Pediatric Visual Screening Assessment

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Questions and Answers

What is a significant limitation of the visual screening mentioned?

It includes comprehensive eye examinations.

It only assesses distance-reading difficulty. (correct)

It tests for color blindness.

It reveals ocular health issues.

Which of the following disorders is most commonly recognized as a childhood visual disorder?

Glaucoma

Amblyopia (correct)

Cataracts

Macular degeneration

What is an important characteristic of the practitioner performing the visual screening?

Screening requires a physician's authorization.

Registered practitioners often specialize in ocular health.

It must be conducted by a registered optometrist.

Screening is led by an orthoptist. (correct)

Why is early assessment of a child's visual status vital?

It is crucial during the time of visual development. Signup and view all the answers

How should a practitioner communicate with a child during visual testing?

Communicate based on the child’s age and maturity. Signup and view all the answers

What is a common parental misconception regarding visual screening outcomes?

Once passed, no further eye care is necessary. Signup and view all the answers

What is the primary reason for conducting a cover test during an assessment?

To check for any strabismus Signup and view all the answers

What should the practitioner aim to obtain during a pediatric eye examination?

A broad understanding of vision and eye health. Signup and view all the answers

Which of the following tests is emphasized as necessary if health and child-centric aspects reveal an issue?

Near Point of Convergence (NPC) Signup and view all the answers

What is a consequence of high false-positive referrals in eye screenings?

Unnecessary worry and utilization of health services. Signup and view all the answers

What should be assessed to understand if a child has any significant refractive error?

Health of the ocular media Signup and view all the answers

For which of the following should a child be re-booked if all tests cannot be completed in one visit?

Cover test Signup and view all the answers

What is an appropriate age-related outcome for evaluating stereopsis?

20 BO^ or better Signup and view all the answers

What type of history is deemed most critical to gather from the child and parent during the assessment?

Accurate and relevant visual history Signup and view all the answers

In assessing a child's visual behavior, which symptom might suggest possible developmental issues?

Unusual viewing distances Signup and view all the answers

What is the key objective regarding the condition of the ocular structures by the end of the assessment?

The ocular media, optic nerve, and macula should be healthy Signup and view all the answers

Which of the following methods is used for assessing vision in infants aged 0-12 months?

Preferential looking with Keeler/Teller cards Signup and view all the answers

At what age does visual acuity typically mature to adult levels?

5-6 years Signup and view all the answers

What visual acuity range is considered normal for a 6-month-old child?

6/15-6/90 Signup and view all the answers

What is a critical test for detecting amblyopia?

Crowded letter matching Signup and view all the answers

What is the primary basis for the preferential looking test?

Children will prefer to look at objects of visual interest Signup and view all the answers

What defines the crowding phenomenon in vision tests?

The presentation of letters or pictures together Signup and view all the answers

Which test is recommended for very young children during a cover test?

Pen torch Signup and view all the answers

Which of the following tests is specifically designed for children aged 12 to 36 months?

Vanishing optotypes using Cardiff acuity cards Signup and view all the answers

What do good stereopsis indicate in children?

Proof of bi-foveal fixation and good binocular vision Signup and view all the answers

When using Kay pictures for visual acuity testing, what is the primary aim?

To estimate the lowest spatial frequency perceived by the child Signup and view all the answers

What is classified as a significant refractive error in a child?

Any visual acuity worse than 20/30 Signup and view all the answers

Which one of the following is NOT a responsibility of a supervisor during the sale of spectacles to children?

Directly assisting the child in trying on frames Signup and view all the answers

What key consideration is vital when selecting frames for children with facial variants, such as those with Down’s Syndrome?

The weight and comfort of the frames Signup and view all the answers

Under GOC regulations, when can unregistered persons sell prescription spectacles to children?

If they are under direct supervision of a registered practitioner Signup and view all the answers

Which of the following best describes the responsibility in ensuring safe dispensing practices to children?

The GOC registrants must supervise all dispensing tasks done by non-registrants Signup and view all the answers

Which aspect is NOT a challenge in testing paediatric patients?

Improving parental understanding of the tests Signup and view all the answers

What is an essential component when adapting routines for testing paediatric patients?

Developing a flexible approach to accommodate individual child needs Signup and view all the answers

The primary focus of paediatric sight testing is to ensure what aspect of child development?

Overall visual development and its impact on learning Signup and view all the answers

What age do most children typically achieve normal refractive error levels?

By 6 years of age Signup and view all the answers

Which of the following is NOT an indication for cycloplegia?

