Download - 2014 Basic Pediatric Vision Examination
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PGH Basic Course 2014
Basic Pediatric Vision Exam
Alvina Pauline D. Santiago, MDPediatric Ophthalmology & Strabismus
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Vision Assessment
Preverbal Age Group
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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
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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
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Fixation preference
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Profound Amblyopia
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Fixation Preference & Visual Acuity
• Central, steady, maintainedCSM 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
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Optokinetic (Catford) drum
• Fast saccades• May be calibrated
based on cycles per degree
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Preferential Looking
• Modified optokinetic flag
• Teller acuity cards or its derivative
• Facial targets
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Teller acuity cards
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Forced Choice Preferential Looking Tests (FPLs)
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School age child
• Not infants and toddlers• Preschool 3-6 years• Regular School 7-12• Adolescent 13-18
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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
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Preschool
• Short attention span• Inability to sustain interest• Language and communication barriers• Cultural and social limitations
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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
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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!
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Visual Acuity Testing
• Test Charts– HOTV / HOTEX– Tumbling “E” Game– Landolt C– Picture Charts
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Illiterate/Preverbal Charts
Landolt C Tumbling E
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HOTV Charts
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Lea Charts
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Grating vs Snellen Acuity
• Grating acuity (cycles per degree)
• Snellen acuity (visual angle)
• Grating overestimates Snellen
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Limitations of Optotype Test
• Snellen acuity unreliable before age 6-8• Not all children will know alphabet &
numbers• Single optotypes may overestimate linear
acuity
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Normal Visual Development
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Development of Visual Acuity
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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
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7-12 years
• Significant number still will not express poor vision
• Easy to perform Snellen linear acuity testing
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13-18 years
• Will verbalize a visual problem
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Vision Assessment
Non/Pre Verbal
OKN Drum FPLOKN Flag Teller
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Vision Assessment
Picture Charts HOTV SNELLEN
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Laser vision ;-)
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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
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Vision Assessment: Nystagmus
• Monocular occlusion– many will increase nystagmus
• Remote occlusion• Sufficient fogging: know refraction!• Neutral density filters• AO vectograph testing• Translucent occluder
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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
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Sensory Tests & Visual Acuity
Circles Seconds of Arc VA9 40 20/258 50 20/307 60 20/406 80 20/505 100 20/604 140 20/703 200 20/802 400 20/1001 800 20/200Donzis 1974
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Thank You!