wk9: BV - Paed exam communication and management Flashcards
When is measuring vision of a child not typically possible? (2)
if child is very young (under 3) or unable to respond due to cognitive difficulties
What methods can we use to measure vision in children? (3)
Lea symbols
Pattie Pics
HOTV
All using a randomised chart where possible
How can we maintain the child’s attention when measuring vision subjectively?
Make it a “matching game” to ensure child understands the concept
If you are unsure of child’s cognitive abilities when measuring vision subjectively, what can you do to make the child more likely to cooperate?
Start with a single symptom that is big so child feels that what you are asking is EASY and they can have a go
Should measuring a child’s vision subjectively start monocularly or binocularly?
binocularly first to gain child’s confidence (also minimal disruption for child)
What is HOVT?
Literally a V.A chart with only the letters H, O, V, and T in random orders
What can you do if a child of 3-5 years confidence improves when measuring vision?
measure single symbol with isobars (crowding/contour interaction bars)
At what age might you consider LogMar presentation for vision testing? And when?
5+ years and only if sure child is able to udnerstand
At what age will we first expect 6/6 vision?
6 years old
What are the distance V.A expected norms for the following ages?
3, 4, 5, 6, 7,
3: 6/12
4: 6/9
5: 6/7
6: 6/7
7: 6/6-
What are the near V.A expected norms for the following ages?
3, 4, 5, 6, 7
3: 6/15
4: 6/12
5: 6/9
6: 6/7
7: 6/6-
For the SCCO 4+ system for evaluating oculomotor fucntion: what represents a rating of 4 +? (3)
fixation ability: smooth and accurate
pursuit ability: smooth and accurate
saccadic ability: smooth and accurate
For the SCCO 4+ system for evaluating oculomotor fucntion: what represents a rating of 3+ (3)
fixation ability: one fixation loss
pursuit ability: one fixation loss
saccadic ability: some slight undershooting
For the SCCO 4+ system for evaluating oculomotor fucntion: what represents a rating of 2+? (3)
fixation ability: 2 fixation losses
pursuit ability: 2 fixation losses
saccadic ability: gross undershooting and overshooting or increased latency
For the SCCO 4+ system for evaluating oculomotor fucntion: what represents a rating of 1+? (3)
fixation ability: more than 2 fixation losses
pursuit ability: more than 2 fixation losses or uncontrolled head movements
saccadic ability: inability to do task or any uncontrolled head movement
What is the most valuable tool we have as optometrists when seeing children? Why?
Retinoscopy: it’s objective, relaible
How may regular retinoscopy differ when used on a child? (1)
consider only putting working distance lens in eye you are doing ret on because otherwise child may not see target properly and therefore not comply/not look at target
What is the most reliable form of retinoscopy in children?
Retinoscopy with cycloplegia
What is the advantage of near/dynamic retinoscopy?
it gives you a real life indication of how the accommodative-vergence system behaves at near. This can sometimes be the only indicator of near function in children,because it is objective
What is mohindra retinoscopy? (2)
Done at 50cm in dark, monocular with no wd lens
Adjust finding: -0.75 for infants, -1.25 after 2 years old
In addition to ret, name 3 other objective refractive evaluation tools
- Keratometry/corneal topography: do routinely on all newly presenting school-aged kids
- Reduced VA from uncorrected Rx
- Autorefraction: can be considered when need further information on refractive status, best with cycloplegia,
What is the downside to autorefraction?
can often overestimate cyl/astig
Why should you do keratometry/corneal topography on school aged children?
serves as a baseline should there by any change in the years following. Also picks up suspicious looking corneas early and can be most valuable when tracking or diagnosing a first time keratoconic
State 5 clinical pearls for evaluating maximum plus with blur function
- children have very active accommodation: therefore over minusing needs to be avoided
- children are more dependent on their spatial (proximal) cues than adults, accuracy may be worse behind phoropter
- do refraction in free space: trial frame
- don’t waste time on conventional subjective refraction unless sure child is reliable
- even in some older children subjective refraction is difficult
Describe in 6 steps how you evaluate maximum plus with blur function in kids
- Add about +1-+1.50 over ret binocularly (or monocularly if child vision assymmetrical)
- Warn child it will be initially blurry
- Use randomised chart and progressively make easier
- Don’t ask if better or worse, get them to read the line
- Keep going until plateau or maximum plus to 6/6
- Can do monocularly as well when child with asymmetric vision
When assessing binocular vision, what is it your goal to evaluate? (4)
Binocularity: is child binocular? do the 2 eyes work together?
Visual efficiency: How efficient is this visual system? How does it cope with age expected visual demands at far and near?
How can you assess binocularity? (3)
Check suppression: worth 4 dot, distance and near, prism doubling
Check alignment: hirschberg, HH, cover test
Check sensory fusion: stereo tests, lang, fly, random dot
How can you assess visual efficiency? (4)
Posture: phorias (distance and near), MEM, NPA
Facility: accommodative facility, vergence facility
Ranges: vergence and accommodative ranges
Near skills: AC/A, NPC< PRA, NRA
How can we measure phoria when child is young? (5)
Prentice card:
- place vertical prism 6-8^BDR
- ask child if mum/dad looks funny or different
- if child picksup that mum has 2 heads, then you can have a go at measuring phoria
- take it slow with step by step instructions
How can we measure binocular vision status in very young children from 3-6? (3)
NPC
MEM ret
Cover TEst
What is the Bruckner Test? (5)
Dim room
1 metre test distance
No pupil dilation
Shine ophthalmoscope onto bridge of nose to illuminate both pupils at same time
Compare brightness and whiteness of fundus (red) reflexes through pupils
What does an unequal reflex in bruckner test mean?
could indicate refraction differences between eyes
What does the bruckner test show if strabismus is present?
deviated eye looks whiter and brighter
What does the bruckner test show if media opacities are present?
can see this via absence of red reflex or obstruction to red reflex
