TOPIC 1: IMPORTANCE OF PAEDS AND OCULAR DEV Flashcards
when should an infant first receive eye exam?
3-4 months
proper exam at 6 months to screen for premature retinopathy or retino-blastonoma
desxcribe tests to be done at 6 months, 3 years, 5-6 years and >6 years
6 months: fundus
visual system is rapidly developing and most part of vision developed by 1 year.
When an eye examination is conducted early, eye conditions can be detected early and treated. This would results in better treatment outcome.
2-3 years: vision and BV (same rationale as above)
Vision problems occurs during this time
Commonly include accommodative esotropia and meridional amblyopia
Children can begin to communicate, Easy to examine, Less fearful than at ages 1-2
5-6 years: vision, BV and learning
Social impact - Ensure child entering primary schools has optimal vision for learning
Learning impact - Detects problems before they impact on learning
6 years: yearly vision, BV and learning
what is the frequency of eye exam for paeds under 16? rationale?
asymptomatic: yearly
at risk: 6 months or earlier upon indication
Vision demands are changing as academic skills increase
Reading in early grades–primarily large print, which is less visually demanding. Check visual perceptual skills for learning difficulties.
Reading in middle to upper grades–smaller print, which is more visually demanding. Check visual efficiency skills for learning difficulties -accommodative, binocular and ocular motor problems become evident due to increased near point demand
**Refractive error changing throughout childhood
state the objectives of each of the following steps of PAEDS eye exam.
HX, VA/Rx, preliminary and BV, ocular health, additional tests, visual perception evaluation
Hx: Any complains or visual issue or concerns that either the parent or child is noted. checking and documentation, allows optometrist to consider possible causes and determine tests to be conducted.
VA/Rx: investigate the child’s refractive status and best corrected monocular visual acuities. CS on indication. vision examination and comparison to age norms. This is also important for documentation of visual function and its development.
preliminary and BV: assessed with Cover Test, Ocular Motility, Stereopsis, Accommodation and Vergence tests.
examination of BV status and comparison to age norms. This is also important for documentation of visual function and its development
ocular health: interior and posterior ocular health of the child’s eye will be assessed using SLE and ophthalmoscopy/fundus
This is important to rule out any anterior and posterior conditions which may affect visual function and its development.
additional tests: Other tests like colour vision, eye pressure and visual field etc can be conducted
This allows for a better understanding and/or ruling out abnormalities.
visual perception evaluation: assessed for any learning disabilities
state some conditions that are developmentally significant and educationally significant
developmentally significant:
-strabismus, Rx error, congenital pathology, visual impairment, genetic disorders, ophthalmological emphasis
educationally significant:
- lesser rx error, functional visual problems, primary care mx (before school)
-visual processing difficulties, vision in cognitive and language difficulties (apparent after school)
describe the developmental changes to the cornea, lens, retina, axial length and pupil in a child
cornea: lengthens, 10mm -> 12mm, radius curvature lengthens 7mm -> 7,9mm
lens: lens flattens
retina: at birth, peripheral retina fully developed, diameter 66% of adult size
axial length: increases in length, 17mm->24mm (62% of final size at 1 years old
pupil: at birth miotic (constriced), slugish reflex (under developed dilator pupillae), protects eye from light
describe the VA development in a child. what are the 4 factors that contribute to VA improving?
Visual acuity of an infant will continue to develop rapidly and approach adult level by about 3 to 5 years old.
- Maturation in size and shape of photoreceptors
- Improved organisation of photoreceptor
- Improve in eye movement and accommodation
- Development of cortical connections and processes
note:
Birth - 3 years old: Near VA only
>3 years old: Near and Distance VA
what info needs to be included in a PAEDS record?
- Reason for visit/ presenting complaint
- Other visual/ocular history (eg. conditions that predispose child to visual problems such as prematurity, certain childhood medical problems)
- Family history of refractive error
- Family history of strabismu
tests that need to be done for PAEDS according to OOB
1, External eye and adnexae
2. Pupillary function
3. Anterior segment (including ocular media)
4. Posterior segment (including ocular fundus)
5. Presenting monocular visual acuities
6. Refractive status
7. Best corrected monocular visual acuities using objective and/or subjective methods
8. Ocular motility
9. Cover test
10. Near point of convergence (NPC)
11. Stereopsis
12. Colour Vision
why is early eye exam important?
Early detection of ocular and/or vision anomalies, allows for timely intervention and better treatment prognosis.
e.g An example is Amblyopia.
It can be present and detected from 6 months old.
If detected, treatment is needed throughout childhood.
list 7 parental concerns and the possible causes behind them
- blur vision: refractive error, ocular condition/disease
- eye related pain or discomfort: trichiasis, distichiasis, hordeolum, blepharitis, allergy, foreign body
- failed vision screening: refractive error, ocular condition/disease
- Binocular misalignment, ocular motility disorder, usual/abnormal head posture: BV issues, habit, epicanthal folds
- Eyes do not looked healthy/normal: refractive error, conjunctivitis, blepharitis, epicanthal folds, ptosis
6.Copy wrong, colouring issues, writing wrong: refractive error, BV issue, Learning difficulties - no particular concern: Seek reassurance.
what is the usual rx status of babies?
babies are usually hyperopes of about +2.00 Diopters, 69% chances of having astigmatism of 1.00 DC or more.
Hyperopia slowly reduce with growth of eye ball