Low hyperopia Signup and view all the answers

What is the average refractive error for a child at 6 months old?

+2.50DS Signup and view all the answers

What must be done before the insertion of cyclopentolate drops?

Check it’s safe and wash hands Signup and view all the answers

During Mohindra retinoscopy, which factor should be subtracted from the final refraction result?

1.25D Signup and view all the answers

What is the recommended recall interval for a child under 7 years with a binocular vision anomaly?

6 months Signup and view all the answers

Which technique is used for static retinoscopy?

Talking to the child to maintain fixation Signup and view all the answers

What is one reason to inform a school about a child's visual defect found during testing?

To address learning accommodations Signup and view all the answers

What should NOT be considered when selecting frames for children?

Aesthetic appeal Signup and view all the answers

Which statement about children's facial growth is accurate?

Most children's facial measurements equal those of adults by age 13. Signup and view all the answers

Which ocular complication is not commonly associated with Down syndrome?

Astigmatism Signup and view all the answers

What is the recommended position for a child's bifocal segment top?

At the pupil center Signup and view all the answers

In selecting frames for children, what frame characteristics are essential?

Stability, rigidity, and strength Signup and view all the answers

What is true regarding the bridge heights of adult glasses?

Adult bridges have heights of 5-7mm. Signup and view all the answers

What percentage of children with Down syndrome experience refractive errors?

60% Signup and view all the answers

Which frame feature is particularly necessary for children with Down syndrome?

Wide and strong frame to accommodate broad nasal bridges Signup and view all the answers

Study Notes

Nut-Free Zone

A sign indicating a nut-free zone is shown.
Images of various foods, including candy bars and nuts, are included.
Products like facial creams and lotions are also shown.

Lecture Recording Information

The lecture is being recorded as part of Plymouth University's Content Capture Project.
The recording will be available via the Panopto block on the module DLE pages.
Students can ask questions during the lecture.
Comments and questions may appear on the recording.
Students can ask the lecturer to pause the recording if they do not want their question to be recorded.

Paediatrics Lecture 04 (Intended Learning Outcomes)

Students should consider GOC regulations.
Paediatric sight testing is important for child development.
Awareness of challenges in testing paediatric patients and adapting routines is necessary.
Knowledge of available vision/visual acuity tests for children and their relation to age is required.
Recognition of significant refractive errors in children and when prescription is needed is important.
Understanding differences in facial anatomy and development, including Down's syndrome, is necessary.
Ability to select appropriate frames and make lens choices is important.

GOC Regulations

Unregistered persons are not allowed to sell prescription spectacles to children under 16 or patients with vision impairments, unless the sale is supervised by a registered practitioner.
The sale/supply of spectacles may be delegated, but the delegating person remains responsible.
The supervising person must be present during key stages of spectacles sale for restricted-group patients.
Supervisors ensure those undergoing the sale of spectacle follow the correct procedures specified.
Supervisors must be identified, so each is responsible for supervision of a sale and supply of spectacles.

Regulated Ophthalmic Dispensing

GOC registrants have a duty of care to ensure that dispensing to children is carried out in person or, if the dispensing is carried out by someone else, the optometrist or dispensing optician ensures a supervised individual has the appropriate knowledge to perform the task.
A professional should maintain a high level of vigilance during the dispensing process to ensure the process is carried out safely.

Summary

Sale of spectacles to under-16s, with sight impairment, is forbidden unless supervised by a registered practitioner.
Supervision is necessary if delegation is made to other persons.
Delegates should be competent.
Dispensing and collection must be supervised by an optometrist or dispensing optician.

Child Protection Issues

All children should be accompanied by a parent or guardian in the consulting room.
Important to note who accompanied the child.
Maintaining suitable test room environment.
Child protection team should be informed for a neglect/abuse concerns.

Provision in UK

Vision screening is available to Reception year (4 and 5 years old) in schools.
Routine eye tests are available for any age.
Refusal to take patients due to their age alone is forbidden.

Other Important Points (BUT)

Limited distance-reading tests might miss ocular pathology.
Screening does not cover ocular health.
Parents might incorrectly assume that if a child passes a visual screening, an eye care is not needed.
Visual screening is not performed by an optometrist but an orthoptist.
Too many referrals might be unnecessary and waste healthcare resources.

Importance of Paediatric Eye Examinations

Visual disorders are leading causes of childhood disability.
Common childhood visual disorders include amblyopia and strabismus.
Uncorrected refractive error is a significant issue.
Visual disorders impact a child's personal and educational development.

