Pediatric Vision Assessment Quiz

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Questions and Answers

What was the stereopsis measurement for the child described?

20 arc sec

50 arc sec

30 arc sec (correct)

40 arc sec

What was the final prescription for the 5-year-old child who failed the vision screening?

+1.00-1.00 X 180

+2.00-1.50 X 180

+1.50-1.00 X 160

+1.00-1.50 X 180 (correct)

What was the visual acuity (VA) of the 4-year-old child at distance and near?

20/50

20/30 (correct)

20/20

20/40

What was the near point of convergence measurement listed in the report?

2/4 Signup and view all the answers

What condition did the 7-year-old child have based on the given retinoscopy results?

Hyperopia and Astigmatism Signup and view all the answers

What was noted about the fixation of the left eye (OS) during the visual field test?

Excellent fixation Signup and view all the answers

What is the primary stressor in the Nearpoint Stress Model?

Blur or diplopia caused by vergence and accommodation drive Signup and view all the answers

Which adaptation method might eventually lead to avoidance in visual function?

Inefficient visual function Signup and view all the answers

What is one advantage of the COVD Quality of Life (QOL) Questionnaire?

Standardized survey format Signup and view all the answers

What scoring does the COVD QOL Questionnaire assign for the response 'never'?

0 points Signup and view all the answers

What is the purpose of the unilateral cover test?

To detect strabismus Signup and view all the answers

What does the score of greater than 20 indicate when using the COVD QOL Questionnaire?

Visual efficiency or perceptual disorder Signup and view all the answers

Which method is not a recognized approach within the Nearpoint Stress Model?

In-depth patient interviews Signup and view all the answers

What does the Von Graefe method primarily assess?

Lateral and vertical phoria Signup and view all the answers

What does a reduced break and recovery indicate in a patient with convergence insufficiency?

Difficulty with eye teaming Signup and view all the answers

During smooth vergence testing, what does a low break finding suggest?

Indicates adaptation is poor Signup and view all the answers

Which method assesses the amplitude of the fusional vergence response?

Near point of convergence test Signup and view all the answers

What is the primary goal of utilizing smooth vergence testing?

To assess the ability to regain fusion after diplopia Signup and view all the answers

Which of the following targets is used to assess convergence amplitude with a red lens?

7cm break, 10cm recovery Signup and view all the answers

What does the term 'prism facility' measure?

The endurance of the fusional vergence system Signup and view all the answers

What does the presence of local/contour stereopsis typically assess?

The organization of monocular cues Signup and view all the answers

In skeffington's assessments, what does low blur finding indicate?

The case is new Signup and view all the answers

What is the expected average accommodation for a 25-year-old individual according to Hofstetter's formulas?

9.67 D Signup and view all the answers

Which method evaluates accommodative response using the monocular estimated method?

Fused cross cylinder Signup and view all the answers

At what age is the minimum accommodation expected to be 3.00 D?

45 years Signup and view all the answers

Which test involves using a near point card or fixation target while monitoring patient response?

Push-up test Signup and view all the answers

What is the main concern when using the minus lens-to-blur method in accommodative testing?

Minification effects Signup and view all the answers

What is the correct average accommodation value for an 11-year-old based on the provided norms?

6.5 cpm Signup and view all the answers

At what age does Hofstetter’s formula predict that the average accommodation drops to 4.67 D?

40 years Signup and view all the answers

In the study conducted by Hamasaki, what was the reported overestimation in accommodative amplitude?

2 D Signup and view all the answers

What was the uncorrected acuity of the 3-year-old female at her second opinion visit?

20/25 OD, 20/30 OS and 20/25 OU Signup and view all the answers

What was the result of the stereopsis test for the 15-year-old male?

Stereopsis was absent Signup and view all the answers

What was the prescribed treatment for the 3-year-old female's condition?

Astigmatism correction and basic eye stretches Signup and view all the answers

At what distance did the 15-year-old male demonstrate intermittent alternating exotropia during the cover test?

At both distance and near Signup and view all the answers

What significant change was noted in the 3-year-old female's cover test results after initial evaluations?

Improvement from 18 PD to 10 PD in exophoria Signup and view all the answers

What does the Nearpoint Stress Model primarily address?

The relationship between accommodation and vergence Signup and view all the answers

What symptom might indicate excessive plus lens prescription?

Blur at distance with glasses Signup and view all the answers

Which visual condition is associated with exophoria during near tasks?

Hyperopia Signup and view all the answers

Which sign could suggest a struggle with reading comprehension in a child?

Holding reading material too close Signup and view all the answers

What does a cover test revealing 4 Exo at near suggest?

