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Pediatric Low Vision Exam

Pediatric Low Vision Exam. Dr. Kate Boland, OD Fall 2008. Sequence of Vision. Awareness Fixation/following Visual recognition Visual perception. General Rules. Work fast! Don’t do at nap time! Keep them engaged! Have fun (when appropriate). Denver Development Test.

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Pediatric Low Vision Exam

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  1. Pediatric Low Vision Exam Dr. Kate Boland, OD Fall 2008

  2. Sequence of Vision • Awareness • Fixation/following • Visual recognition • Visual perception

  3. General Rules • Work fast! Don’t do at nap time! • Keep them engaged! • Have fun (when appropriate)

  4. Denver Development Test • Review what they should be able to do, visually, at different ages

  5. Goals of LVE • Functional assessment • Vision demands/tasks • Varies with age & grade • Education of parents, teachers, others

  6. History • OHx, MHx, Dev’l Hx, Educ’l Hx • Inc OT/PT, devices using, prev LVE, etc • Use camera to show retina, ONH, etc to parents to educate! • Parents, teachers, others’ perceptions of child’s function

  7. VA Testing • Recognition • Resolution • Detection • Localization

  8. Recognition • LEA symbols • Book, D, N, puzzle (3D) symbols • LH pictures • House, apple, umbrella • Broken wheels • Letters/numbers • Tumbling E, ETDRS, Landolt C • HOTV, Allen symbols, Pediatric Feinbloom • Near cards, projection

  9. Resolution • Preferential looking • Teller cards • Lea gratings • OKN drum • VEP

  10. Detection • Sheridan graded ball test • Bock candy bead test • Ball retrieval • Gross objection recognition • LP, LProj

  11. Localization • Vernier/hyperacuity • Ability to determine different spacial positions of targets

  12. VA Testing • Occlusion • Mom/child’s hand • Pirate patch • “Fun” occluding glasses • Adhesive patch • clip-on occluders • 3M tape • Card choice • WD problems in recording • Not age-appropriate for low vision

  13. OM, Binocularity, EV/EF • Cute targets • “CSM”—central, steady, maintained fixation • H, Kappa, Bruckners, red reflex, CT • But could be using EV!

  14. (cont) • EOM • VF • Refraction • CV • CS • Eye-hand coordination • Developmental testing

  15. Common Ocular Disorders in Children • Cornea • Leukocornea—Most common onset for toddlers • Posterior segment • Retinoblastoma—most common malignant tumor in children • Others: • Cataract • Glaucoma

  16. LV Aids • Start using at ~5 years of age unless very smart • Rarely used on small children • Changing visual needs • Social issues • Parents/teachers • Finances

  17. Visual Considerations in an Educational Setting • Seating • Lighting • Reading?/Writing? • Braille? • Making learning fun • Students adjust to vision loss • Socialization/play • Setting goals • Feedback & communication • When services are no longer needed

  18. Other considerations • Watch for: • Organizational skills • Self-responsibility • Personal care needs • Indoor O&M • “labelling” • Team effort

  19. Devices • Same as for adults • Special kid size frames • Dome & bar magnifiers • Galilean telescopes • Software

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