacing differences and different number of letters per VA LINE
  2. Log MAR Acuity
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5
Q

Electrophysiologic Methods

  1. VA in a 6 Month old with this?
    a. Why?
A
  1. 20/20 in a 6 month old

a. More attentive the child, the BETTER and NARROWER RANGE of RESPONSES

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6
Q

Pupils

  1. How is it done?
  2. Pupils are usually what in a NEWBORN?
  3. Avg size by age 12-13?
  4. What can create an APD?
A
  1. Same as we do for adults!
  2. Miotic, so not very responsive to light
  3. about 7 mm
  4. VERY DEEP AMBLYOPIA
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7
Q

Before testing Oculomotor Skills (Fixations, Pursuits, and Saccades), what should you make sure your patient can do?

A
  1. Make sure they can PROPERLY FIXATE!
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8
Q

Oculomotor Control

  1. Do normal eye movements develop in visually impaired children?
A
  1. NO!
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9
Q

Saccades

  1. Initial eye movement, usually in which direction?
  2. Infants use what to reach the target?
  3. Infants also use more what than adults to track and follow?
  4. Early on, saccades are what?
  5. When do they reach adult levels?
A
  1. in the right direction, but only a FRACTION of the DISTANCE!
  2. use a series of saccades to reach the target
  3. more head movements than adults.
  4. Hypometric w/INCREASED LATENCY!
  5. Adult like levels by 1 year
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10
Q

Pursuits

  1. Infants can track an object if the following conditions are met: (4)
A
  1. Slow moving
  2. Large (12 degrees)
  3. Visually interesting (face)
  4. Short Duration (300-400 msec)
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11
Q

Evaluation of Fixation

  1. What is the best way to evaluate fixation?
  2. How long should they fixate on the Near ACCOMMODATIVE TARGET?
    a. 4+ = ?
    b. 3+
    c. 2+
    d. 1+
  3. Expected finding?
A
  1. CT or isolated target fixation
  2. For 10 seconds
    a. No FL
    b. 1 FL
    c. 2 FL
    d. More than 2 FL
  3. ALL Pts should be able to fixate and sustain it for 10 seconds w/no observable movement of the eyes UNLESS they’re very young, anxious, hyperactive or inattentive.
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12
Q

Evaluation of Saccades

  1. NSUCO Oculomotor Test
    a. What do they do?
  2. What are the 4 categories of performance that are rated?
A
  1. Look at 1 object from another for 5 round trips (10 fixations)

Targets at HARMONS DISTANCE (10 cm from midline for each target)

No instructions given to pt to move or not move head.

  1. Ability; Accuracy; Head and body movement
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13
Q

Ocular Alignment

  1. CT: How is it down?
  2. What other 2 tests?
  3. What is done with Krimsky?
A
  1. U/L, Alternate; Slow and Deliberate
  2. Hisrchberg/Kappa/Krimsky (Objective Measure)

and Bruckner

  1. PUT prism over the deviating eye until the reflex BECOMES EQUAL to the FIXATING EYE!!!
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14
Q

Bruckner Test: Aim towards bridge of the patient

  1. Anisocoria
  2. Anisometropia:
  3. Strabismus
A
  1. Larger Pupil, BRIGHTER
  2. LARGER REFRACTIVE CONDITION: BRIGHTER
  3. Non-Fixating Eye: BRIGHTER
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15
Q

Ocular Alignment

  1. Cover Testing
    a. Age of children where they should have something checked…?
A
  1. 3 and older, should have SENSORY FUSION checked FIRST to confirm Binocular Status
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16
Q

Cover Test

  1. What is an appropriate target for an infant/child?
A
  1. Detailed small sticker on popsicle stick, or a small toy.
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17
Q

CVFs

  1. Number of targets used?
  2. Test for Infant, Toddler, Preschool aged?
  3. Test for School age?
  4. VF adult like by what age?
A
  1. 2 targets
  2. Test OU
  3. Test OD and OS
  4. VF adult like at 1 year
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18
Q

Stereopsis

  1. When should you do this test FIRST?!
A
  1. If there is ANY HISTORY of an EYE TURN!

Lang 1, Randot E, Stereo Smile II Test, Randot Preschool Acuity Test, Worth 4-Dot/3 Animal Test

