Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.
PGH Basic Course 2014
Basic Pediatric Vision Exam
Alvina Pauline D. Santiago, MD
Pediatric Ophthalmology & Strabismus
2007
Vision Assessment
Preverbal Age Group
2007
Visual milestones
• Birth Bright lights
• 7 days vestibulo-ocular reflex
• 3 mos transient fixation & following
• 6 m...
2007
Vision Assessment
• Fixation pattern
• 3 mos: transient fix and follow
• 6 mos: fix and follow
– “CSM” : central, ste...
2007
2007
2007
Fixation preference
2007
Profound Amblyopia
2007
Fixation Preference &
Visual Acuity
• Central, steady, maintained
CSM 20/20-20/30
• CS, maintained briefly 20/40-20/6...
Optokinetic (Catford) drum
• Fast saccades
• May be calibrated
based on cycles per
degree
Preferential Looking
• Modified optokinetic
flag
• Teller acuity cards or
its derivative
• Facial targets
Teller acuity cards
Forced Choice
Preferential Looking Tests (FPLs)
School age child
• Not infants and toddlers
• Preschool 3-6 years
• Regular School 7-12
• Adolescent 13-18
Vision testing
• Quantifiable
• Depends on patient discrimination
• Depends on examiner ability to interpret
response
• St...
Preschool
• Short attention span
• Inability to sustain interest
• Language and communication barriers
• Cultural and soci...
Preschool Tests
• Detection acuity tests
– Stycar graded balls (Sherian 1973)
– Catford drum (Catford & Oliver 1973)
– Dot...
Vision Assessment: 3-6 years
• Allen pictures: cultural bias
• Sheridan Gardner or HOTV/HOTEX
• Illiterate E / tumbling E ...
Visual Acuity Testing
• Test Charts
– HOTV / HOTEX
– Tumbling “E” Game
– Landolt C
– Picture Charts
Illiterate/Preverbal Charts
Landolt C Tumbling E
2007
HOTV Charts
2007
Lea Charts
2007
Grating vs Snellen Acuity
• Grating acuity (cycles
per degree)
• Snellen acuity (visual
angle)
• Grating overestimates
Sne...
Limitations of Optotype Test
• Snellen acuity unreliable before age 6-8
• Not all children will know alphabet &
numbers
• ...
Normal Visual Development
Development of Visual Acuity
Susceptible Period
• Most sensitive first 2-3
years
• Decreases until age 6-
7 years (12? 18?)
– complete visual
maturatio...
7-12 years
• Significant number still will not express
poor vision
• Easy to perform Snellen linear acuity
testing
13-18 years
• Will verbalize a visual problem
2007
Vision Assessment
Non/Pre Verbal
OKN Drum FPLOKN Flag Teller
2007
Vision Assessment
Picture ChartsPicture Charts HOTVHOTV SNELLENSNELLEN
2007
Laser vision ;-)
Vision Assessment: Nystagmus
• Binocular near vision test
– allow patient to assume own distance
– test at standard near d...
Vision Assessment: Nystagmus
• Monocular occlusion
– many will increase nystagmus
• Remote occlusion
• Sufficient fogging:...
2007
Random dot stereograms
• 2 plates of randomly
displayed dots, one
plate to each eye
• Shape of figure
displaced horiz...
2007
Sensory Tests & Visual Acuity
Circles Seconds of Arc VA
9 40 20/25
8 50 20/30
7 60 20/40
6 80 20/50
5 100 20/60
4 140...
2007
Thank You!
Próxima SlideShare
Cargando en…5
×

2014 Basic Pediatric Vision Examination

A Basic Course Lecture in Ophthalmology, [Section of Pediatric Ophthalmology and Strabismus (Motility)]in the Philippine General Hospital, Sentro Oftalmologico Jose Rizal, 2014

