Peds Exam 1

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L2Q10: which single test can detect most common and significant vision disorders in preschool children: A) stereopsis B) cover test C) autorefraction D) visual acuity

L2Q1: the American academy of pediatrics recommends a child's first comprehensive eye exam: A) at birth B) at 6 months C) at one year D) at 5 years E) none of the above

1 out of every ____ people in the US have learning disabilities and over 6 million children (ages 6 through 21) receive special education in school for learning disabilities. over half of all children who receive special education have a learning disability

1. dyslexia 2. dysgraphia 3. dyscalculia

3 "dys's" of learning disabilities: 1. _____ - reading disorder (neurological and genetic that can be inherited) 2. ______ - writing disorder (difficulty transferring language into written output) 3. _____ - math disorder (difficulty in understanding numbers and concepts with numbers)

1. F2 or PACT 2. wagonner - color vision made easy 3. D15 or lea plates

3 tests we can do for color vision: 1. ____ or ____ - child puts color blocks on matching squares ("park car") 2. _____ - uses colored objects 3. _____ or ____ ___ - child puts colors in ordered gradient (can do at 5 or older)

1. cardiff cards 2. lea acuity paddles 3. teller acuity cards

3 types of targets for forced choice preferential looking: 1. _____ ____ - cards with pictures that we present either up or down to see where the child looks. on each of the cards, the image size is the same, but some are harder to see 2. _____ ____ _____ - paddles with stripes at various sizes at 57 cm 3. ____ ____ ____ - most commonly used and researched the most. these are calibrated for 3 test distances (38, 55, and 84, cm), and test 20/20 to 20/2000 VA

1 age school

4 criteria for DSM 5 definition of specific learning disability: 1. have at least ____ of 6 symptoms of a learning disability that have persisted for at least 6 months despite intervention 2. measurement of these characteristics which are below expected for the ____ and cause impairment in academic, occupational, and everyday acitivites 3. age of onset during _____ years 4. Specifies which disorders (uncorrected auditory, VA, mental or intellectual disabilities) or adverse conditions (psychosocial adversity, inadequate instruction, lack of proficiency in language of instruction) must be ruled out before a diagnosis of SLD can be confirmed

L1Q10: if a parent brings their 13 year old daughter to you for an eye exam, what are the most to least likely vision disorders you would find? A) color anomaly, RE, amblyopia B) coloboma, amblyopia, BV disorders C) myopia, exotropia, cataracts

L1Q11: if a parent brings their 4 year old son to you for an eye exam, what are the most to least likely vision disorders you would find? A) exotropia, color anomaly, amblyopia B) coloboma, amblyopia, color anomaly C) RE, esotropia, cataracts

L1Q12: there is agreement by ODs, MDs, and nurses that: A) eye exams before age 6 are not necessary B) an eye exam upon school entry is important C) exams should be yearly during school D) none of the above are true

L1Q13: you examine a 12 month old child with 20/40 VA and otherwise normal findings. you should tell the parent their child: A) likely have amblyopia B) should be seen again at age 2 years C) will likely need eyeglasses by age 8 D) all of the above are true

L1Q14: you examine a 3 year old child and find 20/40 VA with normal findings in all other areas. you should tell the parent: A) the child likely has ocular pathology B) the child likely has reduced VA and amblyopia C) the child likely have a significant RE D) the child does not have a vision problem

L1Q15: you examine a 7 year old for a routine exam and find 20/40 VA with otherwise apparently normal findings in all areas. you should tell the parent: A) the child likely has an ocular pathology B) this is an essentially normal exam C) the child's VA is reduced for their age D) further testing is not needed

L1Q16: you examine a 2 month old boy and find his right eye drifts inward about 50% of the time. the rest is normal. you should tell the parent: A) the child likely has amblyopia B) should re-evaluated in 2 months C) will likely need strabismus surgery D) all above are true

L1Q17: you examine a 3 year old for his first exam and find +4.00 sph OU (wet). his eyes are aligned and he has normal stereo. you should tell the parent: A) the child likely has amblyopia B) has a binocular vision problem C) not do well in school unless corrected D) has normal acuity

L1Q18: you examine a 10 year old boy who has been having trouble learning in school since grade 1, and find 20/40 VA. you are most likely to find what type of vision problem: A) elevated IOP and restricted fields B) a significant refractive error C) a binocular vision problem D) a visual processing disorder E) unlikely to find a vision problem

L1Q19: you examine a 6 year old girl who has a wet refraction of +0.25 OU. is this child at risk for having a vision problem during the school years? A) yes - she should be seen again in 2 years B) yes - she should be seen again in 1 year C) no - should be seen again in 2 years D) no - she should be seen again in 1 year

L1Q1: How many children have you worked with in clinic thus far? A) none B) 1 or 2 C) more than 5 or 10 D) not enough E) way too many

L1Q2: how many children have you had a conversation with or interacted with outside of clinic in the last year? A) none B) maybe 1 or 2 C) just a few (3-5) D) quite a few E) too many

L1Q3: how would you describe your current comfort level with children? A) extremely comfortable B) reasonably comfortable C) not so comfortable D) what are children

L1Q4: for an eye exam, I am currently ok seeing: A) children over age 10 B) children over age 5 C) from birth and up D) no children at any age

L1Q5: in my practice after graduating from Salus, I plan to see: A) many children B) some children C) children once in a while D) no children if possible

L1Q6: in my practice after graduating from Salus, I plan to examine children below 5 years of age: A) often B) sometimes C) rarely D) never, never, never

L1Q7: these percentages represent what: utah 10%, texas 8%, arizona 8%, NJ 6%, and PA 6%: A) the % of children B) the % of school age children C) the % of preschool children

L1Q8: which is the correct order for the development of these visual skills from earliest to develop to last to develop? A) VF, CV, pursuits B) CV, 20/20 VA, VF C) stereoacuity, VA, color vision D) refractive error, contrast sensitivity, stereoacuity

L1Q9: during the first year of life, there is rapid development and change in many of the characteristics of vision, including VA, CV, stereopsis, ocular motilities, accommodation, VF, contrast sensitivity, and refractive error. because of this, optometrists can first examine children: A) beginning shortly after birth B) beginning at age 6 months C) when they enter preschool D) when they enter kindergarten E) when there is a problem

L2Q2: what is the purpose of a vision screening: A) diagnose vision problems in children B) detect and treat vision problems in children C) provide vision care to children who will not be getting eye exams D) detect children at risk for vision problems

L2Q3: with regard to vision screenings: A) every state has guidelines for vision screening B) there are some states without any guidelines C) most state guidelines for screening are similar

L2Q4: are there any federal laws for vision screenings or exams in children: A) yes B) no

L2Q5: of the 7000+ children screened in Philadelphia each year, 20% are at risk for a vision disorder. what percentage of these children receive an eye exam? A) 82% B) 62% C) 42% D) 22%

L2Q6: if a test has a sensitivity of 75%, it missed 25 children with a vision problem A) true B) false

L2Q7: if a test has a specificity of 60%, it: A) correctly identified 60/100 children with a vision problem B) correctly identified 60/100 without a vision problem C) failed to identify 40 children with a vision problem

L2Q8: the two most important factors to consider when choosing preschool screening tests are testability and sensitivity/specificity for the age group being tested A) true B) false

L2Q9: the results of the VIP study showed that a single test can detect most common and significant vision disorders in preschool children: A) true B) false

L3Q10: you scope -2.00 on a 1 year old with Mohindra. the actual refractive error is: A) -3.25 B) -2.75 C) -1.25 D) -3.25

L3Q11: you examine a 5 month old child with the InfantSee program and the baby does not track the picture on the fixation stick. next you should: A) consider this normal B) refer for a neuro work up C) use a smaller picture D) use a larger object

L3Q12: infants seen in your office: A) do not need to be dilated on their first visit B) must be dilated on their first visit C) can be evaluated with direct ophthalmoscopy if the child is not cooperating

L3Q1: a child with 20/50 FPL at age 1 year will likely have the following snellen VA at age 5: A) 20/20 B) 20/50 C) 20/80 D) 20/100

L3Q2: when preforming forced preferential looking: A) cards are best presented vertically initially B) point to the stripes and encourage the child to look C) FPL should always be done monocularly D) present each card 3 to 4 times E) a test distance of 55 cm is standard and ok to use

L3Q3: does the child in the previous screen have amblyopia: A) yes B) no

L3Q4: a 14 month old child with a 25 PD constant right ET does not alternate fixation on the 10 PD vertical prism test. this indicates: A) the child likely has amblyopia in the right eye B) the child likely has amblyopia in the left eye C) the child likely does not have amblyopia

L3Q5: a 14 month old child with a 25 PD constant right ET would show was on the first step of the Bruckner test: A) the right eye would be lighter, brighter, whiter B) the left eye would be lighter, brighter, white C) both eyes would be equal

