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PGH Basic Course 2014
Basic Pediatric Vision Exam
Alvina Pauline D. Santiago, MD
Pediatric Ophthalmology & Strabismus
2007
Vision Assessment
Preverbal Age Group
2007
Visual milestones
• Birth Bright lights
• 7 days vestibulo-ocular reflex
• 3 mos transient fixation & following
• 6 m...
2007
Vision Assessment
• Fixation pattern
• 3 mos: transient fix and follow
• 6 mos: fix and follow
– “CSM” : central, ste...
2007
2007
2007
Fixation preference
2007
Profound Amblyopia
2007
Fixation Preference &
Visual Acuity
• Central, steady, maintained
CSM 20/20-20/30
• CS, maintained briefly 20/40-20/6...
Optokinetic (Catford) drum
• Fast saccades
• May be calibrated
based on cycles per
degree
Preferential Looking
• Modified optokinetic
flag
• Teller acuity cards or
its derivative
• Facial targets
Teller acuity cards
Forced Choice
Preferential Looking Tests (FPLs)
School age child
• Not infants and toddlers
• Preschool 3-6 years
• Regular School 7-12
• Adolescent 13-18
Vision testing
• Quantifiable
• Depends on patient discrimination
• Depends on examiner ability to interpret
response
• St...
Preschool
• Short attention span
• Inability to sustain interest
• Language and communication barriers
• Cultural and soci...
Preschool Tests
• Detection acuity tests
– Stycar graded balls (Sherian 1973)
– Catford drum (Catford & Oliver 1973)
– Dot...
Vision Assessment: 3-6 years
• Allen pictures: cultural bias
• Sheridan Gardner or HOTV/HOTEX
• Illiterate E / tumbling E ...
Visual Acuity Testing
• Test Charts
– HOTV / HOTEX
– Tumbling “E” Game
– Landolt C
– Picture Charts
Illiterate/Preverbal Charts
Landolt C Tumbling E
2007
HOTV Charts
2007
Lea Charts
2007
Grating vs Snellen Acuity
• Grating acuity (cycles
per degree)
• Snellen acuity (visual
angle)
• Grating overestimates
Sne...
Limitations of Optotype Test
• Snellen acuity unreliable before age 6-8
• Not all children will know alphabet &
numbers
• ...
Normal Visual Development
Development of Visual Acuity
Susceptible Period
• Most sensitive first 2-3
years
• Decreases until age 6-
7 years (12? 18?)
– complete visual
maturatio...
7-12 years
• Significant number still will not express
poor vision
• Easy to perform Snellen linear acuity
testing
13-18 years
• Will verbalize a visual problem
2007
Vision Assessment
Non/Pre Verbal
OKN Drum FPLOKN Flag Teller
2007
Vision Assessment
Picture ChartsPicture Charts HOTVHOTV SNELLENSNELLEN
2007
Laser vision ;-)
Vision Assessment: Nystagmus
• Binocular near vision test
– allow patient to assume own distance
– test at standard near d...
Vision Assessment: Nystagmus
• Monocular occlusion
– many will increase nystagmus
• Remote occlusion
• Sufficient fogging:...
2007
Random dot stereograms
• 2 plates of randomly
displayed dots, one
plate to each eye
• Shape of figure
displaced horiz...
2007
Sensory Tests & Visual Acuity
Circles Seconds of Arc VA
9 40 20/25
8 50 20/30
7 60 20/40
6 80 20/50
5 100 20/60
4 140...
2007
Thank You!
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2014 Basic Pediatric Vision Examination Slide 1 2014 Basic Pediatric Vision Examination Slide 2 2014 Basic Pediatric Vision Examination Slide 3 2014 Basic Pediatric Vision Examination Slide 4 2014 Basic Pediatric Vision Examination Slide 5 2014 Basic Pediatric Vision Examination Slide 6 2014 Basic Pediatric Vision Examination Slide 7 2014 Basic Pediatric Vision Examination Slide 8 2014 Basic Pediatric Vision Examination Slide 9 2014 Basic Pediatric Vision Examination Slide 10 2014 Basic Pediatric Vision Examination Slide 11 2014 Basic Pediatric Vision Examination Slide 12 2014 Basic Pediatric Vision Examination Slide 13 2014 Basic Pediatric Vision Examination Slide 14 2014 Basic Pediatric Vision Examination Slide 15 2014 Basic Pediatric Vision Examination Slide 16 2014 Basic Pediatric Vision Examination Slide 17 2014 Basic Pediatric Vision Examination Slide 18 2014 Basic Pediatric Vision Examination Slide 19 2014 Basic Pediatric Vision Examination Slide 20 2014 Basic Pediatric Vision Examination Slide 21 2014 Basic Pediatric Vision Examination Slide 22 2014 Basic Pediatric Vision Examination Slide 23 2014 Basic Pediatric Vision Examination Slide 24 2014 Basic Pediatric Vision Examination Slide 25 2014 Basic Pediatric Vision Examination Slide 26 2014 Basic Pediatric Vision Examination Slide 27 2014 Basic Pediatric Vision Examination Slide 28 2014 Basic Pediatric Vision Examination Slide 29 2014 Basic Pediatric Vision Examination Slide 30 2014 Basic Pediatric Vision Examination Slide 31 2014 Basic Pediatric Vision Examination Slide 32 2014 Basic Pediatric Vision Examination Slide 33 2014 Basic Pediatric Vision Examination Slide 34 2014 Basic Pediatric Vision Examination Slide 35 2014 Basic Pediatric Vision Examination Slide 36 2014 Basic Pediatric Vision Examination Slide 37
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2014 Basic Pediatric Vision Examination

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

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2014 Basic Pediatric Vision Examination

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

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