Visual Development

Infant and early childhood are crucial times for visual development, including eyeball growth, vision improvement and skill maturity.

Paediatric Eye Testing (Necessary Skills)

Enthusiasm, skill, speed, accuracy and adaptability are needed in paediatric eye tests.

The Routine: What is expected of you?

Students should follow College of Optometrists (C1) guidelines for examining younger children.
Obtaining information about vision/visual acuity, oculomotor balance, refractive error, and the health of the eyes is crucial.
Rapport with the child is important, showing respect and explaining the test procedures clearly.

Checklist

The checklist shows what needs to be done during an eye examination for children.

By the end of the test...

Eye straightness, any refractive errors, evidence of amblyogenic factors and the wellbeing of ocular media, optic nerves and macula are important to know.
Re-booking the test if everything is not achieved in the first visit is also good practice.

Starting Point

Engage children directly and introduce oneself.
Ask simple questions.
Parents holding the child, if nervousness, is acceptable.
Make general observations about eye/head position and visual attention.

History & Symptoms

Collect accurate and relevant history from the child and parent.
Pay attention to whether there are other concerns.
Use child-friendly language when questioning the child.
Get details on birth history, developmental issues, visual behavior, and school progress.
. Collect details on general health, medications and their family history (myopia, strabismus or high prescription).

Caution

Some eye conditions do not display symptoms.
Symptoms of an issue, such as difficulty concentrating, frequent eye rubbing, or headaches, can be indicators of an underlying problem.

Assessment of vision

It's important to assess monocular vision, not only binocular.
Simple tests such as eye patches can be helpful.
Acuity tests, depending on age, are important aspects, such as preferential looking and vanishing optotypes.

Approx VA by age

Visual acuity improves quickly in the first 12 months, and then develops further to maturity levels by 5 to 6 years of age.
The visual acuity for each month has been provided in the summary.

Preferential looking - Keeler/Teller cards

This is a fast and sensitive way to test young children's vision.
It relies on children looking at patterns with the best visual interest.
Testing distance is 55cm or 84cm

Vanishing Optotypes - Cardiff acuity cards

Used for children aged 12-36 months.
A target is made with white or gray bands.
Visual acuity is the best view recognized by the child.

Picture/Letter matching tests

Can be used for various age groups to assess their vision and ability to match patterns.

Crowding phenomenon

A task that requires a more sensitive test.
Amblyopic patients tend to fare worse in crowded tests.

Next step...

Cover tests depend on the child's age and should be visually appealing.
Suitable targets for young children include, but are not limited to, toys, puppets, picture cards, and pen torches.
Alternatives include the Hirschberg test, and 20D base out test.

Stereopsis

Evidence of good stereopsis shows bi-foveal fixation and good binocular vision.
This test is a useful, additional test or alternative if other methods are not suitable.
It's often a fun, interactive way to perform.
Difficult to detect clinically until 12 months of age with steady improvement by 6 years.

Colour vision

Similar to stereopsis, colour vision testing can be interactive and fun.
Appropriate targets depending on age should be selected.
If an issue is found, both the child and parent should be informed so they can be addressed to aid the betterment of the child's eyesight.

Retinoscopy and Refraction

Most children initially have hyperopia, which decreases with age to reach emmetropisation.
Normal refractive errors for each age category are listed for a better understanding.

Static Retinoscopy

Relies on good fixation.
Use caregiver support during testing for better results and to encourage the child.
Use a dark room and a 50cm working distance.

Indications for cycloplegia

Unexplained poor vision acuity, lack of stereopsis are some reasons for cycloplegia.
Anisometropia (more than 1.5D difference in the eye's refractive power) is also an indicator.
A family history of high hyperopia or strabismus, together with poor cooperation and a dry ret (refraction) are some considerations.

Inserting cyclopentolate

Follow standard eye drop procedures.
Ensure safety measures are taken.
Position the patient to allow easy instillation.

Recall

Recall duration for an earlier test depends on the presence or absence if an anomaly.
Specific age thresholds for follow-up are given.

Cyclo: How to Explain

Explain the process of cycloplegia clearly and appropriately to the patients and their parents.

Paediatric Prescribing

Assessing and deciding when to prescribe for children depends on factors like age, binocular status, visions, anisometropia, and symptoms.