L3Q6: an 18 month old with an intermittent 25 PD left exotropia would show what on the second step of the Bruckner test (an eye was turned out during step one): A) the right eye would be lighter, brighter, whiter B) the left eye would be lighter, brighter, whiter C) the right eye would darken in color D) the left eye would darken in color

L3Q7: the cardiff cards are what type of VA: A) resolution B) recognition C) OKN D) detection E) fix and flow

L3Q8: you scope +3.50 on a 3 year old with Mohindra. the actual refractive error is: A) +2.75 B) +2.25 C) +1.25 D) plano

L3Q9: you scope +3.50 on a 1 year old with Mohindra. the actual refractive error is: A) +2.75 B) +2.25 C) +1.25 D) plano

L4Q10: it is ok to do retinoscopy on a 5 year old without fogging (scoping) glasses if no hyperopia is present: A) true B) false

L4Q11: a 4 year old boy is brought in due to concerns he has a color deficiency. he is able to name all of the brightly colored blocks you present to him. this means: A) he does not have an acquired color defect B) he has a receptive language problem C) his expressive language skills are not well developed D) he may still have an inherited color defect

L4Q12: the best fixation target to use when doing a near cover test on an active 3 year old is: A) a vertical line of letters above the best VA B) one letter above the best VA C) a 1 inch color sticker of Dora D) a spider man hand puppet E) an illuminated 6 inch globe light

L4Q1: from left to right, name the characters in the photo: A) donald, sister bear, ernie pluto B) daffy, sister bear, bert, woodsy C) donald, mama bear, bert, goofy D) daffy, mama bear, ernie, pluto E) I only watch spongebob

L4Q2: a child who reads the 10/20 linear lea card at 10 feet should have their VA recorded as follows (so that everyone will understand): A) 10/40 B) 20/20 at 10 feet C) 10/20 = 20/40 D) 20/40 at 10 feet

L4Q3: when performing a linear Lea acuity cards with a 3 year old, it is important to NOT isolate letters so that: A) the child will understand the test B) the child can complete the test quickly C) amblyopia will not be missed D) strabismus will not be missed

L4Q4: when using the HOTV cards: A) the child doesn't need to know their letters B) the child should be in school C) the child needs to know the letters H, O, T, V D) children should be at least 4 years old

L4Q5: a 4 year old girl present for a vision exam. what is the preference for testing (best test to try first, second, and third): A) allen pictures, tumbling E, lea symbols B) allen picture, HOTV, lea symbols C) lea, broken wheel, tumbling E D) lea, OKN, tumbling E

L4Q6: a 5 year old with a 25 prism diopter constant left esotropia at distance and near would say they see which figures on the 3 figure flashlight: A) 3 green figures B) 2 red figures C) 2 green filters D) 3 red figures

L4Q7: a 4 year old with a 15 prism diopter intermittent right exotropia at distance and near could say they see which figures on the 3 figure flashlight: A) 2 green figures B) 3 figures C) 4 figures D) all of the above

L4Q8: a 6 year old with ortho at distance and 10 prism diopter constant right hypertropia at near could say that they see which of the following on the 3 figure flashlight: (choose all correct answers) A) 1 green figure B) 2 green figures C) 3 figures D) 4 figures

L4Q9: 5 year old children: A) can usually sit behind a phoropter B) should never sit behind of phoropter C) can sometimes sit behind a phoropter

L5+6Q10: if sarah has a vision problem, what would we diagnose: A) VA problem B) efficiency problem C) visual processing problem

L5+6Q1: this picture is of a: A) pet animal B) a farm animal C) an inkblot from the Rorschach test D) an abatract painting E) i have no clue

L5+6Q2: learning disabilities: A) usually have their onset in adulthood B) have both medical and educational definitions C) are diagnosed by optometrists D) are an indication of low IQ

L5+6Q3: which of the follow groups of conditions are directly related to vision and optometric practice: A) dyseidetic - visual/spatial - phonetic B) dysphonetic - graphomotor - visual/spatial C) visual spatial - dyseidetic - graphomotor

L5+6Q4: a teacher refers a child to rule out a visual perception problem contributing to their learning disability. what are the chances the child will have this type of problem: A) 20% B) 40% C) 80% D) 100%

L5+6Q5: the two main components of reading and their associated cortical systems are: A) saccades (magno) and fixation (parvo) B) saccades (parvo) and fixation (magno) C) pursuits (magno) and saccades (parvo) D) pursuits (parvo) and saccades (magno)

L5+6Q6: saccades during reading involve: A) sustained visual system and magno B) transient visual system and magno C) sustained and parvo D) transient and parvo

L5+6Q7: how do we learn best: A) intramodal learning (visual - visual) B) intermodal learning (visual - auditory)

L5+6Q8: why did Duane pass his vision screening at school and was reported to have a normal vision exam 2 years ago: A) he likely never had a vision disorder because he was reading well in first grade B) the school screening and vision exam didn't detect Duanes type of vision defect C) Duane's vision skills and reading demand likely changed between first and fourth grade D) B and C E) all of the above

L5+6Q9: if Duane does not have a vision problem, you are most likely going to dx/tx: A) a VA problem B) a visual efficiency problem (binocular) C) a visual processing problem (visual memory)

EPSDT (early periodic screening, diagnosis, and treatment program) improved

Medicaid is also a partner in providing vision screenings through a program called ______, which is within medicaid and is a mandatory set of services and benefits for all individuals under age 21 who are enrolled in Medicaid. this is administered by each state, but there is no standardized screening from state to state. the title V program and state medicaid agencies together are required under federal low to coordinate activities to improve access for children. basically title V and medicaid gives people _____ access

1. inspection 2. ophthalmoscope 3. Hirschberg 4. tracking

Pediatricians perform these early assessments using these 4 tests/tools: 1. _____ - using a pen light to shine in the baby's eyes 2. _____ - used to look for the red reflex 3. _____ - used to look for strabismus and make sure that the response is symmetric between the two eyes 4. ____ - test done with a pen light to see if the baby can follow a moving target for neurological function

pediatric nurses lay screeners

_____ ____ and _____ ____ can be experienced in working with young children, and can be trained and certified for vision screening tests. therefore they can do a very good job in administering these tests in a normal preschool environment

allen pictures tumbling E

_____ ____ are another type of recognition acuity test that uses symbols (hand, bird, cake, phone, etc.). however, these are not ideal as they do not blur equally, meaning some can be easier to see than others, and some pictures are abstract and old. the ____ _____ is another recognition acuity test that is not ideal as children might not know their directions to determine which direction this letter is pointing. these should be used only if they are the only type available. recognition acuity at near can also be done with the ATS 4

learning disabilities processes

_____ _____ are the most common childhood disorder requiring special education (affects 5-15% of school children). these can be in a wide range of subjects including math, reading, listening/reasoning, and written and oral language. we can help with the relationship between vision and learning. this term is a general one used to describe learning difficulties. the children with these can be average to above average intelligence but just have differences and how their brain works and how it ______ info. there is no cure but this doesn't say how to teach the children. these children can become high achievers but also life long learning challenges

vision

_____ disorders are the 4th most common disability in the US, and is the most frequently occurring handicapping condition of childhood. we can also use this as rationale for early screening exams

HOTV lea

_____ is another form of recognition acuity that also needs to be confirmed at near before we move to a distance. the examiner will point to one of the letters and the child can either verbalize it or match it. this different from lea as this is letters while lea uses symbols. we also found that these were very similar in picking up vision defects, however the _____ was slightly better. however, the smaller this is, it can be guessed more easily whereas the lea cannot (recall they all start looking circular)

recognition resolution

______ acuity is the gold standard for visual acuity. this is based upon the Snellen optotypes and the child must recognize, identify, or match shapes, numbers, or letters. generally this is not used in children below 3 years and instead we should begin with ______ acuity tests for birth to 2 years old, which is the clinical test of choice in babies and COGNITIVELY or actually below 3. this is easy to administer, easy to quantify, allows comparison to the other eye, and the results can be compared to a table of expecteds

InfantSEE

______ is a program developed by the AOA and was sponsored by Johnson and Johnson to help children get screenings from birth to 1 year of age using OD volunteers. in year 1 it provided 50,000 exams using 7,300 providers with public service announcements. this has a similar minimum database that includes history, VA, ocular motility, alignment/binocular potential, refractive status, external/anterior segment evaluation, visual field assessment, pupil evaluation, internal assessment, and summary

dyslexia font

_______ is the most common childhood learning disorder and is considered a 'specific learning disability'. this is difficulty with accurate and/or fluent word recognition, and poor spelling and decoding abilities, which typically result from a deficit in phonological component of language that is often unexpected in relation to other cognitive abilities & provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge. however, a _____ was developed to try to mitigate these reading disabilities

yearly decreases

after school entry around the age of 5-6, subsequent vision exams are now recommended ______. this is because the visual system will continue to change as children are using their eyes for more detailed tasks with increased time demand on vision. eye exams and correction of refractive error also becomes very important because as children progress through education, the print ______ in size with in increase in reading to learn. recall that vision disorders can affect the way a child learns, and the performance and self esteem of the child are sensitive to these changes

risk

again we should note that these early screenings by MD's are important. this is because they detect children at _____. however, we should also note that these are NOT eye exams and they do not actually diagnose vision disorders. the children are then referred to an eye care specialist for evaluation and diagnosis.