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19
Q

Randot Stereo Smile Test II

  1. Age to use this test for?
A
  1. 6 months to 3 years old.
20
Q

Randot Preschool Stereoacuity Test

  1. Book 1
  2. Book 2
  3. Book 3
A
  1. 200/100 seconds
  2. 60/40 seconds
  3. 400/800 seconds
21
Q

Lang Stereo Tests I

  1. Big Advantage to this test?
  2. Disparities measured:
    a. Star?
    b. Cat?
    c. Car?
A
  1. No POLAROIDS NEEDED!
  2. a. 600 sec of arc
    b. 1200 sec of arc
    c. 550 sec of arc
22
Q

Color Vision

  1. Age to start testing?
  2. Color deficiency rate
    a. Boys
    b. Girls
  3. Ishihara Tracing
    a. number of plates?
  4. Color deficient on what?
A
  1. 3-4 yrs
  2. a. 1:12
    b. 1:200
  3. a. 9 plates
  4. See only 1 out of 2 shapes for plates 1-6 and NONE on LAST 3 PLATES!
23
Q

Autorefraction: Kids

  1. Non-Cyclo: Reliable?
    a. Why?
  2. Diagnostic ONLY when what?
A
  1. NO!
    a. D/t induced Accommodation
  2. when cyclopleged
24
Q

Keratometry

  1. Infants have steeper/Flatter corneas?
A
  1. STEEPER!!!
25
Q

Mohindra Ret: Instead of Cyclopleging

  1. WD performed?
  2. Subtract how much?
    * REMEMBER: MONOCULARLY DONE
A
  1. 50 cm

2. Subtract 1.25 D from gross sphere. (+2.00 WD adding -1.25 results in Net: +0.75D…D/t lens…)

26
Q

Binocular/Accommodative Testing

  1. Subjective Testing (4)
  2. Objective Testing (4)
A
  1. a. Accom Amps and Facility
    b. NRA/PRA
    c. Phorometry
    d. Risley Prism Vergence Ranges
  2. a. CT
    b. MEM
    c. NPC
    d. Prism Bar Vergences
27
Q

Goldmann Tono

  1. Can attempt on what ages?
    a. Tell them to look for what?
A
  1. 3-4 yrs and up.

a. (Mickey Mouse, Blue Ghost, etc.)…tell them to look for what they want to see

28
Q

Tonopen

  1. What’s needed?
  2. May be Falsely elevated/lowered d/t to discomfort reactions?
  3. Be sure it’s at what % significance?
A
  1. Anesthetic
  2. FALSELY ELEVATED
  3. 5%
29
Q

iCare

  1. What’s so great about it?
A
  1. Portable; Easy to use; No anesthetic or disinfection needed!
30
Q

Tactile

  1. How is it done?
  2. Want to ASSESS in what 3 cases?
A
  1. Press thumb against globe; Soft, medium, hard; Record: SOFT and EQUAL OU
  2. a. Infantile Glaucoma; Megalocornea; Photophobia
31
Q

What is one way to assess Angles?

A
  1. LIMBAL GLOW
32
Q

DFE: Infants vs. Toddlers

  1. Infants
    a. What’s Standard?
    b. Used for Cyclo?
    c. Less than 1 YEAR?
  2. Toddlers
    a. Standard?
    b. Used for Cyclo?
  3. What should be done on both to ensure proper amt of drops instilled?
A
  1. a. 0.5% Tropicamide and 2.5% phenyl
    b. 0.5% cyclopentolate and 0.5% Tropicamide
    c. 0.2% or 0.5% cyclo but can instill 2-3 times, 10 min apart
  2. a. 1.0% tropicamide and 2.5% phenyl
    b. 1.0% cyclo and phenyl
  3. Do NASOLACRIMAL OCCLUSION for BOTH!
33
Q

Posterior Segment Evaluation

  1. Panoptic: Degrees
  2. Direct: Degrees
  3. BIO: Degrees
A
  1. 5x; 45 Degrees
  2. 15x; 6.5-10 degrees
  3. 2.5x; 35 degrees
34
Q

DFE

  1. Do on infant when they’re doing what?
  2. What should you always do after?
A
  1. Sleeping or eating.
    * Use toys w/sounds

ONH and Macula important.

