Toddler And Preschool Exam Flashcards
Signs of uncorrected RE
Difficulties w/ depth perception and hand-eye coordination - “clumsy”
Confuses similar things - poor discrimination of details
Rubs eyes, blinks excessively, squints
Double vision (vs shadowing)
Closes one eye
Lack of interest in outdoors or sports
Close working distance/avoids near tasks
VA assessment
Subjective acuity by age 3
Recognition acuities preferred over preferential looking
Forced choice (preferential) or matching
Detection acuity: Cardiff cards
50 to 100 cm
Acuity range: 20/12.5 to 20/320
Recognition acuity
Lighthouse - easy to guess
Allen figures (D&N) - outdated pics
Lea symbols (D&N) - 4 alternative forced choice, naming or matching
HOTV (D&N) - same as Lea symbols
Resolution acuity
Tumbling E or Landolt C - difficult for children w/ directionality issues
Broken Wheel - Landolt C target
- 20/20 to 20/100 at 10 ft
- highly correlated to Snellen
- Must get 4/4 for credit at each level
Electronic charts
- Snellen, Allen, Tumbling E, Broken Wheel, HOTV, numbers, crowding bars
- records how acuity was taken
Pupils, EOMs, CVF, NPC, CT are performed same as you would for adults. True or false?
True
Amp of accom
Average = 18.5 - 1/3 (age) Minimum = 15 - 1/4 (age)
Pull away — most likely for toddler; MORE RELIABLE
Cm -> diopters
Push up - results often inflated
Color tests
Ishihara
CVME - preferable
HRR
Fusion
W4D ~4 yo
3 figure flashlight ~2 yo: red girl, green elephant, white ball OR Lea shapes - green house, white circle, red square
Stereopsis (basic binocular tests)
Lang
Randot- local and global
Randot 3 - Lea symbols
Forced Choice PL
- PASS test: non-stereo target used to determine understanding; VA of at least 20/80 and no constant strab req
- Randot E: control plate w/ 3D image; blank vs E
RE measurements
Static ret (usually attempt) - movies, ret bars, loose lenses vs phoropter
Damp ret - 1% trop
Cyclo - 1% cyclo (preferred for first eval of preschoolers; must quantify significant RE in presence of visual conditions: strab, amblyopia, anisometropia)
Mohindra - dark
Subjective - NRA/PRA/FCC (not likely but can attempt)
Autorefractor - problems w/ this method?
Vergences
- Step vergences: prism bar, no blur reported, OBJECTIVE
- Smooth vergences: phoropter, SUBJECTIVE
Dynamic ret (MEM)
Accom lag/lead
WD: habitual (~40cm)
Target: age-appropriate (greater lab w/ easy reading material)
0.25s before pt adjusts accom - must work quickly
Expected findings: +0.50D to +0.75D
Ant seg (angles)
Penlight
20D lens and transillumination
Burton lamp
SLE (older child— preferred)