autorefractors photorefractors/photoscreeners higher (can be static or video/powerefractor)

alternatives for the non-cycloplegic retinoscopy that can be done in a screening setting includes _____ (measures refractive error monocularly) as well as ____/______ (measures refractive error binocularly and can measure alignment) in terms of general categories. the second group shows refractive error by a crescent or brightness that appears in one eye compared to the other. this will indicate type and magnitude of RE as the brighter has a ____ RE

readiness vision loss

amblyopia, strabismus, and significant refractive error are all significant and prevalent vision disorders in preschoolers that can cause other problems. they can also affect school _____ and may have life long negative impact on learning. in addition, _____ ____ secondary to these problems is common, but often preventable. in young children, they do not known how they should see, vision problems do not hurt, and are unable to tell us if they cannot see. this is why screening is needed

strabismus

another disorder we want to screen for is ______. if this is left uncorrected, it can cause amblyopia and reduced or absent binocularity/stereopsis. this is also associated with psychosocial issues

refractive error amblyopia strabismus

another example is significant _____ _____, including nearsighted, farsighted, astigmatism, and anisometropia. these are the most frequently occurring disorders and the most correctable (glasses and contacts). however, if left uncorrected, it can cause _____ and _____, as well as interfering with performance. this is why this is important to screen for and detect early

9 motor environments

as optometrists, babies under _____ months of age are the easiest to examine. they like to look at lights so it is easy to get their attentions for pursuits, saccades, etc. it is also easy as these children have minimal _____ activity, have minimal stranger anxiety, and have no fear of new _____

Bruckner test lighter/brighter/whiter

another supplemental test to confirm amblyopia is the ____ test, which is done in 2 steps for strabismus and amblyopia. in step 1, the child fixates at our light as we look at both eyes with our ophthalmoscope so we can compare the reflexes to see if they are equal. if they are, we stop the test. if not, it indicates strabismus, amblyopia, or significant refractive error is present, so we go to step 2. now we would zoom in to look only at the _____ eye, and look to see if there is fixation/darkening. if yes, there is no amblyopia. if not, there is amblyopia

rapid automatized naming phonological

another way we process info is through ____ ____ ___, which is the ability to name visual stimuli quickly. this is highly predictive of future reading skills as it involves many visual, cognitive, and linguistic processes. this skill is also responsive to vision therapy. this is also another aspect of _____ processing as it is the ability to retrieve easily and rapidly verbal info held in long term memory. most children and adults with reading difficulties have pronounced difficulties when asked to rapidly name familiar symbols and objects

simultaneous successive/sequential

another way we process information is through _____, which would be for example looking at all the pieces and putting the object together, and _______ processing, which is following a set of information, for example following directions on building something. both of which are factors for children with LDs

visual information processing

as optometrists, our role is not to teach reading, diagnose, evaluate, or treat learning disabilities, or treat dyslexia. however, we do evaluate and treat VA, visual efficiency, and visual processing disorders for both children and adults. we define ____ _____ _____ as the ability to identify and discriminate visual information, and then be able to act upon it and integrate it with our other senses

title V Maternal and Child Health Block Grant Program

as one of the largest federal block grant programs, _____ ____ funding is a key source of support for promoting and improving the health and well being of the nation's mothers, children (including children with special needs), and their families. in 2019, the _____ and ____ ___ ___ ____ program funded 59 states and jurisdictions to provide health care and public health services for an estimated 60 million people. services reached 92% of all pregnant women, 98% of infants, and 60% of children nationwide, including children with special health care needs

kentucky missouri illinois north carolina california

as a government law, some states do require eye exams at certain ages. for example: - _____ - exams prior to kindergarden - _____ exams prior to kindergarden - _____ - exams prior to kindergarden or first grade - ____ ____ - had an act passed that required exams in kindergarden, but was repealed - _____ - tried to suggest mandatory eye exams in 2017 but did not pass - "a bill that would require a comprehensive eye exam rather than basic vision screening, for some school children has sharply divided the experts; the board of optometry backs the measure, while an official with a national pediatric ophthalmologists group says such a shift would be a tremendous waste of resources"

behavior change

because these children have better communication skills, it is ok to ask the child to cooperate with us and tell the child what we want them to do. for example, we can say things like "I need you to cooperate with me". we can also use rewards for _____ throughout the exam, but not for correct responses. for example we can use praise, stickers, or snacks from the parents. _____ is also helpful, whether it be our voice, movement, or the test, especially if the child is being uncooperative

motor

beyond 6 months of age, the children begin to develop more _____ control and start sitting up more easily. they can also interact with the examiner and can do "peek a boo". we should be careful as these children like to grab lights and can begin to crawl at 7 months. because of this, we should allow the babies to remain in their car seat or stroller, or even in the parents lap during the exam

n/a

binocularity has both motor and sensory components: Motor: - how the eyes look - cosmetic appearance - eye contact - bonding - closer alignment- easier to achieve sensory binocularity sensory: - what the eyes see - fusion - stereopsis - visual development - orientation and mobility - behavioral responses

dyseidetic auditory

boder also described the _____ group of dyslexia which is defined as a deficiency in the ability to perceive letters and whole words as configurations or visual gestalts. they also read laboriously as if seeing each word for the first time (have to sound it out each time), and have difficulty learning what the letters look like. these people spell by ear, not by sight, and are therefore more ____ learners

mixed visual

boder also identified a ____ category which include people that are deficient in both areas (language and visual processing). these people have the most severe reading problems and their response to standard remediation is poor. if we take into account that boder said 22% have this problem while 9% have dyseidetic problems, then he states that 33% have ____ processing deficits

20/50 20/40

certain passing criteria was also determined for the lea wheel. for children 3 years old, they needed a _____ VA, and for 4-5 year old children, they needed ____ VA. recall the sensitivity was best at 5 feet for amblyopia

n/a

chart in notes here for comparison of amblyopia, strabismus, refractive error, and reduced VA

79%

currently, we know that 1 in 3 children have received eye care service before the age of 6 years old (screening or exam). however, ____% of children have no visited an eye care provided in the past year, and 35% have never seen an eye care professional (basically very few kids have an eye exam and many do not have vision screenings)

loss of vision readiness

early detect and treatment is important as it can prevent _____ of _____ and/or decrease their negative impact. it can also improve school _____, increase ability to learn, the child's self esteem and confidence, athletic ability, and improved behavior

recognition acuity

for VA in 3-5 year olds, we want to do _____ acuity testing, which can be done with lea symbols, broken wheel, HOTV, allen pictures, or the tumbling E. this type of acuity is based upon gold standard VA for adults, and the child must recognize a shape, object, or letter. because of this, it correlates well with snellen and is also used for social service purposes. this is the test of choice if the child is cognitively 3 years or older

MEM

for accommodation testing, we can use the _____. this is age appropriate cards that can be used to measure the lag of accommodation and provides an indication for prescribing

understands electronic

for all recognition acuities, we should establish the test at near first to make sure the child ______ the test. if they do, then we can move back to the proper distance. if they cannot, we would record as unable. we can also do _____ recognition acuity testing either with lea or HOTV. it is preferable to use crowding bars with these

occlude prism

for distance retinoscopy modifications for strabismus, we should _____ or use _____ in front of the eye not being scoped. we also want to make sure we are scoping the eye on axis and not turned

sensitivity specificity 90%

for example, a test with 70% ______ means that it finds 70 out of 100 children with a problem, and missed 30 children. a test with 70% _____ means that it over refers 30 children without a problem. recall we want both of these to be around _____%

cover test vergences

for motor assessment for binocularity, we can do a ____ _____ in which we use our thumb or an occluder, target on the nose or the child holds it, and ask to look at a picture so we can measure the phoria or tropia. we also do near point of convergence, versions, and _______ where we ask the child is they see 2 images and use the prism bar with a high interest target

report card glasses

for older children who are in school, the parents should bring the child's ___ ____, a sample of their school work, psycho-ed testing, previous exam record, any previous _____, and a good attitude

thumb park's 3-step

for the cover test, we want to use our ____ in place of the occluder as it is less intrusive. do so by resting the hand on top of the infants head while using a fixation target for distance and small illuminate target for infants with detailed high interest target for toddlers. we can also change the target to maintain interest and move the target periodically during testing. we can use a sticker on our nose for fixation and measurement. then we need to quantify the direction, magnitude, comitancy using _____ ____-_____ test, frequency (constant vs intermittent), and laterality (unilateral vs alternating and preferred eye for fixation)

