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Binocular Vision > Vision Screening Amblyopia Investigation - Miriam > Flashcards

Vision Screening Amblyopia Investigation - Miriam Flashcards

1
Q

When are ocular health screenings carried out?

A
  • Before baby leaves hospital
  • 6 week check
  • 1-2.5 years old (when this happens is postcode dependent)
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2
Q

What two things does an ocular health screening consist of?

A

Making sure there is a red reflex and eye is structurally normal

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3
Q

Name five different groups of children which should be closely monitored

A

1) Children with systemic disease (diabetes, sickle cell)
2) Premature/low birth weight
3) FH of stab, amb or refractive error
4) Children with hearing loss
5) Children with learning disability

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4
Q

How many times more like are children with a learning disability likely to have an eye condition or require glasses?

A

28 times

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5
Q

What are premature babies/ low birth weight at risk of?

A

Retinopathy

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6
Q

What aged children undergo the pre-school vision screening?

A

4-5 year olds

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7
Q

What is the aim of pre-school vision screening?

A

Identify children with impaired sight so they are able to intervene in a timely manner

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8
Q

Who are allowed to carry out the pre-school vision screening?

A

Orthoptists or professionals trained by orthoptists

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9
Q

Why are 3 year olds not part of the pre-school vision screening programme?

A
  • Younger children= more false positive—> unnecessary referrals
  • Poor attendance rate when parents and children are invited
  • Delaying treatment to 5 years old will not adversely affect the child
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10
Q

What is the gold standard screening test to measure vision and why?

A

Linear LogMAR
It includes crowding and does not use singles which helps to detect amblyopia (treating at this age is vital to treat the amb)

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11
Q

Describe the procedure of vision screening tests

A
  • Explain test to child
  • Get consent from both parent and child
  • Ensure the child is able to match the letters at near for understanding
    -Test each eye separately (RE first unless they are struggling/ have strab)
  • Ensure other eye is occluded
  • Measure vision using Keeler logMAR
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12
Q

What age group is the crowded keeler LogMAR designed for?

A

3.5-5 year olds

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13
Q

What distance should keeler LogMAR be used for ?

A

3m

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14
Q

What six letters does the keeler LogMAR consist of?

A

XVOHUY

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15
Q

How many letters are on each line of the keeler LogMAR ?

A

4 letter each scoring 0.025 and each line scores up to 0.100

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16
Q

How is the keeler LogMAR carried out?

A
  • Occlude one eye
  • Start with s2 screener plate
  • If they cannot identify the biggest letter then move onto S1
  • Present the line of the last correct letter
  • 4 letters must be attempted before moving on to a small liner
  • Note line which error occurred and measure
  • Test other eye and use other test
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17
Q

What is the LogMAR pass criteria?

A

Children need to see at least 0.200 in both RE and LE

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18
Q

What is the main condition that the vision screening test is trying to detect?

A

Amblyopia

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19
Q

What conditions may you detect with the vision screening test?
(*hint there are 9)

A
  • Amblyopia
  • Cataract
  • Refractive error
  • Strabismus
  • Nystagmus
  • Ptosis
  • Muscle problem
  • Anisocoria
  • Rare pathologies (Coloboma and leuocoria)
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20
Q

What is amblyopia?

A

Visual impairment which results in reduced vision in one or two eyes causes by interruption of normal visual development

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21
Q

What can cause abnormal visual development?

A
  • Refractive error
  • Pathology
  • Strabismus
  • OCCURS DURING CRITICAL PERIOD
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22
Q

What age is the critical period?

A

7-8 years old (where vision is susceptible to abnormal visual input)

23
Q

What age is the sensitive period?

A

From time of deprecation to teen/adult years (basc when treatment is effective)
-BUT poorer prognosis

24
Q

What is development period?

A

Birth- 3/5 years old (when vision is developing)

25
Q

What can amblyopia effect?

A
  • vision
  • CS
  • Depth perception
  • Difficulty with crowding
  • Motion perception
  • Visual distortion
26
Q

Why would you treat amblyopia?

A

Better quality of life

27
Q

What struggles may someone with amblyopia face?

A

Driving, navigation around obstacles, threading beads, reaching and grasping
Reading (slower speed), cautious behaviour

28
Q

How many more times likely is someone with amblyopia at risk of a binocular visual impairment?