The patient may have a convergence insufficiency. Signup and view all the answers

What is indicated by a Child reporting good grades but reading below grade level?

The child may have issues related to visual processing. Signup and view all the answers

What role does the AC/A ratio play in visual therapy?

It reflects how accommodation and vergence are linked. Signup and view all the answers

What would likely improve the clarity of a patient’s distance vision?

Decreasing the plus lens prescription Signup and view all the answers

Study Notes

Stress Theory (Physics)

Stress is the force that deforms a body.
Strain is the result of stress.
In everyday language, we say "under stress," implying the effect. But in physics, stress is still the cause.

Hans Selye's Stress Theory

Stress is the body's response to a demand.
Stressors are the factors that produce the body's response.
The response of the body is non-specific to the demand.

Influences on Adaptation

Stress affects individuals differently.
Individuals have varying tolerances to stress.
Stressors: type, persistence, intensity, concurrent conditions.
Factors: genetics, external factors (temperature, pollution, noise), psychological factors (personality, attitude), prior conditioning.

Skeffington's Model of Vision

The model emphasizes four key dimensions of vision:
Centering (convergence): directing the body, head, and eyes toward a spatial area for processing information and attention to the external world.
Antigravity (vestibular): internal balance, orientation, and spatial localization.
Identification (accommodation): gathering the meaning from areas of selected attention (resolution, discrimination, differentiation, and determination of relationships between details)
Speech-Auditory: analysis and communication of what is seen

Nearpoint Stress Model (Skeffington)

Humans are not biologically suited for near-vision tasks.
Near-vision tasks cause sustained concentration, immobilization, and mental effort which lead to a stress response.
The centering process to localize is a more crucial and stronger individual drive than identification.

Nearpoint Stress Model (Efficient Reading)

Accommodation and vergence need to localize at the plane of regard.
The drive for vergence to be closer than accommodation leads to blur and diplopia — the stressor!
Adaptation is the way out of this.

Nearpoint Stress Model: Choices

Avoidance: the easiest solution.
Inefficient visual function: avoidance can lead to ineffective reading.
Accommodative or vergence adaptation: addressing the issue (e.g., accommodative or convergence insufficiency).

COVID Quality of Life (QOL) Questionnaire

Developed in 1995 by a COVID committee.
Ascribes to vision therapy, change in distance spectacle RX, and near point lenses.
Original version had 30 questions; shortened version has 19.
Advantages of survey: easy administration, low cost, standardized.
Disadvantages: leaves no room for clinic elaboration.

COVID QOL Questionnaire Scoring

Scoring system: points for 'always' (4), 'frequently' (3), 'occasionally' (2), 'seldom' (1), 'never' (0).
Summing scores from each question to gain a total; scores above 20 suggest visual efficiency and/or perceptual disorder concerns.

Cover Test

Used for unilateral and alternating tests to determine strabismus and phoria.
Norms for distance and near vary.

Phoria Measurement (Von Graffe Method)

Uses a phoropter for assessing lateral and vertical phoria.
The patient must keep the letters clear.
Norms for distance and near tests are available.

Near Point of Convergence

Assesses convergence amplitude with objective and subjective tests.
Repetition is critical for accuracy.
Different target types are used, including those for accommodative testing (5cm break, 7cm recovery, penlight with red lens).

Smooth Vergence

Measures the amplitude of the fusional vergence response in positive and negative fusional vergence.
Assessment includes blur finding, accommodation, break finding and recovery.

Stereo Testing

Evaluates the presence and degree of stereopsis.
Methods include suppression check, local/contour stereopsis, Wirt circles, and Titmus instruments.
The tests are used to see if peripheral stereopsis exists.

Prism Facility

Measures the dynamics of the fusional vergence system while also tracking the ability to respond given periods of time.
Evaluates the accommodative amplitudes and accommodative facility.

Accommodative Testing

Amplitude methods such as push-up, pull away, and minus lens-to-blur.
Facility methods include monocular and binocular.
Response methods such as Monocular Estimated Method (MEM) and Fused Cross Cylinder (FCC).
Additional methods include NRA/PRA.

Hofstetter's Formulas

Formulas based on Donders and Duane's work on accommodation.
The target is a single black line.
Methods for minimum accommodation and average accommodation.

Accommodative Amplitude

Push-up vs. pull-away measurements.
Materials include near point cards or target systems (like tongue depressors).
Monitoring patient response, including facial expressions, is important.
Comparison to existing Hofstetter formulas.