1. diagnosis 2. treatment 3. compliance 4. outcome

from birth to 2 years old, we want to know various components about their history. for example, we need to know the chief complaint, family vision history, previous eye care including these 4 things, as well as the length of the pregnancy. delivery and hospital stay is also important

cover test stereo smile stereo smile strabismus

from these alignment screenings, we learned that the testability was best for the ____ ____ and ____ ____ with at least 98%. in addition, the sensitivity of the ____ ____ was better than the cover test (72% vs 60% to detect strabismus). however, these eye alignment tests did not detect children at risk when used alone for most disorders, but did improve detection of ______ when used with a test of refraction

20/64 strabismus

group 1 was the most important. the guidelines for children to be placed into this group includes: - amblyopia worse than or equal to _____ - constant _____ or eye turn - most important refractive errors (moderate to high hyperopia, high myopia, moderate astigmatism, severe anisometropia)

near retinoscopy cycloplegic refraction

in terms of measuring refractive error, the main techniques are _____ _____ and _____ ____, however these can be supplemented with autorefraction and distance retinoscopy

visual maturation recognition resolution

if the acuities are not normal, there can be many causes, including strabismus, refractive error, structural abnormalities, pathology, neurological/cortical impairment, as well as developmental delays such as delayed _____ _____. when doing visual acuity, typically the most important type of acuity we want to test is ______ acuity, and then _____ as the second most important. but this is not always the case

color identification 3-4 years

if they cannot do color naming, meaning they can't verbalize, they can do ____ ____, which does not require expressive language skills and instead the child is asked to point to a colored block to match the color. this skill typically develops by ____-___ years

light and form perception

if they cannot fix and follow, then we would do ____ and ____ _____ testing. this is useful when there is no response to objects. we want to look for the blink reflex to large thrusting objects and we can use light stimulus to elicit fixation. one option is room lights on and off

individuals with disabilities education act (IDEA)

in 1975, the education for all handicapped children act was signed that required all states that received money from the federal government to provide equal access to education to children with disabilities in public school systems. however, this was amended in 2004 with the ______ with ____ _____ ____ which called for earlier intervention for students, greater accountability, and better educational outcomes. it also defined a learning disorder as a disorder in one or more of the basic psychological processes involved in understanding or in using language that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do math. however, they do NOT include problems that are the result of visual, hearing, or motor disabilities, or emotional or environmental or economical disadvantages

lions international

in addition to these two, there are also private non-profit volunteer organizations both locally and globally. these programs have about 1.4 million volunteers and serve communities around the world in times of need. one of the most important organization is the _____ ______, in which one of their main priorities is vision screening for children

younger older

in addition, a lot of kids will have separation anxiety from their parents. for _____ children, we almost always want the parent in the room with the child. for _____ children, we can leave it up to them to decide if the parent wants to come back and observe (unless the parent is given hints, such as "you know that letter, its the first of your name")

1. meridional amblyopia 2. accommodative esotropia 3. moderate refractive error

in addition, another advantage of seeing a child at 3 years old is that there will be onset of vision disorders that previously would not have been detectable, for example thees 3

ocular media strabismus binocular

in addition, early child assessments may be performed in the peds office by an MD. these screenings are important as they help detect some significant pathology. the pediatrician will typically look at the ____ ____ to make sure the red reflex is present, will look for gross ocular deformities like an iris coloboma, look for obvious _____ with the Hirschberg test, and ensure there is an intact neurological system via tracking a moving target (Brazelton). early assessment by the MD may not be able to detect _____ vision disorders, significant RE, amblyopia, and other pathologies

testability cost available

in addition, the screening tests that were used must have high ______ for children (close to 100%), meaning nearly every child must be able to do the test. the test must also be safe to administer, have a reasonable _____ to administer, lead to improved health outcomes, and be widely _____

education questionnaire

in addition, we should know infancy behaviors (if its normal), general health, developmental history, ______ information, goals for the exam, and we should ask the patient if they have any specific questions about the child. normally for the history, we do a comprehensive _____. this is done at the first exam only but is updated at subsequent exams

n/a

in another state example, in New Jersey, a bill was proposed that would direct the state board of education to require every child age size and under who is entering a public preschool, public school, or a head start program for the first time to have a comprehensive eye exam completed by an optometrist of ophthalmologist by January first of the child's initial year of enrollment in the school or program. however, the governor said he was concerned that comprehensive eye exams may be cost prohibitive for uninsured and underinsured families, and therefore many families that lack or have limited health insurance coverage may find it very difficult if not impossible to comply with the bill's new mandate. his recommended changes would improve upon the regulations by requiring a vision screening for children six and under who are entering school for the first time, and then annually through fifth grade, and then every other year until graduation

51% (26 states) 78% (40 states)

in general, only ___% of states require vision screenings for preschool aged children, and _____% of states require vision screenings for school age children. therefore, many children are not screened and most children are not examined. in addition, recommended screening methods vary widely from organization to organization and from state to state

1 age

in general, there are special considerations when working with children as it can be difficult to determine what they are seeing, especially because we are strangers to them. a pediatric exam also differs from the typical exam in that now we are trying to communication information to more than ____ person, which is not typical in a normal exam (such as both parents being present). another consideration is that when we examine kids, we should NOT think of them as mini adults, and it is not "one size fits all" in regards to what tests need to be done. the tests we do is determined by many factors, such as the ____ of the child, their developmental level, and their attention

n/a

in order to work with children, we need to have knowledge of their visual system, when things develop, and knowledge of the prevalence of vision disorders. we also need to know what is normal and what is abnormal, as well as what exam techniques to use on children and how to manage problems within the visual system

"flying baby"

in our ocular health assessment, we need to position the child where it is comfortable for them. this may be over the parents shoulder and the parent may even have to hold the child in the slit lamp called the "____ _____". there are also handheld slit lamps that can be used. for dilation, the size of the child will determine positioning but may be easier if laying flat and if parent is holding them

young worse education

in peds vision care, there has to be a rationale for early evaluation and screening. we do this because the visual system is rapidly developing, and very _____ children are easier to examine. in addition, vision problems can occur early, so we need screening to catch them and improves prevention. the longer the issue is present, the _____ the prognosis. it is also important to screen because if there is undetected vision loss, it can affect the child's _____ unless we intervene

stereopsis anisometropia

in sensory assessment for binocularity, we think of stereopsis, fusion, suppression, diplopia, anomalous and retinal correspondance, and amblyopia. however, in babies up to 2 years, the only thing we can really measure is _____, which helps detects problems that are not evident through the child's behavior or appearance. this will be abnormal in a child with intermittent/small angle strabismus, _______, amblyopia, and ocular pathology. we can measure this with PASS, lang, stereofly, and butterfly

lea of HOTV ATS4 MEM CT and PASS/RDPST good target refracting glasses +video F2 or CVTME confrontation dilation

in summary for preschool exam for best test: - distance VA = _____ or _____ - near VA = ____ - accommodation = _____ - binocularity = _____ and ______/____ - ocular motilities = _____ ____ - refraction = ______ ____ + _____ - color vision = ____ or _____ - visual field = ______ - ocular health = ______

phonetic saccades fixations

in summary, dyseidetic is visual processing while dysphonetic is language processing. visual/spatial and ____ which is visual processing vs language, and graphomotor which is fine motor control. we also know that reading involves _____ from the magnocellular pathway and ____ from the parvocellular pathways. in addition, learning is facilitated through intermodal learning

environment

in summary, for young children, we should work quickly, provide a comfortable _____, make the testing fun, change tasks when necessary, use age appropriate targets and tests, and develop a caring, trusting relationship with both the parent and child. follow up visits are also ok to do

magnocellular parvocellular

in summary, reading involves saccadic eye movements from the _____ pathway and fixations from the _____ pathway

10% retinomax autorefractor lea symbols stereo smile

in summary, there is wide variation in test performance across the tests. there was only ___% over referrals, and the best tests included that ______ ____, suresight vision screener, ____ ____ VA at 5 feet with patch glasses, and ____ ____ for strabismus

20/600 20/100 20/50 20/20 20/16 (up until 1 year of age, we can use 600/age in months to find VA)

in terms of FPL estimates: - at 1 month - _____ VA - at 6 months - _____ VA - 12 months - _____ VA - at 4-6 years - ____ VA - at 11 years - _____ VA

abnormal

in terms of FPL in premature babies, if VA was normal with FPL in infancy, it would also be normal with Snellen at 5 (does not predict actual acuity level). but is VA was _____ with FPL in infancy, then it was also this with Snellen at 5 years

automaticity processing speed

in terms of automaticity and processing speed, children with a LD need more time for a task and don't retain the experience of doing a task over and over again as well (i.e. driving to work). children with a LD struggle with ______, which is important in skills acquisition and helps to make learning fast and effortless, as well as ____ _____ which is the ability to perform simple, repetitive cognitive tasks quickly and fluently, and is now a part of the IQ testing (WISC)

