The Pediatric Eye Exam Revised test 2024

One important thing to remember when performing a pediatric exam - ANSWERSstranger anxiety 3 types of pediatric patients - ANSWERSindividual differences 40% easy child 10% difficult child 15% slow to warm up chld Easy Child - ANSWERS-has routines -positive outlook -adapt well Difficult Child - ANSWERS-no real routines -negative about novelty -intense responses -negative mood Slow to Warm Up Child - ANSWERS-low activity level -withdraws from novelty -slow adaptation -somewhat negative Newborns should be examined for - ANSWERS-ocular structure abnormalities --> cataract, corneal opacity & ptosis -then referred to pediatric ophthalmologist Vision Screening - ANSWERS-strong reliance on primary care physicians or school screenings -if fail screening many do not receive follow-up care Current problems with vision screening system - ANSWERS-parents' current lack of knowledge about the importance of early professional eye care & doing follow-up AOA Recommedations for Eye Exams - ANSWERS-0-3: should get by 6 mos of age (95% of kids are just fine) -Preschoolers: at ages 3 & 5 -School Age: (6-19) annually -Adult (20 <): every 1 to 2 yrs Vision screening for babies under 1 yr - ANSWERSfree if do Infant SEE How many children under 18 - ANSWERS72.3 million 26% of population What percentage of children 6-16 had full exam in last year - ANSWERS31% What percentage of children under 6 had eye exam in last year - ANSWERS14% What percentage of infants will have normal eyes - ANSWERS90-95% Hyperopia prevalence in 0-6 yo - ANSWERS33% Myopia prevalence in 0-6 yo - ANSWERS9.4% Strabismus prevalence in 0-6 yo - ANSWERS21.1% At a very young age large amounts of _____ are allowable, but - ANSWERShyperopia reduced amount allowable as age As a child ages and cooperates more, pediatric exams will go from - ANSWERSobjective to more subjective tests Tips for pediatric exam - ANSWERS-watch the child & how they engage with their surrounding -when can, work around nap & snack time -reschedule if pt exhausted -calm flow -only introduce 1 toy at a time (hide others) -rewards like cheerios Types of toys - ANSWERS-plastic not cloth if pt will touch -very visible (colorful, high contrast, sound) -small toys for fixation targets -larger toys to keep hands busy -puppets Your equipment & toys will distract pt - ANSWERSuse to your advantage, but may need to use your hands for more (won't get distracted by) Cover test - ANSWERS-puppet on finger -play peek-a-boo & cover their eye with your hand If the child is just arriving for their exam - ANSWERS-try to let them finish their nap -may take off white coat (anxious) -don't be overly exaggerated right off the bat -you only have 15-20 min -child under 6, NEED parent in room, but engage with child as well Before start exam - ANSWERSexplain to parents: -not full adult exam--> special games to look at 4 things *Binocularity *acuity *refraction *health Make sure to tell parents right away - ANSWERSdon't give glasses for small Rx, just for large--> parent then know if you say the child need them than they really do need them, not just about making money Patient Ocular History - ANSWERS-examined before -Rx -Who Medical History - ANSWERS-pregnancy -birth prematurity -Apgar -illness Apgar score - ANSWERS-given 1-5 min after birth to assess: heart rate, respiratory effort, muscle tone, reflex irritability, & color -use 0, 1, or 2 Family Ocular History - ANSWERS-childhood vision problems -Rx/strab/amblyopia/color vision issues Special ROS question for peds exam - ANSWERS-family status -academic history -home behaviour Common Pediatric Chief Complaints - ANSWERSParental reasons/noticed -eye turn -head tilt -standing/reading too close -rubbing, blinking, squinting -Family Hx of vision problems OR -routine before school starts -school screening referral -second opinion Pediatricians usually refer to - ANSWERSophthalmologists--> see health concerns Blood pressure is only taken on children - ANSWERS3 and up Preliminary and Binocular testing - ANSWERS-be smooth & efficient--> don't take notes after each test (keep game going) -use words/games kids understand -Versions Hirschber Cover NPC/base out prism for fusion pupils Bruckner (brighter reflex in non-fixating eye) Versions - ANSWERS-puppet "Follow the ___, oh look he's tickling my knee, now he's ___ may have to stand & move around (they will move their head--> fine as long as you can get eye into position you need) Throughout the exam be - ANSWERSgentle and positive if need to do something kid won't like, save it until they warm up to you or until the end Pupils - ANSWERShands between eyes to block light going into both eyes When recording acuity, note - ANSWERS-distance at which tested -confidence of the measure -what test was used If visual field necessary - ANSWERS-big bright toy held in front -bring wand around and see when the baby whips around to put wand in fixation Acuity Measures - ANSWERS-occlusion preference -fix & follow -base up prism before one eye (do they fixate with each eye) -Teller cards -Cardiff Cards -Lea Symbol Matching -Lea Symbol Naming -Letters when able What acuity measure should you not use - ANSWERSAllen figures Why should you not use Allen figures - ANSWERS-difficult to know what the symbol is -when blur still look different Qualitative Measures of Acuity - ANSWERSocclusion preference fix and follow Base up prism Occlusion preference - ANSWERSsee if baby try to get out from behind your hand more so when cover one eye and not the other Base-up Prism before one eye - ANSWERS-with child attending object, introduce prism -with either look down or keep looking straight ahead -how often down, how often straight ahead, happen when cover eye as well Quantitative Measures of Acuity - ANSWERS-Teller cards -Cardiff cards -Lea Symbols Matching -Lea Symbols Naming -Letters Teller Cards Age - ANSWERSBirth to 9 mos Teller Cards - ANSWERS-line grating that when blur out look the same -show baby card & should look at stripped portion if can see it--> based on what child do (then see which side stripes on) Cardiff Cards Age - ANSWERS9 mos to 2 yrs Cardiff Cards - ANSWERSimages on top or bottom of card that look plain gray when reach resolution What condition are Cardiff cards particularly good for - ANSWERS-nystagmus Lea Symbols Matching Age - ANSWERS2.5 to 3.5 yrs Lea Symbols Matching - ANSWERS-start next to child -"We are going to play a game" -point to a picture and ask child to point to same picture in their book -when get activity say "you are so good at this" -move to distance and repeat If need a monocular VA - ANSWERS-blacked out sunglass with only one lens -need to pairs of sunglasses -let child "choose" which sunglasses they want to wear, which color (aka which eye they want occluded first) If you have any concerns about one eye - ANSWERSdo the most suspect eye first (child may lose interest or get tired) Refractive Error - ANSWERS-retinoscopy *ret bar *loose lenses *phoropter With your retinsocopy - ANSWERSneed to be on visual axis must be as accurate as you can make it, often have to prescribe based on your ret learn to estimate the reflex Types of Ret - ANSWERS-Dry -Mohindra/Near -Cyck=loplegic Dry Ret - ANSWERS-distance fixation toy -cyl, aniso & approx sphere Mohindra Ret - ANSWERS-totally dark room, where pt stares at ret beam -monocular -1D working distance -done well with practice Approach to explaining cycloplegic drops - ANSWERS-Ask parent if they have had their eyes dilated -Done to check the health of the eyes -would like to do that today if they "have the time" -need to check the health of the back of the eyes -Need drops to see if child needs glasses, with adult ask them if lenses make vision better, but can't with kids--> drops help us to relax their focus -pupils may take up to 24 hr to come down but ability of eyes to focus will come back sooner Cycloplegic drops - ANSWERS-under 6 mos: 1 gtt OU 0.5% cyclopentolate -over 6 mos: 1 gtt OU 1% cyclopentolate