General Prescribing Guidelines

Extreme refractive errors, strabismus and amblyopia, or anisometropia (1.00D+) should be reasons to prescribe.
Younger children (under 2) should often only be monitored initially.
Signifiant Rx in older children, with no signs of decreasing, should also be a reason to prescribe.

Significant refractive errors in age 2+

High hyperopia, myopia, and astigmatism are considered significant in children above 2 years old.

When/What to refer

Refer patients to other providers when the optometrist's skills or expertise are not enough to manage the child's case appropriately
Large angles, or manifest tropia may need surgical intervention.
Refer patients who have anisometropic amblyopia but also observe the improvement in visual acuity for the first six months.
Significant astigmatism should be referred to appropriate specialists.
The referring optometrist should consider how long the child needs to be seen, and if it is necessary to carry out cylco and prescribe the child while waiting.

Lens choice

Lens material options for children include CR39, Polycarbonate, Trivex, and High Index Plastic.
Various aspects, such as high impact-resistance, surface durability, and suitability for UV protection, are important to consider when selecting lenses for children.

Frame Selection

Frames should be anatomically correct and comfortable.
Visual axes must be considered.
Frame fit and comfort should not inhibit the child's facial development.

Children's frame design

Frames must hold lenses correctly and safely.
Frames need suitable stability, rigidity, and strength.
Frames must be well fitted and comfortable.
The natural field of view should be considered for the frames design and position.

Children's frames Vs Adults frames

Children's frames should accommodate a child's lower crest height compared to adult frames.

Results from Studies

Facial growth is not steady, and facial structures differ from adults.
The nose structure changes substantially during development and does not attain the complete adult state during a child's growing process.
Only two dimensions remain unchanged.

General facial development

Features like head width and facial structure, such as nose and front curvature, changes between the ages of 13 and 13+.

Down syndrome: Visual stats

Children with Down syndrome might have a high prevalence (up to 60%) of requiring correction for refractive errors and other related conditions like strabismus and cataracts.
Accommodative problems are highly prevalent in children with Down syndrome (76%).
Facial features such as a broad nasal bridge may cause glasses to slip.

Down syndrome: ocular complications

Complications such as congenital nystagmus, strabismus, cataract, blepharitis and reduced visual acuity, as well as keratoconus, might arise.

Baby Frames

Various types of frames for babies and toddlers are available.
Features include, but are not limited to, Grilamid frames, flexible and lightweight plastic material, or rubber on samples.

Metal Frames

Different metal frame styles are available for children.
Features might include adjustable styles, or adjustable elements for personalization or modification, for a customized fit of the frame.

Side Styles

Different types of side styles are available for children, depending on age.
Examples include, but are not limited to, loop-end, drop-end or curl styles for young infants or toddlers, while larger children may have more complex side styles.

Length to Bend

The length of the temple area from the dowel point to the middle of the temple bend is measured on a child's head with appropriate equipment.

The Fitting Triangle

This is a diagram for understanding how to fit a frame to a child's head
The diagram features points for fitting children's frames to a child's head with reference to the bridge, the sides of the head, and the temples.

PD measurement

Binocular PD (pupillary distance) is measured from the nasal side to the temporal side of the limbus.
Monocular PD measurement should always be accompanied by +/- 3.00DS.
Binocular PD is measured from the inner to outer canthus.

Crest height

Measuring the distance from lower eyelid to the nasal crest on the face using ruler or appropriate measuring equipment.

Bridge Projection

Measuring the distance from the face of the eye using a device to measure from the face of the eye to the eye lashes, when the frame is positioned or protruding..

Frontal angle

Measuring the angle of the frame from the horizontal plane using angled measurement equipment placed on the child's nasal bridge area to the horizontal plane.

Splay Angle

Measuring the angle of the frame from the vertical plane using angled measurement equipment placed on the child's nose to the vertical plane.

Facial measurement and frame measurement

Table illustrating the different measurements of the facial structure to aid in the fitting of frames to children.

Head width and Temple width

Head width is the distance between ear points calculated using callipers.
Temple width measurement is done 25mm from the front.

Pantoscopic angle/tilt

The angle of the frame sides, where viewed in relation to primary eye position, aids in measuring the pantoscopic angle.

Video Clips

Links are provided for instructional videos for testing visual acuity in children, such as 4-year-olds, 8-year-olds and a 6-month-old.

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Description

This quiz evaluates key concepts in pediatric visual screening, focusing on important characteristics of practitioners, common misconceptions, and the significance of early assessments. It includes essential testing methods and the impacts of false-positive referrals in visual screening outcomes.