3-4 months 6 months

in terms of binocularity and stereopsis, stereopsis typically emerges at ___-___ months, and the eyes should be aligned by ____ months at the very latest

eye contact

in terms of communication, we want to use verbal and non verbal cues, such as using a caring voice, but also smiling and appropriate facial expressions. we want to also make sure we maintain _____ ____ with the parent and the child. we should also talk to both the parent and child and listen to both their concerns

in terms of conclusions, 1 in 5 children with a LD has a pure perceptual disorder and 1 in 5 children with a LD have a mixed disorder. therefore, up to ____ in 5 children with a learning disability have vision factors (not the major of LDs)

45 days follow up

in terms of federal laws, there is a program called Head Start that required all children to be screened for vision within _____ days of school entry. this is a program that provides comprehensive early childhood education, health, nutrition, and parent involvement services to low income children and families. however, there a challenge to this. a high percentage of children who fail the initial vision screening do not get the appropriate _____ _____ care. within head start in Philly, there are at least 7000 children screened yearly and about 20% are at risk for vision disorder

trial frame amblyopia

in terms of general modifications, we can ____ ____ the findings to give the child a preview of their refraction. here we can buy these specially for children that are more lightweight and smaller. we can then do a VA retest in order to rule out _____. for example if they go to 20/20, they don't have this

1. auditory-linguistic visual 2. visual-spatial auditory

in terms of how we learn, some people are auditory learners while others are visual learners. based on this, there are two subtypes of dyslexia: 1. _____-____ - low verbal IQ relative to their performance. these people have reading errors involving phonologic aspects of language and their spelling errors have poor phoneme to grapheme correspondence (having trouble taking a sound they hear and matching it with a picture or word). these people would be more of a _____ learner 2. _____-_____ - low performance IQ relative to their verbal IQ. they also have right-left disorientation, and is associated with spatial dysgraphia (poor handwriting and poor use of space). they also have reading errors involving visual aspects and spelling errors characteristic of letter and work reversals. these people would be more of ____ learners

varies

in terms of its relationship to vision, learning disabilities can occur with or without a vision disorder, and vision is required for most, but not all types of reading. vision problems can contribute to vision problems, but how much they impact the disabilities _____ from person to person. recall that optometry is often the entry point and a vision evaluation is often required for school evaluation. our role is to determine where vision fits in the treatment hierarchy

1. near retinoscopy 2. cycloplegic refraction 3. distance retinoscopy

in terms of ocular motilities, here we are talking about tests such as pursuits and saccades with age appropriate targets. for retinoscopy, we can do these 3 techniques: 1. _____ ____ - can still be used when necessary but need a correction factor of 1.25 D for equal to or older than 2 years old 2. _____ ____ - use 2 gtt cyclopentolate (1%, 0.5%, or 0.2% combo) and wait 30-45 minutes. then can do a wet distance retinoscopy or wet autorefraction 3. _____ _____ - use an age appropriate video for distance fixation, then use a lens rack or loose lenses and refracting glasses on the patient to neutralize RE

moderate color learning amblyopia/strabismus

in terms of optometric concerns between 3-5 years old, we are most concerned with _____ refractive errors, ocular pathology, neurological disorders, inherited ______ deficiencies, visual perception deficiencies, ____ difficulties, as well as _____/_____

5-10% 30% 10-20%

in terms of prevalence of significant vision disorders in children, significant refractive error occurs in ___-__% of the preschool pediatric population, and up to ___% of 5-16 year old children. in terms of nonstrabismic binocular/accommodative disorders, it occurs in ____-___% of school age pediatric population

visual acuity

in terms of some of the tests that were included, the first was _____ _____. this is the oldest test but is still widely used. it is easy to administer, easy to interpret, and easy to understand

98%

in terms of testability for all of these tests of refractive error, it was greater than ____% for 3-5 year olds. the sensitivity for NCR was 90% and with the retinomax it was 88% (with correction factor of +1.5 added to sphere)

checklist denver

in terms of the developmental assessment, we need to know if the child is on track. we do so in an informal way by observing and asking question, as well as in a formal way by using a parent behavior/developmental _______, as well as the _____ developmental screening test that uses 4 main areas to test the childs development (personal/social, fine motor, gross motor, language)

1. cover test 2. near point of convergence 3. versions (can also supplement with hirschberg/krimsky and bruckner)

in terms of the motor assessment for binocularity from birth to 2 years, we can use these 3 tests to examine the motor component

gravity finger puppets

in terms of the ocular health assessment for 3-5 year olds, to dilate, we should tilt the head back as far as possible while the parent holds the child's arms, and use _____ to help put the drops in and do it very fast. we can also do the basic anterior segment ocular health exam in the slit lamp. having their knees on the exam chair generally gives us the right height to put the child in the slit lamp. we should also use _____ ____ to help the child look in the correction directions. we want to make sure we are viewing all quadrants and give the sunglasses for going outside with dilation

cortical optic nerve amblyopia

in terms of the useful of teller acuity cards, it is sensitive to _____ visual impairment, ____ ____ loss, delayed visual maturation, developmental disabilities, and ______. however, it is less sensitive to mild myopia, moderate astigmatism, macular loss, and screening VA (26% false positive rate - so not good for screening)

5 3

in terms of vision disorders in preschoolers, vision disorders are the fourth most common disability in the US and the most frequently occurring handicapping conditions of childhood. we also know that approximately 1 in ____ preschoolers and 1 in ____ school age children have a vision disorder that can be treated and/or corrected. therefore, based on this, if there are 15 million preschool children in the US, 3 million have vision disorders. however, most of the 15 million do not get their vision checked, so these vision disorders are not always detected

adhesive patch glasses

in terms of visual acuity occlusion for 3-5 year olds, we can use _____ patches, strap patches, bootie/slide on patches (for children with glasses), or ____ ____ that can either be totally black or fogged. it is important to monitor for peaking, and the parent may need to help hold the child's hands so they do not interfere with the patch

confrontation fields education vision

in terms of visual fields, the best way to do this in children is _____ _____, which we can do finger targets. in terms of color vision, there are 3 levels of testing, beginning at age 3 years. the color naming and color identification both take _____ into account while the color defects take _____ into account

perception

in terms of visual information processing, it begins with _____, which depends on the image but also our previous experience with the image. this is an active process where we locate and extract info using our sense organs as tools. this helps us learn and then to help make inferences which then help to guide our actions. tehse are the core process in the acquisition of knowledge (ex - smoke smell).

ages white coat

in terms of welcoming the child to our office, we should make sure we have user friendly tables, chairs, books, puzzles, etc. for all _____. we should also include pictures of familiar characters on the walls, possibly used a stuffed animal in the exam chair, and schedule the appointment at a time where the child can be cooperative and ensure a problem based exam. the doctor in a peds exam should also not wear a ____ ____ as it can be scary

toy exam records glasses

in terms of what to bring, for younger children, they should bring the child's favorite ____ or music/video, as well as a change of clothes and a snack/bottle. they should also being their previous ____ ____ as well as any previous _____

horizontal auditory vertical

in the typical set up for FPL, there is a stage, _____ card presentation, with normal illumination. modifications include using no stage, vary reinforcers, using _____ stimulation, change illumination, change position, and use a _____ presentation (this may make it easier to see the patients response)

bright many

in these 3-5 year olds, we are also moving away from illuminated targets. we want targets that are non-illuminated, ______, recognizable, 1/2 to 1 inch in diameter, and characters that are friendly (avoid scary characters, but can use cookie monster and hairy monster). therefore we should also be familiar with recent children characters to we are up to date. it is also important to have _____ of these targets to keep the child interested

size learners

in visual perception, our eyes are more than receptors of form, and instead function to relay info the brain such as direction, ____ of the object, distance, and color of the objection. we think of this as a learned, dynamic process. the easier it is for us to extract info from the environment (perceive), the easier our thinking process becomes and the better _____ we become

fear attention span

kids of this age group are generally talking at this point so we can talk to them, but will have different levels of cooperation. some will be shy, withdrawn, crying, angry, or hyperactive, so it is ok to rescheduling if needed and prepare the children. they may also have a _____ of the new environment/strangers, separation anxiety from strangers, as well as a short ____ ____

wheel 5 78%

leas summary: - single letter or _____ was a better format - ____ feet distance - patch glasses could be used - nurses and lay screeners did well (can be used by all screeners) - sensitivity improved from 50-60% to ____% with specificity set to 90%