Audiolibros relacionados

Gratis con una prueba de 30 días de Scribd

Ver todo
  • Sé el primero en comentar

2014 Basic Pediatric Vision Examination

  1. 1. PGH Basic Course 2014 Basic Pediatric Vision Exam Alvina Pauline D. Santiago, MD Pediatric Ophthalmology & Strabismus
  2. 2. 2007 Vision Assessment Preverbal Age Group
  3. 3. 2007 Visual milestones • Birth Bright lights • 7 days vestibulo-ocular reflex • 3 mos transient fixation & following • 6 mos fixation & following even for distance • 2-3 y 20/30 • 5-7 y 20/2
  4. 4. 2007 Vision Assessment • Fixation pattern • 3 mos: transient fix and follow • 6 mos: fix and follow – “CSM” : central, steady, maintained – cover one eye – start distance fixation
  5. 5. 2007
  6. 6. 2007
  7. 7. 2007 Fixation preference
  8. 8. 2007 Profound Amblyopia
  9. 9. 2007 Fixation Preference & Visual Acuity • Central, steady, maintained CSM 20/20-20/30 • CS, maintained briefly 20/40-20/60 • CS, not maintained (NM)20/70-20/80 • C, NS, NM 20/100-20/200 • Not C, Eccentric </= 20/300
  10. 10. Optokinetic (Catford) drum • Fast saccades • May be calibrated based on cycles per degree
  11. 11. Preferential Looking • Modified optokinetic flag • Teller acuity cards or its derivative • Facial targets
  12. 12. Teller acuity cards
  13. 13. Forced Choice Preferential Looking Tests (FPLs)
  14. 14. School age child • Not infants and toddlers • Preschool 3-6 years • Regular School 7-12 • Adolescent 13-18
  15. 15. Vision testing • Quantifiable • Depends on patient discrimination • Depends on examiner ability to interpret response • Standard: Snellen acuity: optotype • Psychophysical tests: test interpretation subjective measured by patient’s ability to communicate recognition to examiner
  16. 16. Preschool • Short attention span • Inability to sustain interest • Language and communication barriers • Cultural and social limitations
  17. 17. Preschool Tests • Detection acuity tests – Stycar graded balls (Sherian 1973) – Catford drum (Catford & Oliver 1973) – Dot visual acuity test • Recognition acuity test – Direction oriented: Illiterate E, Landolt C – Picture charts – Letter charts
  18. 18. Vision Assessment: 3-6 years • Allen pictures: cultural bias • Sheridan Gardner or HOTV/HOTEX • Illiterate E / tumbling E / E game • Landolt C • Snellen numbers, letters – kids memorize!
  19. 19. Visual Acuity Testing • Test Charts – HOTV / HOTEX – Tumbling “E” Game – Landolt C – Picture Charts
  20. 20. Illiterate/Preverbal Charts Landolt C Tumbling E 2007
  21. 21. HOTV Charts 2007
  22. 22. Lea Charts 2007
  23. 23. Grating vs Snellen Acuity • Grating acuity (cycles per degree) • Snellen acuity (visual angle) • Grating overestimates Snellen
  24. 24. Limitations of Optotype Test • Snellen acuity unreliable before age 6-8 • Not all children will know alphabet & numbers • Single optotypes may overestimate linear acuity
  25. 25. Normal Visual Development
  26. 26. Development of Visual Acuity
  27. 27. Susceptible Period • Most sensitive first 2-3 years • Decreases until age 6- 7 years (12? 18?) – complete visual maturation – retinocortical pathways and visual centers resistant to abnormal visual input
  28. 28. 7-12 years • Significant number still will not express poor vision • Easy to perform Snellen linear acuity testing
  29. 29. 13-18 years • Will verbalize a visual problem
  30. 30. 2007 Vision Assessment Non/Pre Verbal OKN Drum FPLOKN Flag Teller
  31. 31. 2007 Vision Assessment Picture ChartsPicture Charts HOTVHOTV SNELLENSNELLEN
  32. 32. 2007 Laser vision ;-)
  33. 33. Vision Assessment: Nystagmus • Binocular near vision test – allow patient to assume own distance – test at standard near distance – check head posture – VA in forced primary • Binocular distance vision • Monocular distance & near vision
  34. 34. Vision Assessment: Nystagmus • Monocular occlusion – many will increase nystagmus • Remote occlusion • Sufficient fogging: know refraction! • Neutral density filters • AO vectograph testing • Translucent occluder
  35. 35. 2007 Random dot stereograms • 2 plates of randomly displayed dots, one plate to each eye • Shape of figure displaced horizontally relative to other plate • No monocular cues • Normal may fail
  36. 36. 2007 Sensory Tests & Visual Acuity Circles Seconds of Arc VA 9 40 20/25 8 50 20/30 7 60 20/40 6 80 20/50 5 100 20/60 4 140 20/70 3 200 20/80 2 400 20/100 1 800 20/200 Donzis 1974
  37. 37. 2007 Thank You!

×