Accommodative Amplitude (Minus Lens-to-Blur)

Important issues related to minification due to varied minus lens powers are present.
Adaptation to testing distance to 33cm rather than 20cm should be considered for better accuracy.
Expected results should differ from push-up methods by about 2 diopters.

Accommodative Facility

Failure to clear minus: accommodative insufficiency, convergence excess
Failure to clear plus: accommodative excess, convergence insufficiency
Record performance deterioration during testing, suppression occurrences, postural changes, patient complaints and attempts at moving cards.

Accommodative Posture (Monocular Estimated Method — MEM)

Used to determine accommodative posture or lag, determining an appropriate near-vision Rx.
Appropriate MEM card choices based on patient reading level (low-demand-large print vs. high-demand-small print) are crucial. Cards should be chosen closely to the actual patient reading level.
Lens speed is crucial, as is checking both meridians for astigmatism.

Accommodative Posture: Recording

Record the neutralizing lens power for each eye and if present the axis and amount of astigmatism.
Record fluctuations or instabilities in the reflexes.
Record the reading level and distance.
Normal lag of accommodation is between +0.25 to +0.75 diopters.

Accommodative Posture

Lag of Accommodation
Lead of Accommodation

NRA/PRA

Indirect measure of accommodation using binocular procedures.
Procedures include having the patient in a phoropter, wearing habitual Rx, target (20/30 line at 40cm), sufficient illumination.
Procedure involves the introduction of plus and minus lenses until the patient reports sustained blur.
Expected PRA amounts: -2.37 +/- 1.00
Expected NRA amounts: +2.00 +/ - 0.50

AC/A Ratio

Measures the change in accommodation and vergence responses to accomodation changes or stimuli.
Calculated using IPD (cm) + NFD (m) (Hn – Hf).
Phoria measurement is repeated with either +/- 1.00.
Calculated ratios are typically larger than gradient ratios due to under-accommodation and lag.

Eye Movements (Fixation)

Includes direct observation, patient position (seated), and binocular/monocular targets.
Grading involves steady fixation.
Issues with fixation can arise after loss of accuracy.

Pursuit Testing (NSUCO)

Direct observation test with the patient standing.
Procedure involves moving an object clockwise and counter-clockwise.
Grading criteria are based on ability, accuracy and body/head movement and on age/gender.

Saccade Testing (SCCO)

Direct observation with the patient seated.
Procedure involves moving a target horizontally, vertically and diagonally.
Grading criteria are based on smooth pursuit, any gross issues with undershooting or overshooting and any uncontrolled head movement.

King-Devick Saccadic Test

Measures reading eye movements (developmental growth).
The procedure involves patients calling out 40 numbers horizontally (with errors and time assessed).

Developmental Eye Movement Test (DEM)

Visual-verbal test involving vertical and horizontal arrays with timing and error evaluations.

Visagraph/Readalyzer

Objective test to measure reading eye movements.
Goggles with infrared sensors record eye movement.
The tests looks at fixations, regressions, backward jumps, reading rate, fixation duration, span of recognition, directional attack and efficiency as assessed by a computer program. This results in a grade equivalent.

Prescribing Based Off the Binocular Vision Examination (Part 2)

Prescribing principles, focusing on binocular vision examination data and treatment protocols.

Nearpoint Stress Model

Describes the interconnected action of stress, vergence, accommodation, and the effect on reading.

Adaptation to Visual Stress

Signs of this include the possible symptoms like exophoria, low or high MEM, fused cross-cylinder, and low absorption levels.

General Management Approach

Discusses the need for plus at near, prism, and vision therapy.

Visual Hygiene

Treatment Strategies (Plus at Near)

Examines whether plus at near alleviates symptoms.
Findings that indicate the need for plus at near are outlined (low AA, eso at near, low PRA, high lag on MEM/FCC, NRA higher than PRA).
Balanced amounts of plus and minus are considered for determining the tentative add power.

Treatment Strategies (Plus at Near): Acceptable Conditions

Describes the conditions that generally respond well to plus at near treatments, including accommodative insufficiency, ill-sustained accommodation, and symptomatic esophoria at near.
Performance testing with tentative added, using MEM, AA, stereo testing, VO star, or NPC.
A trial period may be implemented to monitor progress with either loaner lenses or in-office use.

Case Studies (Various)

Provides case examples of children with various ocular conditions, including symptoms, test results, diagnoses, treatment plans, and follow-up results.

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Description

Test your knowledge on pediatric vision assessments, including stereopsis, visual acuity, and retinoscopy results. This quiz covers various measurements and conditions that affect children's visual health. Perfect for those studying optometry or pediatric care.