1-3% 8% 0.5%

more prevalence of vision disorders in children (however these will vary based on the population that is being studied): - amblyopia = ___-__% - color vision anomalies in males = ___% - color vision anomalies in women = ___%

non-cycloplegic retinoscopy screening

next they wanted to determine the best test for refractive error. the first screening that was looked at was ____-_____ _____, which was performed by an optometrist or ophthalmologist. it was found that this works well (90% sensitivity and specificity) but requires extensive training. because of this training needed, this is NOT practical for most ______ settings

n/a

of the 75 million children, and using the percentages we just talked about, we can project that about 7.5 million children need glasses (10% with refractive error), 15 million have accommodation/binocular disorders (20%), 3 million has strabismus (4%), and less than 0.75 million have pathology

amblyopia glasses treatment

one example of these disorders are called ______, or a lazy eye. this is an important disease to screen for as it causes reduced vision that is not correctable with _____ alone. it also affects 6 million Americans but it is preventable. this presents a 16x greater risk for blindness in the normal eye, and is also good to screen for because the _____ is cost effective for the patient

birth to 2

one important group of children that need to be examined are infants and toddlers. these children fall between the ages of ______ to _____ years old. concerns during the this period include eye turning, squinting, eye rubbing, photophobia, eyes looking funny, or a family history of vision problems. more optometric concerns in this period include congenital malformations of the eye or lid adnexa, neurologic disorders including ptosis and nystagmus, pathologies, significant refractive error, strabismus, and amblyopia

detection acuity stycar candy beads

one lower form of acuity that we do not use as often is _____ acuity, which determine whether an object of specified size and distance can be seen. this is typically only used when other methods are unreliable. one downside is that optical blur can actually increase visibility of this and has little correlation to snellen. one form of this is using ____ that involves motion, or ____ ____ but are difficult to quantify

communication behavior

other special considerations are that infants and toddlers have very little ______ skills, and so we need to use different procedures. they also cannot tell us if something is wrong but may communicate through their _____ (i.e. squinting may mean they cannot see), and so we must be aware of what is normal and what is not. it is important to remember the "critical periods" of visual development where intervention at an earlier age can result in better outcomes

language dysphonetic

others have categorized dyslexia differently. Mattis found that 47% had a _____ component, 37% with graphomotor, and 16% with visuospatial. Boder however found that 63% had a ____ component, 9% with dyseidetic, and 22% mixed

5-6 education

our third comprehensive vision exam should take place around ___-___ years of age. at this point, the child will have good communication skills and can begin to take part in subjective testing. at this time vision orders can arise such as mild myopia, and that these children are often preparing for formal _____ so an eye exam may be needed to ensure the child can see and take in info properly. some states require that children have a comprehensive eye exam when beginning school but is controversial

school screening

parents frequently bring children with learning challenges to the optometrist as potentially these challenges may be due to their vision. here the child may be brought in for an entry level exam prior to any further testing, or they may be coming in as a result of a _______ _____ indicating possible vision problems. it is important to know that the OD may be the first person consulted before a problem is identified. therefore we need to explain to the parent whether to do testing and what to expect. the OD can be part of the decision making process when there is a vision problem involved

transient sustained

recall in our visual processing, there are 2 interactive parallel but segregated pathways, and therefore retinal images are sampled twice by our visual system but in different ways. information sampled about "where" is the _____ system while information sampled about "what" (fine detail) is the ____ system. it is through that alterations in the order and timing or processing speed of these two systems can result in a visual processing deficit

primary 3-4

recall one level of color vision is color naming where the child is asked to name a color. here we can use blocks, beads, etc. here we want to start with the bold _____ colors and then transition into pastel and muddy colors that are more difficult. this color naming ability typically develops by ___-___ years of age, but develops earlier in genetic girls than genetic boys

dysphonetic sound

recall that boder talked about a ______ type of dyslexia. these people show a deficit in symbol sound integration and trouble with phonetic word analysis synthesis. these people may spell by sight, but not by ear, i.e. words read as a gestalt, not by sounding out. they also have difficulty learning what the letters _____ like. therefore we think of these people being more visual learners

transient system deficit

recall that in a _____ ____ ____, the preceding pattern is not erased, and two successive patterns overlap creating a masking effect, which makes reading confusing and inefficient. this is one theory of something that can cause dyslexia

6-8 weeks 6-8 weeks nystagmus glow

recall that pursuits should be smooth by about ___-___ weeks and saccades are accurate by about ____-___ weeks in which they can alternate between 2 targets. in terms of position maintenance, lack of maintenance would mean the patient has _____ (covered later). for visual fields, we do something similar to confrontation fields/monster fields in which we screen for large field defects. we need appropriate high interest targets that change periodically. we should avoid lights that cast _____ and avoid objects with sound. we can use something like a long black stick with illuminated diode and TV/VCR for fixation. we may need an assistant and record the size of the target. a double arc perimeter can also be used for visual fields in which a ball moves along the arcs

6-12 3-5 first annually

recall that the AOA has clinical practice guidelines as to when eye exams are recommended. the first exam is typically done between ____-____ months old, then the second exam is ____-____ years old, then before the _____ grade, and then _____ throughout school. however, there are still many questions that remain, such as how to implement, will it be mandatory, what if families don't comply, and who will pay

stereo smile

recall the ____ ____ had the best testability and sensitivity in detecting strabismus. it was also successful with nurses and lay screeners

genetics nutrition premature 2500 CNS

risk factors for learning disabilities include: - ______ - psychosocial and biological factors - maternal _____ - ______ birth - low birth weight less than _____ grams which is related to a higher risk of low IQ - neonatal seizures - _____ trauma including TBI - birth experience - intraventricular bleeds - abuse

n/a

should read and be familiar with article in notes

age

so far we as optometrists treat vision disorders, including anything related to visual acuity (refraction, ocular health), and visual efficiency problems (binocular, accommodative, ocular motor). therefore we need to know the onset of signs/symptoms, as well as the typical ____ of onset. for example, if a child has mild astigmatism that is blurring some words, it might not bother the child in second grade when the words are easier and larger print. but it might bother the child in 6th grade when the words are harder and smaller print

clinical chronic note: it is possible for a child to be classified as having an educationally defined disability and not a clinically defined disability

so far we have been talking about education definitions of learning disabilities, but there are also _____ definitions which are defined by the american psychiatric association and defined in the diagnostic and statistical manual of mental disorders. they define this specific learning disability as a neuro-developmental disorder that impedes the ability to learn or use specific academic skills which are the foundations for learning. these learning difficulties are unexpected. these specific learning disabilities are cross cultural and _____ as they can persist into adulthood

vision in preschoolers study part 1

so how do we know what works? there was a study called the _____ in _____ ____ ____ ____ that aimed to identify the best tests by looking at 15 different screening tests by licensed eye care professionals (MDs and ODs) that were both experienced in pediatric care. they did so with a mobile medical unit in order to provide a controlled environment. all the children had a comprehensive, cycloplegic eye exam by these providers with standardized testing procedures, and doctors did not know the screening results

1. noncycloplegic retinoscopy 2. retinomax autorefractor 3. SureSight vision screener

so in terms of refractive error screening tests, we found that these 3 tests that assess refraction perform better than tests that use photorefraction, for example the iScreen photorefractor, MTI photorefractor, and power refractor. we also learned at lay screeners and nurses performed equal to doctors with autorefraction and sensitivities close to doctors with retinoscopy

90% non-cycloplegic retinoscopy

so in the VIP study part 1, they found that with the specificity set at ___%, the best tests detected 90% of children with the most severe conditions. _____-______ _____ had the highest specificity at 90% out of the screening tests

lea symbols (linear) single note: there was no significant difference between lea and HOTV

so what did we learn? in terms of the _____ ____ visual acuity, it had a 99% testability, meaning 99% of children could complete it, with a sensitivity of 77%. this was with an OD or MD as a screener. when used with nurses, it was 60%, and with lay screeners, it was 50% sensitivity (not so good). to try to increase this sensitivity, we made the target a ______ crowded target as compared to the linear form previously, and moved the test distance to 5 feet

referral criteria performance

so which tests should be done on vision screenings for children? nearly every national organization concerned with the eye health of children recommends screening children. however, recall that methods for screening vision vary from state to state and _____ _____ is not uniform. in addition, the _____ of vision screening methods are often not compared to head to head and are not compared to the results of an eye exam for all children screened. this is a problem because there are many ways to screen and many people doing it, and we didn't know what worked and what didn't.