  1. RE-SCOPE!: ALWAYS do Post-dilated RET!!!
35
Q

Examination Tips

  1. What should guide your Subjective Testing?
  2. What kind of targets should u use?
  3. Test to what level?
  4. White coat on or off?
  5. Schedule appt during when?
  6. Have What pre-filled out?
  7. Work how?
A
  1. Objective testing should guide subjective
  2. Test and use Developmentally appropriate targets
  3. to the Highest level
  4. White coat off
  5. During patient friendly hours
  6. Have Hx form pre-filled out
  7. WORK QUICKLY!
36
Q

KNOW!! Recommended Eye Exam Frequency for Peds Pt

  1. Birth to 24 months
    a. Asymptomatic/Risk Free
    b. At-Risk
  2. 2-5 yrs
    a. Asymptomatic/Risk-free
    b. At-Risk
  3. 6-18 yrs
    a. Asymptomatic/Risk-Free
    b. At Risk
A
  1. a. at 6 months of age
    b. At 6 months of age or as recommended
  2. a. At 3 yrs of age
    b. At 3 yrs of age or as recommended
  3. a. Before first grade and every 2 yrs after
    b. Annually or as recommended
37
Q

Exam of Infant/Toddler

12 things

A
  1. Hx
  2. VA
  3. EOM, NPC
  4. Pupils
  5. CT/HK/Bruckner
  6. CVF OU
  7. Stereo (if able)
  8. Near Ret
  9. Ant Seg Eval
  10. IOP
  11. Cyclo Ret
  12. Post seg eval
38
Q

Preschool Exam:

  1. What Concerns are we looking for? (5)
A
  1. Mod RE
  2. Strab (Accom ET)
  3. Amblyopia
  4. Neurologic Disorders
  5. Ocular Pathology
39
Q

Preschooler Exam Components

14 of them…

A
  1. Hx
  2. VA (Lea or HOTV)
  3. EOM, NPC
  4. Pupils
  5. CT, HK/Bruckner
  6. CVF OU
  7. Stereo
  8. Near Ret
  9. PFV and NFV at NEAR, MEM
  10. Color Vision
  11. Ant Seg Eval
  12. IOP
  13. Cyclo Ret
  14. Post Seg Eval
40
Q

Exam of School Age Child

Concerns (7) (2/3 new ones compared to preschool exam)

A
  1. MILD to Mod RE
  2. VE SKILLS
  3. VIP
  4. Strab (accom ET)
  5. Amblyopia
  6. Neurologic Disorders
  7. Ocular Pathology
41
Q

Exam Components of School Age Child (14)

A
  1. Hx
  2. VA (SNELLEN!) **
  3. EOM, NPC
  4. Pupils
  5. CT, HK/Bruckner
  6. CVF OD and OS **
  7. Stereo
  8. Color Vision OU
  9. Near Ret and Refraction*
  10. Vergence and Accommodative Testing **
  11. Ant Seg Eval
  12. IOP
  13. Cyclo Ret
  14. Post Seg Eval
42
Q

Pediatric Prescribing: AOA Guidelines Statement

  1. Children of what ages?
  2. CEE Performed on 2K pts. Most common things optometrists will encounter?
A
  1. 6 months to 18 yrs
  2. Refractive Anomalies; **(Most common Conditions optometrists likely to encounter are BINOCULAR VISION and ACCOMMODATIVE DISORDERS)
43
Q

Most Kids: Types of Vision Disorders

  1. Most common vision disorder seen from 6 months to just under 6 yrs?
A
  1. HYPEROPIA (33%); Also…About 21% have STRABISMUS that you will see.
    * 6 yrs to 18 yrs: 23% for Hyperopia.
  2. 5% Astigmatism up to 2 Diopters (6 months to 18 yrs)
44
Q

Normal Development

  1. Infants (0-1 yr)/Toddlers (1-2 yrs 11 months): What do they typically have?
  2. Preschoolers (3-5 yrs 11 months): Same question
  3. School Aged (6 yrs or older)?
A
  1. +2.00D w/Astigmatism; up to 2DC and variable Anisometropia
  2. +1.00D w/Less astigmatism and less variation in Anisometropia
  3. Emmetropia
45
Q

Emmetropization: Time Course

  1. 3 Months
  2. 9 Months
  3. 18 Months?
  4. 36 Months
  5. Most critical period for Emmetropization?
A
  1. ~2.25D (w/Deviation of 0.75-3.5D)
  2. ~1.25D (0.25D - 2.5D)
  3. 1.12 D (0.25 - 2.0D)
  4. 1.25D (0.25D - 2.25D)
  5. First 1 1/2 yrs

Pediatric Optometry (6 decks)

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