A

X2

29
Q

What are the five classifications of amblyopia?

A
  • Strabismic amblyopia
  • Stimulus deprivation amblyopia
  • Anisometropic amblyopia
  • Meridonal amblyopia
  • Ametropic amblyopia
30
Q

What type of strabismus is a child more likely to have related to strabismic amblyopia?

A

Constant manifest deviation- esotropia
*occurs monocularly

31
Q

What are the three most likely causes of stimulus deprivation?

A

Cataract and ptosis and nystagmus
An image cannot be clearly formed; occurs monocularly AND binocularly
Make sure to note how much the pathology prevents the macula

32
Q

Does anisometropic amblyopia occur monocularly or binocularly?

A

Monocularly

33
Q

What is anisometropic amblyopia?

A

Difference in refractive error where one eye receives better visual input than the other (can be sph and/or astigmatic difference)
*will occur in the eye with larger rx

34
Q

Does meridonal (astigmatic) amblyopia occur monocularly or binocularly ?
(*hint this is a trick question ish)

A

MONOCULARLY with anisometropic amblyopia
BINOCULARLY with ametropic amblyopia

This is because a burred image is formed along more ametropic axis

35
Q

Does ametropic amblyopia occur bilaterally?

A

Yes

36
Q

What are causes of ametropic amblyopia?

A
  • High hyperopia (accom can not compensate for this)
  • High astigmatic error
  • High myopia (make sure to look for pathology)
37
Q

What are three things you must do when investigating amblyopia?

A

History
Refraction (cyclo in children)
Ophthalmoscopy
VA
CS (optional)
CT
OM
Accom.
Convergence
Binocular status (PFR, stereopsis, CT)

38
Q

What should history include when investigating amblyopia?

A

What is the problem, what age did problem Start, how long has it been there for, with strabismus is it Constant/intermittent/alternating

39
Q

Do you know which refractions you should prescribe to which children?

A

No?
Look at the American academy of Ophthamology 2012 table as a guide line

40
Q

What is the average LogMAR for a 4-5 year old for crowded LogMAR test?

A

0.087

41
Q

What is the average LogMAR for a 4-5 year old for an uncrowded LogMAR test?

A

-0.010

42
Q

When measuring VA should you measure near or distance or both?

A

Both

43
Q

What may you want to use if the child has manifest latent nystagmus to occlude the eyes?

A

Spielman occluder

44
Q

Should you measure VA with CHP?

A

Yes- you should measure VA with compensatory head posture AND without

45
Q

In what instance would you measure CS?

A

If you have time and they are not losing concentration- not practical in younger children

46
Q

Wit a child who has alternating unilateral deviation, would you expect them to have unequal vision?

A

No- there vision should be equal ish

47
Q

What observations should you look out for if VA is not possible?

A

When doing CT:
- Note whether there is an unilateral deviation
- If the amblyopic eye holds fixation after blink
- Central fixation or eccentric fixation through corneal reflections
- Constant or intermittent deviation

48
Q

If the amblyopic eye holds fixation after blink, what does this show?

A

They are trying to use this eye and treatment may be working/ vision is improving

49
Q

What would you see if the px looks through eccentric fixation and why is this problematic?

A

The px turned eye does not move to take up fixation, therefore is viewing eccentrically and not using the macular so the vision will be very reduced

50
Q

What should you be looking out for when carrying out OM and the px is on amblyopia treatment/ thinking of starting this?

A

Look out for incomitancy as pxs with incomitancy are more likely to decompensated when you start occlusion which could lead to retractable diplopia

51
Q

What are three things you should do to check binocular status to ensure that occultation will not cause the child to decompensate?

A

-PFR (motor fusion range)
- Stereopsis
- Cover test (recovery)
- OM - look for incomitancy

52
Q

If a 4 year old had RE 0.200 and LE -0.100, would you refer them?

A

Yes due to the large difference in rx
-also more than 2 lines which makes it clinically significant

53
Q

Does a reduced VA mean this px has amblyopia?

A

No if there is no amblyopic RF then probably no amblyopia
- Reduced VA may be due to incorrect VA measured/ incorrect refraction done —> REPEAT TESTS

Binocular Vision (30 decks)

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