6-12 3-5 first yearly

the AOA also gives pediatric guidelines. they recommend that children are seen between ____-___ months of age (assuming they have the early screening in the hospital), and again when they are ____-___ years old. after this, the AOA states that they should be seen before the ____ grade, and then _____ throughout school

vision function vision therapy

the AOA has stated that learning is accomplished through complex and interrelated processes, one of which is vision. determining the relationships between vision and learning involves more than eye health and VA. Problems in identification and treatment of people with learning related vision problems arise when such a limited definition of vision is employed. Expected outcome of OD TX is improvement in _____ ____. Optometric intervention for people with learning-related vision problems consists of lenses, prisms & _____ _____, which should be part of multidisciplinary approach to LD but does not directly treat LD.

low 73.3% preschool

the Maternal and Child health title V program helps to ensure health to the nation's mothers, women, children, and youth. it also assures access to quality care, especially for those with _____ incomes or limited availability of care, an increase in health assessments and follow up diagnostic and treatment services, especially for low income children, as well as access to preventive and child care services, and rehabilitation services for children in need of specialized medical services. in a survey of vision screening services in MCH title V programs by PBA, of 45 responses, ____% of states report having specific codes regarding children's vision screening. nearly all are related to school aged screening, and very few states have guidelines for ______ children or children with an individual education plan

predict empower

the VIP group had 2 goals: 1. to identify whether there are vision screening tests which can accurately ____ those 3 and 4 year old preschoolers at risk for common vision disorders 2. can the best tests be used by nurses and lay screeners in order to _____ communities

lea symbols

the ____ ____ is one type of recognition acuity test that is calibrated for distance and near. some of these have crowding bars but they all have equal blur. as the optotypes get smaller and smaller, they all begin to appear like a circle instead of the various shapes. the child needs to get 3/3 or 3/4 in order to move to the smaller line and may be used in both a screening and threshold phase

broken wheel

the _____ ____ is another recognition acuity test that is done at 10 feet (can also be landolt C's). this also takes into account crowding and is a form of forced choice where the child looks at two cars and will move their gaze to one of them. the child needs 4/4 o4 4/5 to move to the next smallest acuity

Krimsky

the _____ test is used to estimate the deviation with prism. basically once we see the hirschberg is misaligned, we can use prism to see how much it takes to align them

vision screenings

the alternative for comprehensive vision exams for all children is _____ _____. however, we still must determine many things such as what ages, who will pay, what is the referral criteria, and how to implement, etc.

more separation anxiety

the children's visual systems are developing rapidly and therefore we need to use different criteria when managing vision disorders. for example children at birth have very poor visual acuity, so we would not worry as much. however, because of this rapid development, we need to monitor them ______ frequently and discern if the changes are normal changes or vision disorders. as they begin to get older, they may also fear new environments/strangers, fatigue easily, and may have _____ _____ from their parents

teller acuity cards forced choice preferential looking

the gold standard test to do resolution acuity is the ____ ____ _____, which have good reliability and be can completed by most infants and toddlers. these are are also useful in children with a variety of visual disorders and developmental disabilities. they can also be used with non-verbal adults. another test for resolution acuity is the ____ ____ ___ ____ in which we present patterned stimuli as a behavioral test in where the task is based on the ability of the child to resolve gratings and their preference for patterns. the VA is then based on the spatial frequency of lines. the basis for decision is based on the child's first fixation and duration of fixation, and behavioral responses

fatigue interest booster seat

the kids and the parents also appreciated a gentle manner and voice, as well as making sure we work quickly and efficiently. this will help decrease the child's _____ during the exam and help keep their ____. we also want to make testing enjoyable if possible, and have a comfortable testing environment such as a ____ ____ if needed in a comfortable chair

HOTV or lea symbols retinomax autorefractor suresight vision screener

the national expert panel to the national center for childrens vision and eye health at prevent blindness america (funded by the maternal and child health bureau of the health resources and serves administration) and the US department of health and human services provided recommendations for vision screening. they said there are two current best practice methods for vision screening, the first being monocular VA testing using _____ or _____ _____ with crowding bars and at 5 feet, and secondly is the _____ ____ or the ______ _____ _____. supplementing with the pass test is also acceptable, and should be screened annually. there are also new technologies for screenings such as EyeSpy 20/20 that uses an ipad type screen as well as Plusoptix devices, iscreen, gocheck kids app, and spot vision with pediavision

versions Hirschberg

the near point of convergence is very easy to test in children. we should use an appropriate accommodative target that is normally 2-3 inches by 3-4 months of age. in addition, _____ should be equal and full, and we can change the target if necessary. the _____ is another test we can do to confirm the presence of strabismus. here 1 mm equals about 22 prism diopters, but this is only a gross estimate of alignment and therefore we will miss small deviations

retinoscopy 50 cm 0.75 D 1.25 D

the near retinoscopy was developed by mohindra and is useful for children from birth. here we use a dark room with the retinoscope as our light source. the child then fixates on the _____ and we use a lens rack or loose lenses to neutralize the refractive error. this is done at _____ cm and can use sound effects to maintain the child's attention. we also must use a correction factor for this, which is _____ D for less than 2 years, and _____ D for greater than 2 years. note: we can also do distance retinoscopy in older infants where they would direct they're attention to a distance target

fix and follow test tropias strabismus

the next lower test is the ____ and _____ test, which is used to assess the presence of vision. this is thought to detect significant levels of amblyopia and is used by many eye care provides for VA. despite this, however, it is inaccurate for measuring VA, and has a high false negative rate of 60-80% and therefore can miss amblyopia with or without small ______. it also has a high false positive rate of 31-68% especially with large angle _____. it may also be insensitive to changes with patching in amblyopia

patch glasses

the study also found the _____ _____ can be just as good as the adhesive patches used to cover one eye. this (the blank) also has decreased cost as they can be reused whereas the adhesive patches cannot

1. Automaticity & Processing Speed 2. Simultaneous-sequential processing 3. Magnocellular vision deficit 4. Rapid automatized naming 5. Integrative Factors 6. Visual Perception

the way we process visual info includes these 6

vision in preschoolers study part 2

then the _____ in _____ _____ ____ ____ was done in which the best high tech and best low tech tests from part 1 were chosen. this is because different screening programs have different budgets. then this study specifically looked at taking these tests and having them administered by pediatric nurses and lay screeners (opposed to MDs and ODs), and performed in the normal, noisy preschool environment (opposed to in the mobile unit)

1. foveal 2. parafoveal 3. peripheral

there are also 3 regions to our field of perception when we are reading: 1. ______ - takes up 1-2% of the total vision (3-6 letters) but gives our best vision 2. _____ - 24-30 letters but not very clear 3. _____ - everything else, mostly gross shapes

state preschool

there are also ______ laws for vision screening. each of these will have different screening requirements for children of different stages. however, some do not require any vision screenings at all. in PA, there are no _____ guidelines for children but there are school-age guidelines

history

there are also different expectations for each person involved, meaning there are different expectations for the child, the parents, and for us as the doctor. because of this, it is helpful for the office to send a letter to the parents prior to the exam. this should include the date and time of the appointment, what to expect at the exam, how to prepare the child for testing, what to bring, and it should also include a questionnaire to help take a _____

1. cover-uncover test 2. random dot E 3. stereo smile (PASS)

there are also eye alignment screening tests. we looked at these 3 in particular

OKN drum superior colliculus

there are also involuntary visual responses that we can test, for example using the ____ ____, which is based on resolution acuity and involves motion detection. this is a subcortical response of the _____ _____ and typically shows a decrease in visual attention at increased distances. however, this dynamic nature raises questions

easier lights

there are also some special considerations when dealing with infants. the younger the patient is, typically the ______ they are to examine due to "babe in arms". they also like to look at _____ up to 6 months of age which helps us. they are also typically very sleepy, and have a short attention span. we should also allow a bottle or pacifier to make the exam go smoother

alternate fixation 10 prism diopter vertical prism

there are also supplemental tests we can use to confirm amblyopia. for example we can do _____ _____ testing in which they change fixation from right to left. if each eye gets used, it is less likely amblyopia developed. another supplemental test is a _____ ____ ____ ____ ____ test. here prism is placed over the childs eye, causing the image to dissociate, and watch the patients eyes to see if are alternating fixation between the two images (which would be a good sign)

10% 25% 15-20%

there are less prevalent conditions, including some anterior segment pathology such as cataracts, congenital glaucoma, albinism, aniridia. neurologic disorders such as nystagmus as well as posterior segment pathology like retinopathy or prematurity and coloboma are also less common. according to the american public health association, about __% of preschoolers and ___% of K-6th students have significant vision disorders. PCO also does yearly screening in the Philly area for preschool children and found that ___-___% have significant vision disorders that we would either want to monitor or treat

HOTV lea symbols 10 or 20 5

there are two primary optotypes that are used for children. these are the ______ visual acuity and the ____ ____ visual acuity. however, we also need to determine which format was best as well as which testing distance was best. traditionally, the test would be done at _____ or _____ feet. however, this presents a challenge as the mobile units and other spaces may not be this big. recently it was switched to _____ feet (could potentially miss kids with low myopia, but low myopia is not very common in children of this age). the type of patch was also examined

eye exams

there is also controversy as to what is the best way to find and treat common vision problems in children. one way to do so is to conduct a _____ ____, in which the purpose of this is to detect, diagnose, and then begin treatment for eye and vision disorders. however, this is not done on most children (which is a problem because recall many children have vision disorders). infantSEE is a problem established to help get children these exams

VIP (vision in preschoolers)

there was also a landmark study on preschool vision screening called _____, which is a group of clinicians and researchers from across the country interested in preschool vision screening, and in particular learning the best ways to screen. they also empower communities by working with nurses and lay screeners, as well as working with different community needs and budgets such as high tech vs low tech. their study was done in 5 mobile vision vans as it made it easier for children and families to participate in terms of providing access

6 treatment

therefore the first comprehensive vision exam takes place at ____ months of age, when we know that most systems are well developed. at this point the babies will be in the parents arms so they are easy to examine. in addition, they will be entertained by simple things, so _____ is easier and more effective. recall that these early screenings will also help us to prevent secondary problems such as amblyopia

discrepancy cutoffs

therefore the major premise is that a significant _____ exists between the child's potential and actual level of academic or language skills. each state, however, may determine _____ for discrepancies or definitions of processing disorders, leading to variability among states and even differences among districts within a given state (people can actually move to a different state to obtain different services).

1. amblyopia 2. strabismus 3. significant refractive error 4. reduced visual acuity

these comprehensive eye exams in the vision in preschoolers study part 1 were used to classify children as either normal or having one or more of these 4 conditions

sensitivity specificity

these screening tests must be able to detect most children with a problem, meaning it has to have a high _____ (close to 90%). this is the probability that a test will indicate the condition among those actually with the condition. however, this alone is not enough. the test should also not over-refer too many children, meaning it has high ______ (close to 90%). this is the percentage of those without the condition who will have a negative test result

reading transient transient system deficit

these system's major function is _____, which involves fixations (sustained for extracting details) and saccades (transient) so we can integrate the information between our eye movements. the role of the ____ system diminished the persistence effect of sustained channels by erasing pattern information from the previous fixation (basically if we look at one word when reading, and then move to the next, we have to erase the previous word imagery otherwise they will appear on top of each other - this is what happens in a LD and words can look very jumbled, called a ____ _____ _____)

1. very important to detect and treat early 2. important to detect early 3. detection is clinically useful

this vision in preschoolers study also realized that not all eye conditions were equally important, and so the children were grouped into these 3 categories

3-5 eye turn colors

vision assessments for preschoolers are also important. typically these children are ____-___ years of age. this eye exam includes basically everything we do with adults with some emphasis on development. the most common reasons that parents bring their children in during these years include ____ ____, squinting, rubbing, photophobia, holds objects too close, too clumsy/falls/bumps into things, tilts or turns heads, and doesn't know their _____

mirrors lights faces

we also need to use age appropriate targets. for example, very young babies like to look at _____ which can be helpful for us to measure pursuits and visual fields. they also like to look at _____ that we can use as well as ______, which we can use for tracking

transient sustained magnocellular

we also process info through our two parallel processing systems. the magnocellular system is _____, motion sensitive, low resolution, and processes overall stimulus organization. the parvocellular system is our _____ system for pattern sensitivity, high resolution, and object identification/stimulus configuration. children with a LD are thought to have a deficit in the _____ pathway

integrative factors intramodal intermodal note: all these forms of learning (visual, auditory, kinesthetic) are related to one another

we also use _____ ____ which is our ability to integrate info from various sensory modalities. these can be ______ factors, which are from the same source, for example visual and visual pattern matching, or they can be _____ factors, which are from a different source, for example auditory and visual. this is the best way to learn as it reinforces and internalized knowledge

targets parent and child

we have to be flexible when working with children. we can change tasks when necessary, meaning we do not always have to do VA first like in adults. we also want to make sure we are using age appropriate _____ for our tests, and ensure we are proficient in these tests for children. also know what happens when with regard to visual development and age expected levels of visual skills. it is important to develop a caring, trusting relationship with both the _____ and ____. it is also ok to bring the child back if needed for a follow up visit for example if the child is scared, and use stickers and prizes if they do well for encouragement

ocular motilities visual acuity

we must also examine _____ _____ in the children. we can do so by using pursuits, saccades, and position maintenance. for targets, we can use puppets, lights, mirrors, and the examiners face, but recall we can change the targets when necessary. the parents can also hold the child's head if needed. if these are abnormal, it may be due to decreased _____ _____, nystagmus, or neurological involvement

stereopsis 3 figure flashlight

we test sensory binocularity through _____, in which any age appropriate random dot test is ok to use. this includes the PASS test, random bot butterfly, lang, randot preschool stereoacuity test, and TNO (red green filters). in addition to this, we can also measure fusion. typically we measure this using the worth 4 dot, but in order to do this the patient must be able to count. therefore for kids we can use the ____ ____ ____, where the child only has to identify shapes. here the child wears R/G glasses (red over right eye) so the the right eye sees the red girl image, the left eye sees the green elephant image, and both eyes see the white ball. using this we can determine which eye is being suppressed

heterogeneous

we think of learning disabilities as a ______ population, meaning they can have one or more of language, speech, auditory, cultural, motor skills, attention, emotion, visual perception, and/or academic deficiency components

ocular health refractive accommodation binocularity ocular motility

what goes good vision mean? when we talk about visual acuity, we are only talking about the clarity of a picture. if we have good VA (20/20), then we know that there is good ____ ____ in the macular area and _____ status is good. however, beyond VA, we also know there are other components of vision, such as _____, _____, and ____ _____ that affect the clarity, comfortability, and efficiency of our vision. this is known as visual efficiency

common treat detect

what kinds of vision disorders are we trying to detect? we are looking for ______ disorders that may not be obvious and may be a significant public health concern. we also are looking for disorders that are easy to _____ and ______, as the earlier we do this the better the outcome will be for the children

regression 10%

when a person is reading a sentence silently, the eye movements show that not every word is fixated. every once in a while a _____ (an eye movement that goes back in the test) us made to re-examine a word that may not have been fully understood the first time. this only happens with about ___% of the fixations, depending on how difficult the text is. the more difficult, the higher the likelihood that these occur

cost referral criteria

when choosing a screening test, we must consider the _____ of the test, as well as the number of children to be screened/budget. we must also pick a test that has been proven to work in studies with large numbers of children, larger numbers with targeted vision disorders, and includes vision disorders important for that population. we also need good ____ ____

testability specificity sensitivity

when choosing a screening test, we want to have high ____, high _____, and high ____. this is because we need these tests to pick up important vision disorders and be used by the designated screener

1-2 3

when do we see the child next after their 6 month old exam? children between the ages of ____-____ years old are notoriously difficult to examine. this is because they have increased motor activity, extreme stranger anxiety, and lights are no longer interesting to them. these children also have limited attention as well as limiting communication and language skills. therefore, we will do our second comprehensive eye exam around _____ years of age. this is because the child will be more cooperative, and their language skills are more developed. however, if a child has never been seen or has a vision problem, we should see them regardless of their age

1-2% 3% 1.5%

when looking at strabismus overall, in the 4% that have strabismus, congenital esotropia makes up about ___-___%, esotropia about ___%, and exotropia about ____%

n/a

when looking at the population in the US, in 2008, there were 304 million people. in 2021, there are about 330+ million people. based on the numbers of new births, new deaths, and new immigration, there is a net gain of one person every 26 seconds. in addition, the average ago of the population is getting older. in the US today, there are 75 million+ kids, distributed equally between 0-5 yoa, 6-11 yoa, and 12-17 yoa, and the number of kids in increasing with time.

birth screening

when should we do our first vision assessment? these typically take place at _____ when in the hospital in which they look at the ocular structures and clarity of the media to see the red reflex to ensure the eye is in tact. rarely this can be preformed by optometrists at the hospital, but typically is performed by pediatricians and/or OMD. it is important to keep in mind this is a ____ only, not an eye exam

adhesive patch (narrow part up and nasal) unequal amblyopia

when testing visual acuity in children, our preferred method of occlusion is a ____ ____ that is applied monocularly to the correct eye. the parent may need to hold the child's hand so that it is not taken off. there are also three main reasons we want to do visual acuity. these including determining if there is reduced VA, but also if there is _____ unequal and to detect _____

1. illuminated 2. high contrast 3. at least 1 inch in diameter note: want to avoid toys that make sound

when we have children look at targets, we want them to have these 3 characteristics (other than mirrors and faces)

breaks engaging varied

when working with young children, we should also allow short ______ during the exam, especially if they are getting anxious or tired. beyond 1 year of age, the child is now known as a "toddler". now our targets have to be both _____ and _____. we should also be cautious as they are grabbing things, fidgety, whining, they tire easily, and respond to treats from the parents

vision disorders

why do we care about development? this is because _____ _____ are associated with many conditions and affect development. in addition, delayed development may affect the visual development. for example, children with cerebral palsy are at high risk for strabismus, or, if a child has very high myopia, they may not develop fine motor as they cannot see up close

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